Blunt neck trauma

Pearls

Suspect vascular damage to the cord if discrepancy between neuro deficit and level of spinal column injury
Down syndome predisposes to atlanto-occipital dislocation; RA predisposes to C2 transverse ligament rupture
Cord injury is more likely if both the anterior (vertebral bodies) and posterior (spinal canal) columns are disrupted

Burst (Jefferson)
Highly unstable
Axial loading transmitted through occipital condyles to the lateral masses
Results in fx of the ant and post arches
Stability is determined by whether or not the transverse ligament is disrupted
Suspect if:
Lateral xray: Increase in the predental space between C1 and the dens
Predental space greater than 3 mm in adults or 5 mm in children is abnormal
Odontoid xray: Masses of C1 to lie lateral to the outer margins of the articular pillars of C2
If either of the above findings on xray then obtain CT c-spine
Posterior Arch
Must ensure that you are not confusing this with a burst fx!
Odontoid view must be normal
Due to forced neck extension
Vertical fx line through posterior arch seen on lateral xray
Stable (b/c anterior arch and transverse ligament are unaffected)

Traumatic spondylolysis ("Hangman's Fx")
Unstable
Forced extension of an already extended neck
Spinal cord damage is often minimal (the AP diamter of the neural canal is greatest at C2)
Odontoid Fracture
Type I
Above the transverse ligament
Stable
Type II
At the base where it attaches to C2
Unstable
Most common
Type III
Extension of the fracture through the upper portion of C2

Anterior Wedge Fracture
Unstable if:
Loss of over half of vertebral height OR
Multiple adjacent wedge fractures
Flexion Teardrop Fracture
Unstable
Associated with acute anterior cervical cord syndrome
Displacement of a teardrop shaped fragment of the antero-interior portion of the superior vertebra
Severe flexion > vertebral body collides with the one below
Extension Teardrop Fracture
Unstable
Abrupt neck extension > anterior longitudinal ligament avulses anteroinferior corner
Avulsed fragment is greater in height than width (contrast with flexion teardrop)
Often occurs at C5-C7 associated with diving accidents
Associated with central cord syndrome
Spinous Process Fracture (Clay Shoveler's)
Stable
Isolated fracture of one of the spinous processes of the lower cervical vertebrae
Burst Fracture
Posteriorly displaced fracture fragment may impinge on the cord
Axial compression > nucleus pulposus forced into vertebral body
Imaging
Lateral xray - Comminuted body and loss of vertebral height
AP xray - Vertical fracture of the body

Bilateral
Unstable
Complete spinal cord injury most often results
Disruption of the annulus fibrosus and the ant longitudinal ligament > ant displacement of the spine
Unilateral
Stable
Spinal cord injury rarely occurs

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