INJURIES OF THE CERVICAL SPINE

Injuries to the cervical spine are common at the level of the second cervical vertebrae, but neurological injury is uncommon. If it does occur, however, it may cause death or profound disability, including paralysis of the arms, legs, and diaphragm, which leads to respiratory failure. Spinal cord injuries are usually accompanied by acute unstable injuries of the spinal column.

                             

Injuries of the cervical spine are dangerous; and if associated with neurological damage, the results can be devastating. Though diagnostic and treatment methods have vastly improved over years, still injuries of the cervical spine pose the greatest challenge to the skill and acumen of  orthopedic and neurosurgeons.

Causes

1. Fall from height: It is the most common cause in developing countries.
2. Diving injuries: Diving into water with insufficient depth or in an inebriated condition.
3. Road traffic accidents (RTAs): Common cause in developed countries, e.g.:whiplash injury, Gunshot injuries, etc. These injure the cervical spine and the cord directly.

Whiplash Injury: Due to sudden deceleration, forceful hyperextension is followed by flexion of the neck. Common mechanism of cervical spine injuries: Hyperextension injury, Flexion extensor injury, Flexion rotation injury, Hyperfiexion injury,

Mechanism of Injury

• Pure flexion force: For example, compression fracture of vertebral body, e.g. fall from height.
• Flexion rotation force: For example, fall on one side of the shoulder, disruption of facet capsule is seen.
• Axial compression: For example, fall of an object on the head results in load compression, e.g. explosive comminuted fracture of body.
• Extension force: For example, avulsion fractures of superior mar gin of vertebral body, e.g. whiplash injury.
• Lateral flexion: For example, fracture pedicle, fracture transverse process and facet joints, etc.
• Direct injuries: For example, fracture spinous process and body. Due to assault, gunshot injury, etc.

Whiplash Injury (SYN: Acceleration injury, cervical sprain syndrome, soft tissue neck injury)

It is an unconventional and inconsequential ligament injury of the cervical spine allegedly due to an extension injury following a rear-end collision in an RTA.

Incidence:

• It is seen in about 25 percent of rear-end collision of RTAs.
•  Seventy percent of those affected are women.
• It is common in the 3rd or 4th decades.

Clinical Features

Symptoms

•  Upper neck pain that becomes worse with movement.
•  Occipital headache.
•   Neck Stiffness.
•   Rarely vertigo, auditory or visual disturbances, etc

Signs

• Decreased range of neck movements.
• Neck muscle spasm is seen.

Treatment

It is mainly conservative and consists of the following:

1. Drugs: NSAIDs, muscle relaxants, etc. are given.
2. Collars: These are recommended for the first three days.
3. Short arc active movements are slowly begun.
4.  Active ROM exercises are slowly commenced.
5. After the pain subsides, isometric strengthening exercises are slowly commenced.
6. Other modalities take ultrasound, traction, manipulation, massage, etc. also helps.

Classification of Cervical Spine Fractures

1. Compressive flexion (5 stages): Ranges from blunting of anterosuperior vertebral margin to posterior displacement into the spinal canal. It is usually a stable fracture but may become unstable if compression is more than 50 percent.
2. Vertical compression (3 stages): Ranges from fracture of superior or inferior end plate with Centrum fracture of the vertebral body. Stable fracture if compression is less than 50 percent of the vertebral body.
3. Distractive flexion (4 stages): Ranges from failure of posterior ligamentous complex to full-width vertebral body displacement. This is an unstable fracture.
4. Compression extension (5 stages): Ranges from unilateral vertebral arch fracture to bilateral vertebral arch fracture with full vertebral body displacement anteriorly. It is unstable.
5. Distractive extension: Ranges from failure of anterior ligament complex to posterior ligament complex. This is also an unstable fracture.
6. Lateral flexion: Ranges from asymmetric compression and ipsilateral vertebral arch to fracture without displacement and with displacement. May become unstable.

Concussion

This is a state of spinal shock and there will be sensory loss, flaccid paralysis, visceral paralysis, reflexes are in abeyance and anal reflex is absent. By 8 hours, concussion is known to regress; and by 8-10 days, there is complete recovery.

Through Physical Therapy, Cervical Spine strength and mobility may be restored. Whether you've just had surgery or suffered an injury to your Cervical Spine, Physical Therapy will give you the exercises, stretches and mobility techniques necessary to address your specific problem. Physical Therapy can restore Cervical Spine strength and mobility. The Cervical Spine is the most flexible joint in the human body. What allows the Cervical Spine to have the freedom to move in almost any direction is the range of motion. It’s very important for the Cervical Spine  to have complete functionality, especially in sporting events. The Goal of Physical Therapy is to improve the function of the muscles that surround the Cervical Spine. Most people only strengthen a few of the large muscles around the Cervical Spine. Physical therapy targets the smaller, but more important muscles around the Cervical Spine that are commonly neglected. By strengthening these muscles, therapy can help compensate for damaged tendons and improve the mechanics of the Cervical Spine