Clinical: cervical spine

Question 1

How does a Jefferson fracture of the atlas occur?

Answer 1

a vertical fall onto an extended neck

e.g. diving into excessively shallow water

Question 2

what happens in a Jefferson fracture of the atlas?

Answer 2

compress the lateral masses of the atlas between the occipital condyles (head) and the axis (C2)

Question 3

what does compression of lateral masses of atlas lead to? (Jefferson fracture of atlas)

Answer 3

cause the lateral masses of atlas to be driven apart, fracturing one or both of the anterior / posterior arches

Question 4

what may also be damaged if the vertical fall in Jefferson fracture of the atlas occurs with enough force?

Answer 4

transverse ligament of the atlas may also be ruptured

Question 5

will there be damage to the spinal cord in Jefferson fracture of the atlas? why?

Answer 5

as the vertebral foramen is large, unlikely to damage spinal cord at C1
may be damage further down the vertebral column

Question 6

how does a hyperextension (whiplash) injury occur?

Answer 6

rear-end traffic collision or poorly performed rugby tackle

result in head being whipped back on the shoulders

Question 7

what is damaged in minor cases of whiplash injury? (hyperextension)

Answer 7

anterior longitudinal ligament of the spine

acutely painful for patient

Question 8

what can happen in more severe cases of whiplash injuries? why?

Answer 8

fractures can occur to any of the cervical vertebrae as they are suddenly compressed by rapid deceleration

Question 9

will there be spinal cord involvement in whiplash injuries? why?

Answer 9

large vertebral foramen = less chance of spinal cord involvement

Question 10

what is the worst-case scenario for a whiplash injury?

Answer 10

dislocation / subluxation of the cervical vertebrae

Question 11

where does dislocation / subluxation in a whiplash injury normally occur?

Answer 11

C2: body of C2 moves anteriorly to C3

C6/C7 (more common - 50% cases)

Question 12

what can dislocation / subluxation at the level of C2/C3 in whiplash injury result in? leading to?

Answer 12

can result in spinal cord involvement - leading to quadraplegia or death

Question 13

what is a hangman’s fracture?

Answer 13

fracture of the pars interarticularis

Question 14

what is the pars interarticularis?

Answer 14

bony column between the superior and inferior articular facets of the axis
(sort of between superior articulating facet and spinous process)

Question 15

how does a hangman’s fracture occur?

Answer 15

sudden deceleration (that occurs in hanging)

Question 16

how is Hangman’s fracture lethal?

Answer 16

either fracture fragments, or force involved are likely to rupture the spinal cord, causing deep unconsciousness, respiratory and cardiac failure and death

Question 17

what is fracture of the dens?

Answer 17

fractures of the axis (40%)

Question 18

what is fracture of the dens most commonly caused by?

Answer 18

traffic collisions and falls

Question 19

what is fracture of the dens at high risk of? why?

Answer 19

often these fractures are unstable and are at high risk of avascular necrosis, due to isolation of the distal fragment from any blood supply - taking a long time to heal