What is a cervical fracture?
A cervical fracture is commonly called a “broken neck” and although all fractures are serious cervical factures carry more serious consequences than other fractured areas. Your cervical spine (neck) is made up of 7 connected bones called vertebrae. The vertebrae are connected to each other above and below through strong discs and joints on either side called facet joints. Your discs protect your spine by acting like shock absorbers to distribute weight evenly through your neck. The facet joints on the other hand not only control but allow the movement of your neck. Think of your facet joints like the steering mechanism of your spine, it is their job to determine what movements can be made and the extent of those movements. The disc in the middle and the facet joints either side form what professionals refer to as the “three joint complex” that makes your spine a strong and durable structure.
Why & when does a cervical fracture happen?
Due to the durable nature of your cervical spine a substantial force is needed to cause a cervical fracture. In most instances cervical fractures are the result of car accidents or severe falls where there is a direct blow or impact to the head and neck. Certain contact sports such as rugby, American football and non-contact sports such as skiing and horse riding carry a greater cervical fractures injury risk. A very common fracture incidence occurs when divers tip backwards off the side of a boat and into shallow water; this creates a very forceful impact on the head against the sea floor. These types of fractures are commonly seen in the elderly as often their bones are weakened by osteoporosis. In cases of advanced osteoporosis fractures can happen as a result of normal daily activities and not as the result of any trauma.
What to do if a cervical fracture is suspected after head trauma.
After any severe head trauma a cervical fracture is suspected until ruled out. When cervical fractures are suspected after a trauma incident the patient’s neck will be immediately stabilised with a neck brace and most likely strapped into a stretcher, this is to ensure no sudden movements are made as this could further damage the spine. That is why if you come across an injured motorcyclist the golden rule is never take off his or her helmet.
What does a cervical fracture feel like?
There is normally an immediate onset of extreme pain after the injury occurs and will be accompanied by swelling and bruising at the back of the neck. The neck will feel very weak and any movements will cause severe sharp pain and at rest the pain levels will fluctuate between the severe sharp pains to an intense ache. This pain will rapidly spread from the neck into the upper back, shoulders and down into the arms. In some cases a nerve or portions of the spinal cord may be compressed or injured. In this circumstance intense arm pain, pins & needles, weakness or sensation changes may occur. Weakness and numbness may also occur in the lower legs.
How will a cervical fracture be diagnosed?
Patients will be taken to A&E and a full neurological examination will be done including muscle strength, reflexes and skin sensation tests to rule out nerve or spinal cord injury. Your doctor will order an X-ray of the neck to confirm the diagnosis and identify the location of the fracture. If your doctor wants to assess the fracture further then a CT scan will be ordered as this will give a more detailed view of the fractured site. In cases where spinal cord or nerve damage is suspected an MRI will be ordered.
What treatment options are available for a cervical fracture?
The patient will remain completely immobile until the doctor is satisfied that it is safe to move the head and neck again. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. The Doctor will most likely provide you with a neck collar to help stabilise the neck as it heals. A fracture can take anything from 6 -12 weeks to heal. You will be referred through to a physiotherapist who will provide you with exercises to strengthen your neck and upper back and may use traction to aid the healing process. In some cases surgery may be needed when the spine is found to be unstable or when there is compression on a nerve or the spinal cord.
There are 8 different types of cervical fracture that come under the umbrella term broken neck.
A Hangman fracture is a fracture of both vertebrae pedicals or pars interarticularis (shown on the diagram) of the second vertebrae (C2) down from the base of the skull called the axis. This fracture is the result of violent hyperextension of the neck for instance like the injury sustained from hanging (hence the fractures name) or when hitting your chin against the dash board in a car accident.
A Jefferson fracture is a fracture of the anterior and posterior arches of the first vertebra quite often the vertebrae breaks in 2 or 3 places. It normally occurs through a combination of compression and hyperextension of the neck. This is the fracture most commonly seen in diving accidents.
An Odontoid Fracture is the fracture through the tip of the odontoid process that extends up from the second vertebrae and rests against the first vertebrae.
A Flexion teardrop Fracture is the compression of the vertebral body that occurs after violent compression and flexion of the neck.
ABilateral (Both sides) or Unilateral (One sided) Facet Dislocation is an extreme hyper-flexion injury. A bilateral dislocation can result in the vertebrae body slipping forwards.
A Burst Fracture is a fracture of the vertebral body of the third to seventh vertebrae that occurs when an excessive downwards pressure is applied to the head and neck. It crushes the front and back of the body. Unlike the compression fracture this is more likely to affect the nerve or spinal cord.
A Clay-shoveler's fracture is the fracture of the spinous process of the lower cervical vertebrae (C6,C7) and is sometimes involves the first thoracic vertebrae (T1). The fracture is caused by an extremely forceful and violent muscle pull on the spinous process.
A Wedge Fracture is a compression fracture of the vertebral body where the front of the body is crushed but the back of the vertebrae stays intact forming a wedge shape. This is normally seen in elderly patients with conditions like osteoporosis.