Fractures and Dislocations

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Fractures and dislocations of the cervical spine demand early and accurate diagnosis so that treatment can quickly be introduced in order to produce a painless, stable neck and prevent pressure on the spinal cord and/or nerves. When the neck is injured in very violent accidents, the bones in the neck can be broken or pulled forcefully out of normal alignment. Fractures and dislocations of the cervical spine are very serious injuries because there is the potential for damage to the spinal cord if the patient is not taken care of very carefully.

Fractures

The type of fracture that occurs after a trauma depends on the magnitude of the force, the spacial orientation, and the location of the fracture in the spine. Stable fractures are those where the posterior ligaments remain in tact, while instable fractures result from tears of the posterior ligaments. A simple compression fracture with minimal deformation points to a lower magnitude directed toward the midline and center portion of the vertebra. A vertical compression fracture with central decompression is similar to a simple compression but the force had a greater magnitude. Finally, the comminuted cervical vertebral body fracture, which is often referred to as the "tear drop" fracture, is due to a high magnitude force which causes an explosive failure and a variable amount of cord compression. Often there is significant spinal cord damage caused by vertebral fragments being driven into the spinal cord.

Dislocations

Anytime there is a partial dislocation of the spine it is referred to as a subluxation. This is a situation where there is no longer a normal side by side position between the articular (joint) surfaces. The term dislocation is used when there is no longer any degree of contact between the articulating (jointed) surfaces. Extension dislocations in the cervical spine are very common and are often missed on x-rays. With an extension dislocation the posterior ligaments remain intact making the dislocation stable. In order for a significant posterior (extension) dislocation to occur there must be a tear in the anterior longitudinal ligament.

Diagnosis

If a fracture or a dislocation is detected in the cervical spine after an accident, then a neurosurgeon or orthopedic surgeon will be called in to take care of the neck injury. He or she will be able to determine if the injury needs surgery or doesn't, and what type of surgery is best for the patient. Often a simple compression fracture, without neurologic deficit, can heal with simple bed rest.

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