Teardrop fracture of the cervical spine is a confusing and loosely used term, often referring to any fracture with a triangular fragment in the involved body. The flexion teardrop fracture is a specific entity that should not be confused with other types of injury with a teardrop fragment. The risk of adjacentlevel ossification development after surgery in the cervical spine. An increasing body of evidence favors the use of multidetector ct as a standalone screening test for excluding cervical injuries in polytrauma patients with obtundation. Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. Most common fracture of axis nearly 23 of all c2 fxs 10 20 % of all cervical fractures bimodal distribution young high energy, multi trauma elderly low energy, isolated injury most common cspine fracture elderly. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative. A fracture, or break, in one of the cervical vertebrae is commonly called a broken. Osteoporosis causes the bones to be more fragile and more likely to fracture. Determination of when to image the whole spine versus selective imaging is based on exam, patient mental status, and mechanism of injury.
In a flexion teardrop fracture, the most severe of all cervical spine injuries, there is a teardropshaped fracture through the anteroinferior vertebral body, typically at c5, with disruption of all the ligaments and retropulsion of the posterior vertebral body into the spinal canal fig. A cervical fracture is a break in a vertebra bone in your neck. The flexion teardrop fracture ftdf is a common injury of the cervical spine that. It is important to correctly classify the fracture to ensure appropriate treatment.
Cervical spine fractures, commonly known as broken neck, typically happen in highenergy traumas such as motor vehicle accidents, and account for the majority of fractures of the spinal column, as the cervical spine represents the part of the spine that is the most mobile and the most vulnerable to injury. The workgroup meets regularly to encourage communication among services and to share best practices. Rescuers should not apply traction to the cervical spine, as this may cause. Cervical spine fractures are potentially deadly conditions that arise after trauma, exaggerated extension or flexion. Biomechanics of cervical spine trauma for example in lower cervical spine. Cervical fractures usually result from highenergy trauma, such as automobile crashes or falls. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but. The catheter is used to inject the fractured vertebrae with bone cement, which hardens, stabilizing the vertebral column. Most common fracture of axis nearly 23 of all c2 fxs 10 20 % of all cervical fractures bimodal distribution young high energy, multi trauma elderly low energy, isolated injury most common. Guidelines for treatment of the cervical spine developed and adopted by the physician advisory committee adopted by the administrator of the oklahoma workers compensation court.
Gravity depends on the location, stability, and pattern of the injury. The benefit of spinal fusion utilizing any cervical plating system has not been adequately established in patients with stable spines. A case report of a patient with cervical spine clinical instability is included to illustrate its presentation and management. Nerves in the spinal cord control your ability to move. Patients who have one identified fracture in the spine should.
Fractures of the cervical spine pubmed central pmc. Cervical spine fractures and osteoporosis springerlink. Cervical spine ap, lateral and open mouth to see the odontoid views swimmers view to see junction of c7 on t1 ct scan outstanding exam to view bone anatomy and diagnose fractures. Cervical spine clearance upstate medical university. If a fracture of cervical spine is seen, complete ct evaluation of c, t, and lspine is required to rule out additional fractures. In the long term, physical therapy will be given to build strength in the muscles of the neck to increase stability and better protect the cervical spine. Instructions for use slimplicity anterior cervical plate.
Cervical spine fracture an overview sciencedirect topics. Fulcrum of movement is different in children than adults, c23 compared to c56, respectively. Factors associated with cervical spine injury in children. Trauma clinical guideline cervical spine injury evaluation. In a radiographic analysis of 45 patients with flexion teardrop fracture, the most characteristic feature. Osteoporotic vertebral fractures classically occur during normal daytoday activities such as bending, twisting, walking or lifting relatively light objects. Accurate diagnosis of acute cervical spine injury requires cooperation between clinician and. Fractures of the cervical spine are potentially serious and devastating if not properly treated. Certain mechanisms of injury, such as mounted blast, warrant imaging of the whole spine. A fracture, or break, in one of the cervical vertebrae is commonly called a broken neck. Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading. They support the head and connect it to the shoulders and body.
In a flexion teardrop fracture, the most severe of all cervicalspine injuries, there is a teardropshaped fracture through the anteroinferior vertebral body, typically at c5, with disruption of all the ligaments. Nov 10, 2014 a number of new developments in cervical spine imaging have transpired since the introduction of 64section computed tomographic ct scanners in 2004. Vertical loading of the lower cervical spine in the forward flexed position reproduce pure ligamentous injuries. While cervical spine injury is more common in patients with multiple injuries, isolated injury may occur following comparatively minor traumatic incidents. Cervical spine injuries associated with the incorrect use of airbags in motor vehicle collisions. Patients should be considered to have a possiblecervical spine injury if they present with any of the following conditions. This procedure has been shown to reduce or eliminate. Cervical degenerative disease disc herniation extremity painweakness neck pain. A number of new developments in cervical spine imaging have transpired since the introduction of 64section computed tomographic ct scanners in 2004.
Cervical spine trauma patterns areas most commonly involved o c12 particularly in children o c57 other fractures 20% particular association of low cervical fracture with high thoracic and thoracolumbar injury cervical spine trauma radiographic evaluation standard 3 view series o ap, lateral, openmouth odontoid oblique views not used much. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Pearls and pitfalls accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervical spine ct, and the awareness that a patient may have a significant and unstable ligamentous injury despite normal findings. Cervical and thoracolumbar spine injury evaluation, transport. The cervical spine is divided into the upper cervical spine. Collars, traction and surgery can be used to immobilize and stabilize the neck after a cervical fracture. A 42yearold man reported to our service with a 1week history of vague cervical neck pain on a background history of a gelastic seizure disorder. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying. What is a jefferson fracture of the cervical spine. Upper cervical spine trauma orthopaedic trauma association. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlantoaxial dislocations, fractures of the odontoid process, and hangmans fractures in the c2. Trauma clinical guideline cervical spine injury evaluation the trauma medical directors and program managers workgroup is an open forum for designated trauma services in washington state to share.
Pdf flexion teardrop fracture of the cervical spine. The seven bones in the neck are the cervical vertebrae. No contrast reference sheet spine body part reason for exam procedure to precert cpt code spine. Radiographic characteristics 1221 teardrop fracture of the cervical spine is a confusing and loosely used term, often referring to any fracture with a triangular. Pearls and pitfalls accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervical. The reported frequency of missed injuries in the cervical spine varies from 4% to 30%. A ct angiogram of carotid and vertebral arteries was normal, and the patient was managed with an occipitocervical fusion.
Cervical spine trauma evaluation spine orthobullets. Cervical spine trauma patterns areas most commonly involved o c12 particularly in children o c57 other fractures 20% particular association of low cervical fracture with high thoracic and. In this procedure, the surgeon inserts a catheter into the compressed vertebra. Osteoporosis as a generalized bone disease appears to affect the cervical spine differently from other spinal regions. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. Feb 03, 2020 a cervical fracture is a break in a vertebra bone in your neck. Cervical discitis masslesion osteomylitis mri cervical spine without and with. This mechanism produced bilateral dislocation of the facets without fracture. The first two vertebrae are called the axis and atlas, respectively, and do not have a disc between them, but are closely bound together by a complex of ligaments. Cervical spine fractures radiology reference article. Because of the orientation of the cervical spine facet joints, the cervical spine is designed for a great deal of mobility, but it lacks stability. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. Imaging of cervical spine trauma cervical spine trauma. Nationalathletictrainersassociationposition statement.
This will minimize motion during the management of the injury. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma. Patients who have one identified fracture in the spine should have their entire spine imaged. Cervical degenerative disease disc herniation extremity painweakness neck pain radiculopathy trauma mri cervical spine without contrast 72141 spine. Any injury to the vertebrae can have serious consequences such as temporary or perman. Nov 09, 20 biomechanics of cervical spine trauma for example in lower cervical spine. The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and acts as a lever. Spine rehabilitation exercises to ensure that this program is safe and effective for you, it should be performed under your doctors supervision. Patients with cervical fractures will likely be prescribed medication for pain control. Retrospective casecontrol study of 65 patients with cervical fracture dislocations treated with posterior instrumentation instrumentation was 47. Vertebroplasty is a new surgical procedure that may be used to treat compression fractures. Anterior cervical plating technique to prevent adjacentlevel ossification development. Cervical spine fractures musculoskeletal medicine for.
Diagnosis and treatment of cervical spine clinical instability. Cervical spine fractures classification system 11 injuries are first classified by their level and primary injury type, either c, b, or a. What is occipital condyle fracture of the cervical spine. Trauma clinical guideline cervical spine injury evaluation the trauma medical directors and program managers workgroup is an open forum for designated trauma services in washington state to share ideas and concerns about providing trauma care. They are usually the result of trauma, such as car accident or a fall. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. The cervical spine is divided into the upper cervical spine occiputc2 and the lower cervical spine c3c7, according to anatomical differences. Cervical spine ap, lateral and open mouth to see the odontoid views swimmers view to see junction of c7 on t1 ct scan outstanding exam to view bone anatomy and diagnose fractures flexionextension views. Radiological imaging confirmed a type ii hangmans fracture through the c2 pedicle. The cspine consists of seven vertebrae c1c7 and supports the weight of the head approximately 14 pounds. Fractures in the upper cervical spine include fractures of the. Upper cervical spine occult injury and trigger for ct exam. Talk to your doctor or physical therapist about which.
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