Fractures of the C-spine

Question 1

Why might dens fracture occur?

What can result from dens fracture?

Answer 1

Fall on head

Displacement
Spinal cord injury
Quadriplegia

Displacement
Medulla injury
Death

High risk of avascular necrosis of distal fragment.

Question 2

What happens in head on car collisions? Where is the pain felt?

Answer 2

Hyperflexion of the C spine
Rupture of lower intervertebral discs (C5/C6 and C6/C7)
Compression of spinal roots

Pain in neck, shoulder, arm and hand

Question 3

What happens in rear end car collisions?
What ligament is damaged?
Where does this usually occur?
What is the worst case scenario?
Where does this occur?

Answer 3

Whiplash injury
Head is whipped back on shoulders.
Hyperextension of C spine

Anterior longitudinal ligament is damaged.
Vertebrae fractured

Often at C2 where C2 body moves anteriorly to C3

Worst case - dislocation or sub laxation of vertebrae
Usually at C6/C7

Question 4

Where does sub laxation of vertebra usually occur?

Answer 4

C6/C7

Question 5

Where does whiplash injury occur?

Answer 5

C2

Question 6

What is osteoarthritis? What does it lead to in vertebrae? How does this present?

Answer 6

Wear and tear damage to bones
Osteophyte formation

Zygophyseal joints are close to intervertebral foramina through which spinal nerves emerge (above respective vertebra except C7 which has above and below)
Osteophyts lead to compression of nerves

Pain in dermatomes
and muscle spasms in myotomes

Question 7

What is a broken neck? What causes this?

Answer 7

Fracture of vertebral arch

Compression of C spine against shoulders

Question 8

Where does a broken neck occur most commonly? Most fatal?

Answer 8

C2, C6, C7

C1/C2

Question 9

What is a Jefferson fracture? What causes this?

What results?

Answer 9

Fracture of atlas in 4 places: anterior and posterior arch

Head first fall from height (vertical fall onto extended neck)
Compresses lateral masses of atlas between occipital condyles and axis
Driven apart, fracturing anterior and posterior arches

Transverse ligament may be ruptured

Damage to spinal cord unlikely as the vertebral foramen is large

Question 10

What is Hangman;s Fracture?
What leads to hangman’s fracture?
What results?

Answer 10

Fracture of the axis (C2) at the pars interarticularis (bony columns between superior and inferior articular facets.

Hyperextension of head on neck

Likely to be lethal
Spinal cord rupture.
Unconsciousness
Resp/cardiac failure