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.
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
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)