The Sports Institute at UW Medicine works to expand participation and safety in sports. In an ongoing effort to educate parents, coaches and medical personnel on best practices in sports safety, we produced a short educational film demonstrating new NATA-recommended techniques for emergent treatment of athletes with a suspected cervical spine injury. These recommendations are made in two peer-reviewed papers written by the NATA Spine Injury in Sport Group.
Learn more about our work on spine injury in sport: https://thesportsinstitute.com/our-work/spine-injury-in-sports/
Dr. Ebraheim’s educational animated illustrates spine concepts associated the cervical spine – trauma.
Transverse ligament:
– It provides the C1-C2 stability
– It is behind the odontoid and it anchors the odontoid to the ring of C1 so it prevents an abnormal movement between C1 and C2.
– A.D.I. in adults is 3.5 mm.
– Of the transverse ligament is injured, C1 and C2 will be free to move & there will be an increase in the A.D.I.
– Isolated traumatic injury to the transverse ligament is probably rare.
– Jefferson fracture
Three types:
– Type II: fracture at the base of the odontoid process, most common, troublesome fracture.
– Nonunion rate is 20-80% due to interruption of the blood supply.
– High nonunion rate in:
– More than 5 mm of displacement.
– Patients older than 50 years of age.
– Other risk factors:
– Delay in treatment
– Posterior displacement of the fracture
– Diabetes
– Do not use halo in early patients, risk of death from pneumonia
– Treatment of young patients:
• Halo: halo traction may be needed initially to reduce fracture, halo for up to 3 months, 30% non-union rate in halo.
• When do you do surgery? Displaced fracture in older patients, risk factors for no-union.
• Odontoid screw is preferred in the young patient.
• Need to preserve C1-C2 motion.
• Do not do fusion in young patients.
• Can use C1- C2 fusion in older patients.
• For older patients:
– Orthosis or Fusion of C1- C2 if there is an indication for surgery and if there is a clearance for surgery.
Type III:
– Fracture through the body of C2.
– Treatment:
• Cervical orthosis
• Halo: if displaced
• Hangman’s fracture is a bilateral fracture of the pars interarticularis
• The spinal canal is wider and there will be a low risk for spinal cord injury.
Levine and Edwards classification:
– Type I: stable fracture with less than 3 mm displacement, no angulation, treatment: cervical orthosis.
– Type II: most common type, significant translation and some angulation, unstable fracture, treatment: cervical traction and extension to improve the displacement, immobilization in halo vest for about 3 months.
– Type IIa: severe angulation and slight translation seen in flexion distraction injuries with tearing of the posterior longitudinal ligament, the fracture is unstable, treatment: do not use traction when there is severe angulation of the fracture.
– Type III: surgical type, C2-C3 facet dislocation, rare fracture of the pedicles in addition to the anterior facet dislocation, it has some neurological deficit association, treatment: surgery for reduction of the facet dislocation and stabilization of the injury, open reduction and posterior spine fusion.
• Facet dislocations: the association of disk herniation and facet involvement is very high, so watch out for a herniated disc in addition to the bony injury.
– Unilateral facet dislocation will usually have less than 50% translation on x-ray and it may affect a nerve root.
– Bilateral facet dislocation will have more than 50% translation and probably a spinal cord injury.
– Treatment: immediate closed reduction, get an MRI, then do surgery, if the patient has a change in mental status, then get the MRI first, and immediately followed by open reduction and surgical fixation.
– When do you go anteriorly?
– Go anteriorly if there is a disc herniation, incidence is about 10%-30% in cervical facet dislocation.
– If you try to do reduction, the disc fragment may stay in the canal causing spinal cord injury.
– When do you do posterior?
– If reduction of the dislocation failed and there was no disc herniation.
– When do you combined anterior and posterior procedures?
– Need to go anteriorly to remove the disc
– Need to go posteriorly because the dislocation cannot be reduced by a closed method or by an open anterior technique.
• Important points:
1- Get the MRI before surgery: make sure there is not a disc herniation.
2- Ligament injuries do not heal: will need fusion surgery.
3- Know the arrangement of the facets: superior and inferior facets in normal, subluxed, and dislocated positions.
Know the “naked facet” or the “empty facet”.
Train yourself to know this, especially for exam questions.
Naked Facet.
Cervical Spine MRI
Facet Fracture
Ligamentous Injury OF THE Cervical Spine
Burst Fracture of Lower Cervical Spine
Tear Drop Fracture
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This video “Spinal Trauma: Cervical Trauma Protocol, Common Spinal Fractures” is part of the Lecturio course “Radiology”
► WATCH the complete course on http://lectur.io/spinaltrauma
► LEARN ABOUT:
– Cervical trauma protocol
– Common mechanism of spine trauma
– Common spinal fractures
– Burst fracture
– Chance fracture
– Jefferson fracture
– Hangman’s fracture
► THE PROF:
Hetal Verma has extensive experience practicing in the field of radiology. She is currently a Clinical Instructor at Harvard Medical School. Hetal has been in practice for over 10 years and has been teaching medical students and residents throughout that time. She has also been invited as a speaker at multiple teaching conferences for other physicians, technologists and the community.
► LECTURIO is your single-point resource for medical school:
Study for your classes, USMLE Step 1, USMLE Step 2, MCAT or MBBS with video lectures by world-class professors, recall & USMLE-style questions and textbook articles. Create your free account now: http://lectur.io/spinaltrauma
C3 Vertebrae Injury, C4 Vertebrae Injury, and C5 Vertebrae Injury are all defined. C3, C4, & C5 Vertebrae Anatomy is described. Cervical Spinal Injury treatments, as well as C3 Vertebrae, C4 Vertebrae, C5 Vertebrae recoveries are all discussed.
C3 Spinal Vertebra Defined
The C2 – C3 junction of the spinal column is important, as this is where flexion and extension occur (flexion is the movement of the chin toward the chest and extension is the backward movement of the head). Patients with a cervical vertebrae injury at the C3 level will have limited mobility in both their flexion and extension.
The C3 vertebra is in line with the lower section of the jaw and hyoid bone, which holds the tongue in place. The flexible C3 vertebrae helps aid in the bending and rotation of the neck.
C4 Spinal Vertebra Defined
This central portion of the spinal cord, which relates to the C4 vertebra, contains nerves that run to the diaphragm, which helps us breathe by contracting and pulling air into the lungs. The C4 vertebra is located in the neck region of the spinal column, just above the thoracic vertebrae. It is located in close proximity to the thyroid cartilage.
C5 Spinal Vertebra Defined
The C5 spinal vertebra is the fifth vertebra from the top of the column. The C5 vertebra is significant for determining the severity of neck and spinal injury. If the injury is at or above the C5 vertebra, the person may be unable to breathe since the spinal cord nerves located between the third and fifth cervical vertebrae control respiration. Damage to the spinal cord at the C5 vertebra also affects the vocal cords, biceps, and deltoid muscles in the upper arms.
C3, C4, & C5 Vertebrae Anatomy
Cervical vertebrae from C3 through C6 are also known as typical vertebrae since they share similar anatomical characteristics to the other vertebrae further down the spinal column. Typical vertebrae share these features:
Vertebral Body
The thick boned vertebral body is cylindrical-shaped and located at the front of the vertebra. It carries most of the weight for a vertebra. Most vertebrae feature an intervertebral disc between 2 vertebral bodies for cushioning and shock absorption.
Vertebral Arch
The vertebral arch is a bony curve that wraps around the spinal cord toward the back of the spine and consists of 2 pedicles and 2 laminae.
Facet Joints
Each vertebra has a pair of facet joints, also known as zygapophysial joints. These joints, located between the pedicle and lamina on each side of the vertebral arch, are lined with smooth cartilage to enable limited movement between 2 vertebrae. Spinal degeneration or injury to the facet joints are among the most common causes of chronic neck pain.
Functions of C3, C4, & C5 Vertebrae
These vertebrae form the midsection of the cervical spine, near the base of the neck. They control function to the body from the shoulders down. All three vertebrae work together to support the neck and head.
Causes of Cervical Spinal Injuries
The most common causes of cervical vertebrae injury and spinal cord damage include a spinal fracture from diving accidents and sports, as well as medical complications. Other common causes include:
• Tumors
• Trauma
• Birth defects
• Motor vehicle accidents
• Infections or diseases
• Slip and fall incidents
C3, C4, and C5 Injury Symptoms
Symptoms of a C3 Level Spinal Cord Injury
Symptoms of a spinal cord injury corresponding to C3 vertebrae include:
• Limited range of motion
• Loss of diaphragm function
• Requirement of a ventilator for breathing
• Paralysis in arms, hands, torso, and legs
• Trouble controlling bladder and bowel function
Symptoms of a C4 Level Spinal Cord Injury
Patients with C4 spinal cord injuries typically need 24 hour-a-day support to breathe and maintain oxygen levels. Symptoms of a spinal cord injury corresponding to C4 vertebrae include:
• Loss of diaphragm function
• Potential requirement of a ventilator for breathing
• Limited range of motion
• Paralysis in arms, hands, torso, and legs
• Trouble controlling bladder and bowel function
Symptoms of a C5 Level Spinal Cord Injury
Damage to the spinal cord at the C5 vertebra affects the vocal cords, biceps, and deltoid muscles in the upper arms. Unlike some of the higher cervical injuries, a patient with a C5 spinal cord injury will likely be able to breathe and speak on their own. Symptoms of a spinal cord injury corresponding to C5 vertebrae include:
• Retaining the ability to speak and breathe without assistance, though respiration may be weak
• Paralysis in the torso, legs, wrists, and hands
• Paralysis may be experienced on one or both sides of the body
• Patients may be able to raise their arms and/or bend their elbows
• Patients will need assistance with daily living, but may have some independent function
