These types of injuries can occur in athletes, car accident victims, or anyone who has undergone some form of acute neck strain or stress. Thoracolumbar spinal fracture classification systems are numerous and represent attempts by various authors to create systems that allow uniform and reproducible classification and description of thoracolumbar fractures which in turn can help with treatment decision making and prognostication despite numerous systems being proposed over the past century no universally accepted and clinically. Gravity depends on the location, stability, and pattern of the injury. Examples of common causes in humans are traffic collisions and diving into shallow water.
An increasing body of evidence favors the use of multidetector ct as a standalone screening test for excluding cervical injuries in polytrauma patients with obtundation. This project describes a morphologybased subaxial cervical spine traumatic injury classification system. The literature on the diagnosis, classification, and treatment of. Fracturedislocation at c6c7 and c7t1 with comminuted burst fracture to c7 and locked facet joint with resultant anterior migration of c6 over c7, unstable cervical spine fracture. A subaxial cervical spine injury classification system was developed.
The biomechanical stability of the spine is altered in patients with a rigid spine, rendering it vulnerable to fracture even from relatively minor impact. Part 1, cervical spine and fracture fixation jonelle m. A vertebral fracture is a break to one of the bones in your spine. Cervical spine fracture an overview sciencedirect topics. American spinal injury association asia impairment scale ais classification of traumatic spinal cord injury. Teardrop fracture extension upper cervical spine usually benign avulsion type flexion lower cervical spine anterior wedge or quadrangular fragment flexion type. Subaxial fractures account for 40% to 60% of the cervical spine fractures. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlantoaxial dislocations, fractures of the odontoid process, and hangmans fractures in the c2 segment. The cervical spine is divided into the upper cervical spine occiputc2 and the lower cervical spine c3c7, according to anatomical differences. Reference acr appropriateness criteria for suspected spine trauma acr 2018 pdf. Concurrent upper cervical fractures are common and should be excluded. It is important to correctly classify the fracture to ensure appropriate treatment.
Accurate diagnosis of acute cervical spine injury requires cooperation between clinician and. Spine and spinal cord injuries william schecter, md. The rigid spine entities are ankylosing spondylitis as, diffuse idiopathic skeletal hyperostosis, degenerative spondylosis, and a. Fractures of the thoracic and lumbar spine orthoinfo aaos. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying. Type i is an impact fracture of the occipital condyle for which the trauma. The c spine consists of seven vertebrae c1c7 and supports the weight of the head approximately 14 pounds. Fractures of the cervical spine pubmed central pmc. Injuries to the cervical and thoracic spine can lead to neurological problems. These include odontoid fractures, posterior c1 arch fractures, and hyperextension teardrop fractures. Types 2a and 3 require surgical reduction and internal fixation and must therefore be differentiated from types 1 and 2.
Of these, it has been found that nearly 20% involve the c7t1 junction. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra and interobserver reliability to be used for clinical and research purposes. Most cervical spine fractures occur predominantly at 2 levels. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteoligamentous instability with spinal cord injury. Odontoid fractures are the most common cervical spine fracture in adults aged 70 years usually result of lowenergy, groundlevel fall head trauma extension injury blunt trauma patients 65 are 2x more likely to have cspine injuries than younger patients. Cervical spine fractures occur in approximately 2% to 3% of blunt trauma patients. There are many different types of spinal fractures. Scis were queried and assessed according to upper c1c4 and lower c5c7 cervical spine levels.
Flexion teardrop fracture of the cervical spine american journal. The causes of injury included traffic injuries in 18 patients, fall injury. Fulcrum of movement is different in children than adults, c23 compared to c56, respectively. A cervical fracture, commonly called a broken neck, is a catastrophic fracture of any of the seven cervical vertebrae in the neck. These types of fractures are typically medical emergencies that require urgent treatment. A cervical fracture is a break or crack that occurs in one of the three vertebral columns of the spine, called the cervical vertebrae. As is the case with all injuries of the spinal cord, injuries located higher on the spine will be more severe, with high cervical spinal cord injury often being fatal. Multidetector ct of blunt cervical spine trauma in adults. These discs allow the spine to move freely and act as shock absorbers during activity. Cervical injuries can affect the muscles, nerves, and vertebrae of this region. Traumatic fracture of the pediatric cervical spine. Cervical spine fractures radiology reference article. This article focuses on fractures of the thoracic spine midback and lumbar spine lower back that result from a highenergy event, such as a car crash or a fall from a ladder. They support the head and connect it to the shoulders and body.
After the immediate trauma, there is a risk of spinal cord injury or worsening of an already injured spine if the fracture is unstable, that is, likely to change alignment without. Compression, burst, flexiondistraction, and fracture dislocation. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. Osteoporosis as a generalized bone disease appears to affect the cervical spine differently from other spinal regions. In a study of surgical residents ability to predict cervical injuries on the basis of clinical examination alone, sensitivity and specificity were 46% and 94%, respectively. The vertebrae of the lower cervical spine have a superior cortical surface which is concave in the coronal plane and convex in the sagittal plane.
Most types of spinal fracture confer a significant risk of spinal cord injury. What are the types of atlas fractures of the cervical spine. The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and. Upper cervical spine trauma orthopaedic trauma association. Other terms your doctor may use to describe a fracture include stable, unstable, minor, andor major. C1 and c2 hangmans fractures more common odontoid fractures evenly distributed younger patients have higher energy injuries ryan and henderson injury 1992. The posterior column remains intact, making this a stable fracture that requires only use of a cervical orthosis for treatment. Cervical spine fractures are potentially deadly conditions that arise after trauma, exaggerated extension or flexion. Teardrop fractures of the cervical spine are defined as fractures involving the anteroinferior angle of the cervical vertebral body, with the vertical dimension of the triangular fragment being equal to, or greater than the transverse dimension1. Aospine subaxial cervical spine injury classification system. The procedure is performed to treat severe neck pain and disability, or instability of the cervical spine, and involves the use of bone graft materials and various types of instrumentation to join the. Many subaxial cervical and upper thoracic spine fractures can be overlooked in the multiplyinjured trauma patient. Compression, burst, flexiondistraction, and fracturedislocation.
Cervical spine fractures and osteoporosis springerlink. The cspine consists of seven vertebrae c1c7 and supports the weight of the head approximately 14 pounds. Clinical evaluation of the cervical spine in a patient with blunt trauma is unreliable. The topic cervical spine fracture you are seeking is a synonym, or alternative name, or is closely related to the medical condition cervical fracture. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury resulting in loss of sensation, paralysis, or usually instant death. Cervical spine fracture evaluation clinical presentation. A number of new developments in cervical spine imaging have transpired since the introduction of 64section computed tomographic ct scanners in 2004. Cervical fractures usually result from highenergy trauma, such as automobile crashes or falls. The neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of the body. Classification and surgical management for the axis fracture. The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and acts as a lever. Cervical atlas, cervical vertebrae, spinal fractures, classification. Approximately 510% of unconscious patients who present to the ed as the result of a motor vehicle accident or fall have a major injury to the cervical spine.
If only facet injuries are identified no a, b, or c injury, they are listed first after the level of injury. Spine and spinal cord injuries san francisco general. Thoracolumbar spinal fracture classification systems. A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Initial management of types i, ii, and iii atlas fractures consists of placement of a cervical orthosis. The cervical spine neck region consists of seven bones c1c7 vertebrae, which are separated from one another by intervertebral discs. Fracture types closedopen and cervical spine levels for varying years and age groups, surgical procedures, and surgical procedures for varying fracture levels were queried using icd9 codes. Cervical spine ap, lateral and open mouth to see the odontoid. The spinal fracture service is led by three of our consultant orthopaedic spine surgeons and are supported by our senior spinal nurse practitioners, physiotherapists, orthotists and occupational therapists what is a vertebral fracture. Fractures of the cervical spine are potentially serious and devastating if not properly treated. Cervical spine injuries often involve permanent complete or partial loss of sensory function, and many associated complications. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. This configuration allows flexion, extension, and lateral tilt by gliding motion of the facets.
The flexion teardrop fracture is a specific entity that should not be confused with other types of injury with a teardrop fragment. Allen and ferguson classification of subaxial spine injuries typically used for research and not in clinical setting. Type iv fracture, or jefferson fracture, is managed with cervical traction. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries.
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