Cervical fracture
Encyclopedia
A cervical fracture is commonly called a broken neck. There are seven cervical vertebrae
(neck bones) in the human neck, and the fracture of any can be catastrophic. The most common causes are traffic accidents or diving into shallow water. Abnormal movement of bones or pieces of bone can cause spinal cord injury
resulting in loss of sensation, paralysis
, or death.
collisions and falls are common causes. A severe, sudden twist to the neck or a severe blow to the head or neck area can cause a cervical fracture. Sports involving violent physical contact carry a risk of cervical fracture, including American football
, ice hockey
, rugby
, and wrestling
. Spearing an opponent in football or rugby, for instance, can cause a broken neck. Cervical fractures may be seen in several non-contact sports, such as skiing
, diving
, surfing
, powerlifting
, equestrianism
, mountain biking
and motor racing as Formula One
Ferrari driver Gilles Villeneuve
died of cervical fracture. Hanging also causes cervical fracture
may also cause pain from the neck down the shoulders and/or arms. Bruising and swelling may be present at the back of the neck. A neurological exam will be performed to assess for spinal cord injury. X-ray
s will be ordered to determine the severity and location of the fracture. CT (computed tomography
) scans may be ordered to assess for gross abnormalities not visible by regular X-ray. MRI (magnetic resonance imaging
) tests may be ordered to provide high resolution images of soft tissue and determine whether there has been damage to the spinal cord
, although such damage is usually obvious in the conscious patient because of the immediate functional consequences of numbness and paralysis in much of the body.
. The only exceptions are when there is imminent danger from an external cause, such as becoming trapped in a burning building. Non-steroidal anti-inflammatory medications (known as NSAIDs) such as aspirin
, or ibuprofen
are useful in decreasing swelling and pain. In the long term, physical therapy
will be given to build strength in the muscles of the neck to increase stability and better protect the cervical spine.
Collars
, traction and surgery can be used to immobilise and stabilize the neck after a cervical fracture. Minor fractures can be immobilized with a collar without need for traction or surgery. A soft collar is a fairly flexible and is the least limiting. It can be used for minor injuries or after healing has allowed the neck to become more stable.
A range of manufactured rigid collars are also used, usually comprising a firm plastic bi-valved shell secured with Velcro
straps and removable padded liner . The most frequently prescribed are the Aspen, Malibu, Miami J, and Philadelphia collars. All these can be used with additional chest and head extension pieces to increase stability.
Rigid braces which include the head and chest, such as the SOMI, Lerman Minerva and Yale types are also prescribed. Special patients, such as very young children or non-cooperative adults, are sometimes still immobilised in medical casts, such as the Minerva cast.
Traction
can be applied by free weights on a pulley or a Halo type brace. The Halo brace is the most rigid cervical brace, used when limiting motion to the minimum is essential, especially with unstable cervical fractures. It can provide stability and support during the time (typically 8-12 weeks) needed for the cervical bones to heal.
Surgery may be needed to stabilize the neck and relieve pressure on the spinal cord. A variety of surgeries are available depending on the injury. Surgery to remove a damaged intervertebral disc
may be done to relieve pressure on the spinal cord. The discs are cushions between the vertabrae. After the disc is removed, the vertabrae may be fused together to provide stability. Metal plates, screws, or wires may be needed to hold vertabrae or pieces in place.
Cervical vertebrae
In vertebrates, cervical vertebrae are those vertebrae immediately inferior to the skull.Thoracic vertebrae in all mammalian species are defined as those vertebrae that also carry a pair of ribs, and lie caudal to the cervical vertebrae. Further caudally follow the lumbar vertebrae, which also...
(neck bones) in the human neck, and the fracture of any can be catastrophic. The most common causes are traffic accidents or diving into shallow water. Abnormal movement of bones or pieces of bone can cause spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
resulting in loss of sensation, paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
, or death.
Causes
Considerable force is needed to cause a cervical fracture. Motor vehicleMotor vehicle
A motor vehicle or road vehicle is a self-propelled wheeled vehicle that does not operate on rails, such as trains or trolleys. The vehicle propulsion is provided by an engine or motor, usually by an internal combustion engine, or an electric motor, or some combination of the two, such as hybrid...
collisions and falls are common causes. A severe, sudden twist to the neck or a severe blow to the head or neck area can cause a cervical fracture. Sports involving violent physical contact carry a risk of cervical fracture, including American football
American football
American football is a sport played between two teams of eleven with the objective of scoring points by advancing the ball into the opposing team's end zone. Known in the United States simply as football, it may also be referred to informally as gridiron football. The ball can be advanced by...
, ice hockey
Ice hockey
Ice hockey, often referred to as hockey, is a team sport played on ice, in which skaters use wooden or composite sticks to shoot a hard rubber puck into their opponent's net. The game is played between two teams of six players each. Five members of each team skate up and down the ice trying to take...
, rugby
Rugby football
Rugby football is a style of football named after Rugby School in the United Kingdom. It is seen most prominently in two current sports, rugby league and rugby union.-History:...
, and wrestling
Wrestling
Wrestling is a form of grappling type techniques such as clinch fighting, throws and takedowns, joint locks, pins and other grappling holds. A wrestling bout is a physical competition, between two competitors or sparring partners, who attempt to gain and maintain a superior position...
. Spearing an opponent in football or rugby, for instance, can cause a broken neck. Cervical fractures may be seen in several non-contact sports, such as skiing
Skiing
Skiing is a recreational activity using skis as equipment for traveling over snow. Skis are used in conjunction with boots that connect to the ski with use of a binding....
, diving
Diving
Diving is the sport of jumping or falling into water from a platform or springboard, sometimes while performing acrobatics. Diving is an internationally-recognized sport that is part of the Olympic Games. In addition, unstructured and non-competitive diving is a recreational pastime.Diving is one...
, surfing
Surfing
Surfing' is a surface water sport in which the surfer rides a surfboard on the crest and face of a wave which is carrying the surfer towards the shore...
, powerlifting
Powerlifting
Powerlifting is a strength sport. It resembles the sport of Olympic weightlifting, as both disciplines involve lifting weights in three attempts. Powerlifting evolved from a sport known as 'odd lifts' which followed the same three attempt format but used a wide variety of events akin to Strongman...
, equestrianism
Equestrianism
Equestrianism more often known as riding, horseback riding or horse riding refers to the skill of riding, driving, or vaulting with horses...
, mountain biking
Mountain biking
Mountain biking is a sport which consists of riding bicycles off-road, often over rough terrain, using specially adapted mountain bikes. Mountain bikes share similarities with other bikes, but incorporate features designed to enhance durability and performance in rough terrain.Mountain biking can...
and motor racing as Formula One
Formula One
Formula One, also known as Formula 1 or F1 and referred to officially as the FIA Formula One World Championship, is the highest class of single seater auto racing sanctioned by the Fédération Internationale de l'Automobile . The "formula" designation in the name refers to a set of rules with which...
Ferrari driver Gilles Villeneuve
Gilles Villeneuve
Joseph Gilles Henri Villeneuve, better known as Gilles Villeneuve , was a Canadian racing driver. An enthusiast of cars and fast driving from an early age, he started his professional career in snowmobile racing in his native province of Quebec...
died of cervical fracture. Hanging also causes cervical fracture
Diagnosis
Severe pain will usually be present at the point of injury. Pressure on a nerveNerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
may also cause pain from the neck down the shoulders and/or arms. Bruising and swelling may be present at the back of the neck. A neurological exam will be performed to assess for spinal cord injury. X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s will be ordered to determine the severity and location of the fracture. CT (computed tomography
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
) scans may be ordered to assess for gross abnormalities not visible by regular X-ray. MRI (magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
) tests may be ordered to provide high resolution images of soft tissue and determine whether there has been damage to the spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...
, although such damage is usually obvious in the conscious patient because of the immediate functional consequences of numbness and paralysis in much of the body.
Treatment and after care
Complete immobilization of the head and neck should be done as early as possible and before moving the patient. Immobilization should remain in place until movement of the head and neck is proven safe. In the presence of severe head trauma, cervical fracture must be presumed until ruled out. Immobilization is imperative to minimise or prevent further spinal cord injurySpinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
. The only exceptions are when there is imminent danger from an external cause, such as becoming trapped in a burning building. Non-steroidal anti-inflammatory medications (known as NSAIDs) such as aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
, or ibuprofen
Ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
are useful in decreasing swelling and pain. In the long term, physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
will be given to build strength in the muscles of the neck to increase stability and better protect the cervical spine.
Collars
Cervical collar
A cervical collar is an orthopedic medical device used to support a patient's neck and head. It is also used by emergency personnel for victims of traumatic head or neck injuries, and can be used to treat chronic medical conditions....
, traction and surgery can be used to immobilise and stabilize the neck after a cervical fracture. Minor fractures can be immobilized with a collar without need for traction or surgery. A soft collar is a fairly flexible and is the least limiting. It can be used for minor injuries or after healing has allowed the neck to become more stable.
A range of manufactured rigid collars are also used, usually comprising a firm plastic bi-valved shell secured with Velcro
Velcro
Velcro is the brand name of the first commercially marketed fabric hook-and-loop fastener, invented in 1948 by the Swiss electrical engineer George de Mestral...
straps and removable padded liner . The most frequently prescribed are the Aspen, Malibu, Miami J, and Philadelphia collars. All these can be used with additional chest and head extension pieces to increase stability.
Rigid braces which include the head and chest, such as the SOMI, Lerman Minerva and Yale types are also prescribed. Special patients, such as very young children or non-cooperative adults, are sometimes still immobilised in medical casts, such as the Minerva cast.
Traction
Traction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
can be applied by free weights on a pulley or a Halo type brace. The Halo brace is the most rigid cervical brace, used when limiting motion to the minimum is essential, especially with unstable cervical fractures. It can provide stability and support during the time (typically 8-12 weeks) needed for the cervical bones to heal.
Surgery may be needed to stabilize the neck and relieve pressure on the spinal cord. A variety of surgeries are available depending on the injury. Surgery to remove a damaged intervertebral disc
Intervertebral disc
Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
may be done to relieve pressure on the spinal cord. The discs are cushions between the vertabrae. After the disc is removed, the vertabrae may be fused together to provide stability. Metal plates, screws, or wires may be needed to hold vertabrae or pieces in place.
See also
- Spinal cord injurySpinal cord injuryA spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
- Cervical dislocationCervical dislocationCervical dislocation, "breaking the neck" or "snapping the spine" are terms used to describe this killing method intended to be quick and painless...
- Internal decapitationInternal decapitationInternal decapitation, atlanto-occipital dislocation, or orthopedic decapitation describes the rare medical condition in which the skull separates from the spinal column during severe head injury...
- Brown-Sequard SyndromeBrown-Séquard syndromeBrown-Séquard syndrome, also known as Brown-Séquard's hemiplegia and Brown-Séquard's paralysis, is a loss of sensation and motor function that is caused by the lateral hemisection of the spinal cord...