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Traumatic injuries to the cervical spine result from forces acting on the head and neck. The incidence of spinal cord injury in the United States is approximately 5 per 100,000 population. Approximately 60 to 80 percent of spinal cord injuries involve the cervical spine. Motor vehicle collisions are the cause of one-third of cervical spine injuries. The second one-third of cervical spine injuries result from falls. Penetrating wounds and other types of injuries account for the remaining one-third.


The primary aim of therapy in the treatment of the person with an acute spinal cord injury is to minimize secondary injury to the spinal cord, to realign the spine, to improve neurological recovery, to maintain spinal stability, and to obtain an early functional recovery. This is achieved by decompression of the neural tissue either by restoring the normal sagittal diameter of the spinal canal or by removing a compressive lesion surgically. This is particularly important in patients who have sustained an incomplete spinal cord lesion and are found to have a progressing neurological deficit. Restoring the normal anatomic position also provides for relief of pain.


Early operative intervention is currently being investigated in the treatment of acute cervical fractures to achieve decompression and restore normal alignment. The use of skeletal traction in the acute spinal cord injury patient remains a very safe and straightforward method of reducing fractures and maintaining the spinal canal in anatomical alignment.


Fabricius Hildanus utilized forceps in treating fractures or dislocations of the cervical spine as early as 1646. Crutchfield developed a pair of self-tightening tongs in 1933 that allowed him to apply traction to the cranium in a patient with a cervical spine fracture.1 These tongs were subsequently modified and have essentially been replaced by the Gardner-Wells tongs.2


Cervical spinal cord injuries can be divided into the upper (occiput to C3) and lower (C3 to C7) injuries. Numerous classification systems exist. These are based upon the morphology and the mechanism of injury. Included in this chapter is the classification proposed by the Orthopedic Trauma Association (Table 102-1).3 No classification is ideal. However, critical to all cervical classifications is the determination of stability of a fracture or dislocation. Stability of the vertebral column is dependent upon the integrity of the vertebra, the intervertebral disk, the facet joints, and most importantly the ligamentous structures.

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Table 102-1. Cervical Spine Trauma Classification of the Orthopedic Trauma Association3

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