Trinity Medical Center I Dr. Marin Guentchev, MD, PhD Fractures of the cervical vertebral bodies C3-C7

Fractures of the cervical vertebral bodies C3-C7

ANATOMY OF THE SPINE

The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid. The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus). The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.

DESCRIPTION

Fractures of the lower cervical spine occur in high energy traumas MVA, sports, head trauma. Some preexisting conditions (e.g. osteoporosis) predisposes individuals to fractures. Stability of the fracture is assessed using the White and Panjabi model. These fractures include the following: Compression fracture due to compressive force to anterior vertebral body. Posterior body complex and spinal canal are intact. Often posterior ligament rupture. Burst fracture fracture afects the whole vertebral body. Its margins spread out in all directions incl. the spinal canal. It is often associated with spinal cord injury. Considered unstable and requires surgery. Teardrop fracture due to flexion/compression. The posterior portion of vertebra is repulsed backwords. Large anterior lip fragment. Often posterior ligament rupture. It is often associated with spinal cord injury. Considered unstable and requires surgery. Extension teardrop avulsion fractures are usually considered stable. The standard treatment is use of cervical collar.

CAUSE OF SYMPTOMS

Acute compression of a cervical nerve root and/or the cervical spinal cord.
Cervical vertebral fracture

SYMPTOMS AND SIGNS

Тingling, numbness, pain or weakness in one hand. The pain usually starts in the neck. In rare cases, total or partial paralysis of the hands/feet and insensitivity from the neck down.
Pain and stiffness in the neck

THE DIAGNOSIS IS BASED ON

Medical history Clinical exam Computer tomography Radiographs Magnetic resonance imaging (MRI)
additionally you may have to do:
Functional (dynamic) radiographs Digital subtraction angiography

TREATMENT

The treatment may be non-surgical or surgical.
Non-surgical treatment may include
Nonsteroidal anti-inflammatory drugs
Immobilization with collar

WHEN SHOULD AN OPERATION BE PERFORMED?

The stability of the spine is compromised
Neurological symptoms caused by compression of the spinal cord or nerve roots
Local pain caused by pseudarthrosis (non union) months after the trauma.

WHAT IS THE GOAL OF SURGERY?

To release the compressed nerve roots and/or spinal cord
To restore the protective function of the spine

HOW IS SURGERY PERFORMED?

Anterior cervical decompression and fusion
Posterior decompression of the spinal canal + fusion

WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)?

Other fractures of the spine Osteoporosis Pathologic vertebral fracture Ankylosing spondylitis (Bechterew's disease)
Adress
Trinity Medical Center 117 Zaichar St /Ground floor/ /Konstantin Velichkov Metro Station/ BG-1309 Sofia, Bulgaria
PDF from this page
Generating PDF from page
It may take up to a minute...
CLOSE