By a cervical spine fracture or a cervical spine fracture, the medical profession understands the complete or partial vertebral fracture of the cervical spine. Colloquially, cervical vertebral fracture is often referred to as a neck fracture. This injury carries the risk of paraplegia if the spinal cord of the cervical spine is also affected. Treatment depends on the severity and type of fracture.
What is a cervical spine fracture?
The cervical spine, or C-spine, is defined as the seven vertebrae in humans and mammals that lie between the head and thoracic spine. Injuries and fractures of the cervical spine occur more frequently in children and seniors. All of the nerve pathways that connect the body and brain pass through the cervical spine, so a fracture of this area can have numerous consequences and symptoms. The typical complaints of a cervical spine fracture are pain in the affected area, both at rest and during movement, a poor posture of the head and the subjective feeling of the affected person that he or she can no longer hold the head. If nerve tracts have been damaged by the vertebral fracture, additional loss of sensation and paralysis symptoms occur, for example, respiratory or circulatory arrest or paraplegia.
Causes
The possible causes of cervical spine fracture must be distinguished according to whether the affected person belongs to a special risk group. In older people, even minor violence such as falls can lead to a cervical spine fracture. In small children and infants, the neck muscles are too weak to keep the large head stable, so that even slight violent impacts can lead to fractures of the cervical spine. Severe traffic accidents involving head-on or rear-end collisions are also more likely to result in cervical spine injury in the elderly and children. If the affected person does not belong to a risk group, the causes of a cervical spine fracture are overextension or hyperextension of the cervical spine, as can occur with direct or indirect force. Common causes of cervical spine fracture include bicycle and motorcycle accidents, contact sports and equestrian accidents, and careless head dives into unfamiliar waters or from excessive heights.
Symptoms, complaints, and signs
A cervical spine fracture is a dangerous injury that can be fatal in some circumstances. Headaches and neck pain are observed as typical symptoms. In addition, turning the head is difficult. This results in unbearable pain and dizziness. Furthermore, paralysis in both arms or only in one arm is possible. Often the head can no longer be held upright, so that some patients even try to support it with their hands. The cervical vertebrae can shift against each other under certain circumstances. This happens particularly often with unstable fractures. In addition, if bone fragments enter the spinal canal, further damage to vertebral bodies may occur. In addition, bleeding into the spinal canal or spinal cord is often observed. A cervical spine fracture is often accompanied by difficulty swallowing and bruising. Breathing function is also sometimes impaired. This is especially true if the fourth cervical vertebra is affected. Among the worst consequences of a cervical spine fracture is paraplegia. Furthermore, respiratory and circulatory arrest is also possible, leading to death. A whiplash injury can also result in a cervical spine fracture. In addition to headaches and neck pain, it is often characterized by paraesthesia in the extremities, weakening of reflexes, dizziness and hearing impairment. Without treatment, a cervical spine fracture often leads to severe disability or even death. Depending on the nature of the injury, a full recovery may be possible with timely treatment.
Diagnosis and course
If a cervical spine fracture is suspected after a violent impact, the physician first performs a physical examination. As part of this careful diagnosis of mobility and painfulness of the cervical vertebrae, nerve function is also checked. The examination is performed while avoiding major stresses on the cervical spine. Since a manual examination can only confirm the suspicion of a cervical spine fracture, but not confirm or rule it out, radiological diagnostics must follow.As a rule, X-ray examination from the front and side is sufficient for this purpose. The X-ray image is informative and can be produced quickly, making X-rays the diagnostic method of first choice. To dispel doubts about the diagnosis or to clarify further questions, such as the exact course of the fracture or injuries to the nerve tracts, additional images can be taken in a computer tomograph (CT) or magnetic resonance imaging (MRI). The prognosis and course of a cervical spine fracture must be assessed individually based on the exact form of injury and any affected nerve tracts.
Complications
The symptoms of a cervical spine fracture usually depend on the extent of the fracture. In the worst case, the affected person suffers a so-called paraplegia and is extremely limited in his everyday life. There are considerable restrictions on movement, so that the patient may be dependent on a wheelchair and on other people in his daily life. The quality of life is extremely reduced by the cervical spine fracture. Furthermore, there are various paralyses on the body and pain in the affected regions. Due to the sudden paralysis and pain, it is not uncommon for psychological complaints or depression to develop. Likewise, patients suffer from sleep disturbances, making it difficult for them to take in fluids and food. As a rule, severe pain also complicates everyday life, which can also lead to sleep problems at night in the form of pain at rest. It is not uncommon for suicidal thoughts to occur. Whether treatment is possible for a cervical spine fracture depends largely on the severity of the fracture. However, no positive course of the disease can be guaranteed. In some cases, the affected persons are dependent on a wheelchair and other aids in everyday life for the rest of their lives. However, life expectancy is not affected by the cervical spine fracture.
When should you see a doctor?
Because a cervical spine fracture can, in the worst case, result in paraplegia that can no longer be treated, a doctor should always be consulted. Since the cervical spine fracture is usually caused by an accident, the affected person is hospitalized. Otherwise, the patient should see a doctor if there is severe pain in the cervical vertebrae or spine. Significant movement restrictions also occur. Furthermore, a hematoma indicates a cervical spine fracture, this is accompanied by swallowing difficulties. The patient is no longer able to take in food and liquids in the normal way. A doctor should also be consulted if the cervical spine fracture causes paralysis or numbness. The earlier these are diagnosed, the higher the chances of a positive course of the disease. As a rule, the cervical spine fracture should always be treated in a hospital or by an emergency physician. After treatment of the fracture, patients often rely on various exercises and therapies to reduce paralysis and restore mobility.
Treatment and therapy
It is important to move the patient as little as possible. The head should be subjected to steady traction so that it is held in a slight backward flexion. The injured patient should be transported in a supine position and wearing a cervical collar (cervical brace). Treatment of the cervical spine fracture also depends on the exact type of injury and consists primarily of sparing and immobilization of the affected vertebral region. In addition to immobilization with a cast, various types of cervical brace are available, which must be worn for eight to twelve weeks. Conservative therapy may only be initiated if the disc between the 2nd and 3rd cervical vertebrae is uninjured. Then the physician speaks of a stable injury. An unstable hernia, in which the second and third vertebrae are displaced against each other due to the disc injury, must be treated surgically. Likewise, if the spinal cord is injured, conservative therapy must not be used. Good results have been achieved with osteosynthesis, the fixation of the fracture fragments with metal implants.
Outlook and prognosis
The prognosis of a cervical spine fracture depends on the fracture present and the severity of the damage. If the fracture of the atlas vertebrae is stable, the patient will experience recovery within six to eight weeks.The patient should take sufficient rest and remain calm so that no complications develop. Afterwards, the cervical vertebrae can gradually be loaded again. Complete freedom from symptoms is usually achieved after several months. In the case of an unstable fracture, the prognosis worsens. The healing process is prolonged and usually lasts three months. The affected region must be spared and sufficiently stabilized within the recovery process. In rare cases, surgical intervention is needed for correction. If the damage can be corrected within one operation, the patient also has a good chance of recovery. Healing of an axis fracture takes two to three months until recovery. If the patient suffers a dens fracture, a healing time of between two weeks and four months must be expected. An atlanto-occipital fracture has an unfavorable prognosis. This cervical fracture has a fatal course and is irreparable. In most cases, trauma occurs in addition to the fracture. This heals completely and leaves no secondary damage. However, within the recovery period, sudden movements should be avoided.
Prevention
It is not possible to completely prevent a cervical spine fracture. In particular, high-risk groups and their relatives should be aware of the risk of injury and act with appropriate caution. With timely treatment, serious complications can be prevented.
Aftercare
After a treated cervical spine fracture, follow-up care and accompanying physical and occupational therapy are started as early as possible. Often this happens on the first day after surgery. Due to the only small skin incisions, special care of the wound is usually not necessary. Slow movements as well as targeted exercises allow spinal mobility to be restored relatively quickly. However, the success of physiotherapy depends largely on whether the spinal cord is injured and on the effects of the accompanying restrictions. The goal of physiotherapy and occupational therapy is to enable the patient to master daily challenges by himself again. In the second step of rehabilitation, the patient should be quickly reintegrated into working life. In doing so, it must always be weighed up whether a continuation of the old profession is still possible. Especially a heavy physical strain in the daily work routine can make a reintegration impossible. This determination can be psychologically stressful and should be attended to psychologically. This is especially the case if the operation did not have the desired effect and the patient retains permanent spinal cord injuries. In cases of paralysis, aftercare is about being able to live with the new conditions. Here, the focus of aftercare is on restoring independence. The challenges of a wheelchair in particular usually require lifelong care.
Here’s what you can do yourself
The cervical spine fracture requires mandatory medical treatment, which, however, can be positively supported by active cooperation of the patient in many cases. This already begins in the acute phase, in which the behavioral measures advised by the treating physicians, such as sparing, must be followed without fail. This includes in particular the consistent wearing of a neck brace over the period of time specified by the physicians. Even in the regeneration phase, there are means with which the affected person can favorably influence the healing process, ideally in consultation with a doctor or physiotherapist. For example, participation in a special back school can teach the patient which movements are unfavorable for the cervical spine and how to avoid them. Even at night, the patient can support the healing process by choosing the right pillow and mattress to ensure that the cervical spine is positioned as recommended by the doctor. When the bony structures are stabilized again after a cervical spine fracture, a trained muscle corset provides additional support. The exercises suitable for this are shown to the patient by the physiotherapist. He can then perform this targeted training program for a stable neck and cervical region at home. Motor training is also recommended for areas of the body where there has been a loss of function due to damage to nerves.
