Cervical fractures and dislocations: Difference between revisions

Latest revision as of 15:06, 21 March 2026

Background

Sensation of cervical nerve roots

Three column concept of spinal fracture stability

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

Clinical Features

C-spine injuries may present with

Rarely neurogenic shock (bradycardia, hypotension)
Posterior neck pain
Pain on palpation of spinous processes
Limited neck ROM with pain
Weakness, numbness, or paresthesias

Differential Diagnosis

Neck Trauma

Neck pain

Musculoskeletal
Torticollis
Dystonic reaction
Cervical spondylosis
Cervical stenosis
Cancer
Epidural abscess
Vertebral osteomyelitis
Transverse myelitis
Temporal arteritis
Epidural hematoma (anticoagulation, hemophilia)
Cervical disk herniation
Blunt neck trauma
Anterior horn disease
Cervical fractures and dislocations
Cervical radiculopathy

Evaluation

Plain films lines

See blunt neck trauma for general workup

Management

Prehospital
- See the NAEMSP National Guidelines for Spinal Immobilization
Hospital
- See page for specific fracture
- Cervical spine clearance

Disposition

Calculators

NEXUS Criteria

NEXUS Criteria for C-Spine Imaging
Criteria (ALL must be absent to clear)	Absent	Present
Posterior midline cervical tenderness	1
Focal neurologic deficit	1
Altered level of alertness	1
Intoxication	1
Distracting painful injury	1
Criteria Present	/ 5

Interpretation
0	C-spine can be cleared clinically — All 5 criteria absent. No imaging needed. Sensitivity 99.6% for clinically significant injury.
≥1	Cannot clear clinically — C-spine imaging indicated.

References
Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma (NEXUS). N Engl J Med. 2000;343(2):94-99. PMID 10891516.

Canadian C-Spine Rule

Canadian C-Spine Rule
Step 1: Any High-Risk Factor? (mandates radiography)
Criteria	No	Yes
Age ≥65	1
Dangerous mechanism (fall ≥1m/5 stairs, axial load to head, MVC >100km/h or rollover/ejection, motorized recreational vehicle, bicycle collision)	1
Paresthesias in extremities	1
Step 2: Any Low-Risk Factor? (allows safe ROM assessment)
Simple rear-end MVC (excludes: pushed into traffic, hit by bus/large truck, rollover, hit by high-speed vehicle)	1
Sitting position in ED	1
Ambulatory at any time since injury	1
Delayed onset of neck pain (not immediate)	1
Absence of midline cervical tenderness	1
Step 3: Able to actively rotate neck 45° left and right?
Can rotate neck 45° L and R	1
High Risk Factors	/ 3
Low Risk Factors	/ 5

Interpretation (stepwise)
High risk ≥1	Radiography indicated — Do NOT assess ROM. Image the c-spine.
Low risk = 0	Cannot assess ROM safely — No low-risk factor present to allow safe assessment. Image.
Low risk ≥1 + ROM OK	C-spine can be cleared — At least one low-risk factor AND able to rotate neck 45°. No imaging needed.
Low risk ≥1 + no ROM	Radiography indicated — Low-risk factor present but unable to rotate. Image.

References
Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848. PMID 11597285. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-Spine Rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-2518. PMID 14695411.

References

Authors:

@@ Line 1: / Line 1: @@
+{{AdultPage|cervical injury (peds)}}
 ==Background==
+[[File:Grant 1962 664.png|thumb|Sensation of cervical nerve roots]]
 [[File:Three-column-concept-2.jpg|thumb|Three column concept of spinal fracture stability]]
-*Suspect vascular damage to cord if discrepancy between neuro deficit and level of spinal column injury
+{{Vertebral fractures and dislocations types}}
-*Cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted
-*Penetrating injury rarely results in unstable fracture
-==Fractures and Related==
+==Clinical Features==
-{{Cervical spine injuries}}
+C-spine injuries may present with
+*Rarely [[neurogenic shock]] (bradycardia, hypotension)
+*Posterior neck pain
+*Pain on palpation of spinous processes
+*Limited neck ROM with pain
+*Weakness, numbness, or paresthesias
-==Workup==
+==Differential Diagnosis==
-*If find injury consider CT C-spine, x-ray rest of spine
+{{Blunt neck trauma DDX}}
+{{Neck pain DDX}}
+==Evaluation==
+[[File:Vertebral lines.png|thumb|Plain films lines]]
+*See [[blunt neck trauma]] for general workup
 ==Management==
-*Prehospital: see the [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]]
+*Prehospital
+**See the [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]]
+*Hospital
+**See page for specific fracture
+**[[Cervical spine clearance]]
+==Disposition==
+== Calculators ==
+{{NEXUS_Calculator}}
+{{Canadian_CSpine_Calculator}}
 ==See Also==
+*[[Blunt neck trauma]]
+*[[Cervical spine clearance]]
+*[[C-Spine (EAST)]]
 *[[Penetrating neck trauma]]
 *[[Spinal Cord Trauma]]
 *[[Spinal Cord Compression (Non-Traumatic)]]
 *[[Neurogenic Shock]]
-*[[C-spine (NEXUS)]]
-*[[C-Spine X-Ray]]
-*[[Fractures (Main)]]
 *[[Unstable spine fractures‎]]
-*[[C-Spine (Canadian Rule)]]
 *[[Vertebral fractures]]
+*[[Cervical injury (peds)]]
-==See Also==
+==References==
-*[[Blunt neck trauma]]
+<references/>
-==Source==
-*National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Injury. Facts and Figures at a Glance. Birmingham, Ala: NSCISC; July 1996
-*Ivy ME, Cohn SM. Addressing the myths of cervical spine injury management. Am J Emerg Med. Oct 1997;15(6):591-5
-*Woodring JH, Lee C, Duncan V. Transverse process fractures of the cervical vertebrae: are they insignificant? J Trauma. June 1993; 34(6):797-802.
-*Tintinalli's
 [[Category:Trauma]]
-[[Category:Ortho]]
+[[Category:Neurology]]
+[[Category:Orthopedics]]