Cervical Spine

Injuries to cervical spine • Injuries to cervical spine are dangerous and if associated with neurological damage, the result can be devastating • Jefferson pointed two areas commonly involved in cervical spine injuries,C1 and C2 and C5 and c7 • According to Meyer C2 and C5 are commonly involved • Neurological damage is seen in 40% of cases • In 10% of cases ,radiographs are

• Causes : • Fall from height: it is the most common cause in devolping countries • Diving injuries: diving into water with insufficient depth or in an inebriated conditions • Road traffic accidents: common cause in developed countries • Gunshot injuries

• Mechanism of injury • Pure flexion force: compression fracture of vertebral body e.g fall from height • Extension type: avulsion fracture of superior margin of vertebral body: whiplash injury • Lateral flexion : fracture pedicle fracture transverse process and facet joints

Clinical features: Pain Swelling Inability to move the neck Tenderness over the involved spinous process • There may be signs of neurological involvement • • • • •

• Concussion : • This is a state of spinal shock and there will be sensory loss, flaccid paralysis ,visceral paralysis • By 8 hours consussion is known to regress and by 8-10 days is complete recovery

• Nerve root involvement: • Individual nerve roots could be affected at their respective intervertebral foramen • All the features of peripheral nerve injury will L.M.N type of lesion are seen • The myotome and dermatome should be assesed to know the nerve root

• Cord involvement : • Complete: this leads to quadriplegia and quadriparesis • Incomplete: here the central cord, lateral cord ,anterior and posterior cord are involved

• Investigations : • Radiograph; lateral vies is important, if and adequate lateral radiograph reveals no fracture or dislocation • Myelography • CT scan • MRI

• Treatment: • At the accident site: resuscitation and transport is important . • In a person lying still without using his neck after an RTA , a cervical spine injury is always suspected until proved otheriwse • While taking to hospital all unnecessary neck movement should

• At the hospital: • Non operative treatment: • Most cases can be treated non operatively by halo vest and cervical collar • Indications: • Stable cervical spine with no neurological signs • Stable compression fracture of vertebral bodies and undisplaced frature of laminae, lateral masses or spinous process • Unilateral facet dislocation reduced in traction may be immobilized in a halo vest

• Skeletal traction: • Reduction with traction is done for unstable fracture • Urgency of reduction is based on neurological loss • Traction is given for 3 to 6 weeks and once satisfactory reduction is achieved ,patient is mobilised with a collar, corset or jacket

• Surgical treatment: • Indications : unstable injury with or without neurologic damage require surgery • Methods: • In most patients early open reduction and internal fixation is indicated to obtain stability • Cervical spine is stabilized usually

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Orthopedic goals: To restore the cervical spinal alignment To prevent future spinal deformity To prevent new neurological deficits To provide spinal stability Rehabilitation goals: To restore the normal or functional range of neck movement with out creating neurological injuryS

Functional goals: To restore the flexibility of cervical Individual fracture: Fracture of C1: This is popularly known as jefferson’s fracture.here the patient is present with pain without neurological deficit. • Treatment • For stable fracture rigid cervicothoracic brace for three months • Unstable fracture: open reduction and posterior spinal fusion, skeletal traction or • • • •

• Physiotherapy management: • First two weeks: • Active ROM exercises are prescribed to the upper and the lower limb muscles. no such exercise to cervical region • Isometric exercises are prescribed to the abdominal quardiceps muscles but not for cervical region • Patient is taught bedrolling with assistance ,transfer and weight bearing with assistive devices • During this period the cervical spine remain

• After 2 weeks: • The same regime is followed upto 8 weeks • By 8 -12 weeks gentle active range of movement to cervical spine are begun • Gentle passive movement to neck after 12 weeks • Isometric strengthening exercises are

• Rotary subluxation of C1 and C2: • Patient is present with torticollis and neck pain • Treatment is usually by reduction and tractionS

• Odontoid process fracture: • Type 1: oblique fracture and its rare and treated by cervical cast • Type 2: junction of odontoid process and body. Common with non union rate of 36 %. Requires surgical process and fusing • Type 3: through upper part body of the body of vertebra. Fracture unites well with a halo cast