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Lower Cervical Spine Injury

  1. Mode of Injuries in Lower Cervical Spine Fractures (C3 - C7)

Mode of Injuries

Pattern of Fracture

Vertical (Axial) Compression

Burst facture (vertebral height is decreased in toto)

Pure flexion

Wedge compression fracture i.e. decreased anterior height of vertebrae

Combined axial compression & flexion

Tear drop fracture i.e. antero- inferior fragment of vertebral body is sheared off

Distraction – flexion/Flexion rotation (most common)

Unilateral &/or bilateral subluxation & dislocation.

Avulsjon injury of spinous process (usually of C7 or T1)

Clay- shoveller’s fracture

Axial compression- extension injury

Second most common type

Distraction-extension injury

Distruption of anterior ligamentous complex followed by posterior soft tissue complex

Flexion —rotation injury is the most common spinal injury followed by compression extension injury (2nd most common)
In a patient unconscious from a head injury, or facial trauma a fracture cervical spine should be assumed until proven otherwise.
  1. Lower cervical spine fractures and dislocations are more common in incidence and are more commonly associated with spinal cord damage in comparison to upper cervical spine fractures.
  2. Due to vital functions of the nearby neurovascular structures, injuries to the upper cervical spine carry a high likelihood of death. Craniocervical injuries (occipital condyle fracture) may cause palsy of IX, X, Xl and XII cranial nerves.
  3. Neurogenic shock is due to loss of normal vasoconstrictive sympathetic control of the peripheral vasculature thus causing loss of normal sympathetic response to low blood pressure.
  4. In distinction from hemorrhagic shock, in which compensatory tachycardia is usually present neurogenic shock results in hypotension accompanied by bradycardia.
  1. Upper cervical spine injury
    1. More chances of cranial nerve (9, 10, 11, & 12) injuries
    2. High likelihood of death
  2. Lower cervical spine injury
    1. More commonly associated with spinal cord damage & neurological deficit.
    2. Hypotension is more common
    1. Approximately 90% of all spinal fractures occur in the thoracic and lumbar spines. Infact, the majority of thoracic and lumbar injuries Occur with in the region between T11 & L1, commonly referred as thoracolumbar junction.
    2. Compression/wedge fractures involves bucking, or fracture of anterior and middle aspect of vertebral body, unlike burst fracture, there is no involvement of posterior vertebral body). Axial loading with a flexion movement is the mechanism of injury.
    3. Osteoporosis is the most common cause of multiple compression fractures
    4. Compression fracture are most common in thoracolumbar spine (lower dorsal> upper lumbar)
  4. Lap seat belt injury / Jack- knife injury / Chance fracture
    1. Occurs when an automobile passenger wearing a seat belt over a lap is thrown forward, so also called as ‘lap seat belt injuries’
    2. Combined flexion & distraction may cause mid lumbar spine to ‘Jack- Knife’ around an axis that is placed anterior to the vertebral column leading to vertebral body fail in flexion and posterior & middle element fail in distraction.
    3. The tear passes transversely through the bones or ligament structures or both.
    4. The classical example (as described by chance) was split running through spinous process transverse processes pedicle & vertebral body.
    5. As the injuries retain the anterior longitudinal ligament neurological damage is uncommom (though the injury by definition is unstable) and hyper extension will usually bring them into a satisfactory position.
    6. X-Ray may show horizontal fractures in pedicles & transverse processes & in anteroposterior view apparent height of vertebral body may be increased. In lateral view there may be opening up of the disc space posteriorly.
    7. ‘All bone’ injuries heal rapidly in hyperextension casting or bracing in 3 months. Severe ligamentous injuries are not likely to heal and surgical stabilization (posterior spinal fusion) is recommended.

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