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
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
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essentially been replaced by the Gardner-Wells tongs.2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.
Table 102-1. Cervical
Spine Trauma Classification of the Orthopedic Trauma Association3 |Favorite Table|Download (.pdf)
Table 102-1. Cervical
Spine Trauma Classification of the Orthopedic Trauma Association3
|Upper cervical spine ||Lower cervical spine|
|1) Occipital cervical dislocations||1) Spinous process fracture|
|Anterior||2) Extension avulsion or teardrop|
|Vertical||3) Lateral mass fracture without subluxation|
|Posterior||4) Isolated lamina fracture|
|2) Cervical spine, occipital condyle||5) Ligamentous strain|
|Type 1||6) Facet injury|
|Type 2||Perched unilateral|
|Type 3||Perched bilateral|
|3) Atlas||7) ...|
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