Cervical Spine Fractures

The human spine comprises 24 vertebrae, or small bones containing the spinal cord. These vertebrae are grouped into three sections according to location: cervical spine (neck), thoracic spine (middle back), and lumbar spine (lower back). Soft tissues, such as ligaments (tissues that connect bones), muscles, and skin, surround and support the spine. Seven vertebrae form the cervical spine. This section of the spine connects the base of the head to the thorax (trunk and shoulders) and, with the help of soft tissues, supports the head. A fracture (break) of the cervical spine is commonly referred to as a broken neck.

Most injuries that involve the neck or cervical spine are the result of a violent collision that compresses the cervical spine against the shoulders. This force can be so great that a vertebra fractures or even bursts into small fragments (Fig. 2, normal C-spine; Fig. 3, fractured C5). For example, striking your head against the bottom of a pool in shallow water or "spear" tackling using the crown of your helmet to stop an opposing football player can fracture the cervical spine (Fig. 4).

Cervical spine injuries may also occur during motor vehicle accidents when the head is violently jerked either backwards or forwards. This type of accident may not cause a fracture but instead injure the muscles and ligaments of the neck. The resulting injury is a neck sprain, which is commonly called whiplash.

Regardless of the cause, cervical spine fractures are serious injuries; they may involve spinal cord damage that can result in partial or complete paralysis or even death.

If you suspect that someone has a neck injury, immediately contact emergency medical services. Do not move the person yourself - no matter how uncomfortable they look. Emergency medical technicians are trained in the proper treatment of people who have neck injuries. If you move a person who has a cervical spine fracture, you risk further injuring that person.

The surgeon will x-ray the injured person's spine to find out if the cervical spine is fractured. To treat the fractured spine, the surgeon first reduces it through traction. This process involves inserting tongs into the skull, attaching a pulley to the tongs, and attaching small weights to the other end of the pulley. The weights pull the head away from the shoulders just enough to enable the soft tissues around the spine to push the fractured bone back into place. After the fracture is reduced, the surgeon examines the spinal cord for damage. Because the spinal cord is soft tissue, it cannot be seen on an x-ray. Therefore, the surgeon injects a dye into the damaged area that coats the spinal cord and other soft tissues so they can be seen on an x-ray.

Most cervical spine fractures must be treated surgically. The surgeon chooses the treatment method based on the severity of the fracture. For example, the fractured vertebra may be fused to the healthy vertebra next to it, or it may be removed and replaced with a bone graft that is fused to the vertebrae on either side.

Cervical spine fractures and other neck injuries occur less frequently because people are more educated about how fractures occur and about how to prevent them. Protect yourself and your family by always wearing a seatbelt, supervising children and adolescents who are swimming and diving in lakes and pools, and using the proper equipment and training during athletic participation. If a significant neck injury does occur, be sure to contact your local emergency medical services for help.

Larry Parker, M.D.