Numbers
- Incidence of cervical spine fractures is estimated to be 9.2– 12/ 100 000/ year
- Gender: male
- Age
- Two peaks,
- 15– 45 years
- High energy injury
- 65– 80 years
- Low energy injury
- 10% of cervical spine fractures will be associated with neurological injury.
- Cervical spine trauma in head injured patients ranges from 4% to 14%
- Moderate to severe head injuries are at the highest risk of concomitant cervical spine injury.
- Most common fracture
- C2
- Esp C2 Peg
Dangerous patients
- Ankspond
- Elderly patient with high energy injury
Anatomy
- Axis Osteology
- Axis has odontoid process (dens) and body
- Embryology
- Axis Kinematics
- Cervical osteology & kinematics
- Occipital-C1-C2 ligamentous stability
- Provided by the odontoid process and its supporting ligaments
- Transverse ligament
- Limits anterior translation of the atlas
- Apical ligaments
- Limit rotation of the upper cervical spine
- Alar ligaments
- Limit rotation of the upper cervical spine
- Blood Supply
- A vascular watershed exists between the apex and the base of the odontoid
- Apex is supplied by branches of internal carotid artery
- Base is supplied from branches of vertebral artery
- The limited blood supply in this watershed area is thought to affect healing of type II odontoid fractures.
ㅤ | Bifid spinous process | Transverse foramen present/vert. artery within it | Flexion/extension | Rotation | Lateral bend |
Occipitocervical | ㅤ | ㅤ | ㅤ | ㅤ | ㅤ |
Occiput-C1 | ㅤ | ㅤ | 50 | 4 | 8 |
Atlantoaxial | ㅤ | ㅤ | ㅤ | ㅤ | ㅤ |
C1 (Atlas) | None | Yes/Yes | 10 | 50 | 0 |
C2 (Axis) | Yes | Yes/Yes | 10 | 50 | 0 |
Subaxial | ㅤ | ㅤ | ㅤ | ㅤ | ㅤ |
C3 | Yes | Yes/Yes | 50 (10/level) | 50 (10/level) | 60 (12/level) |
C4 | Yes | Yes/Yes | 50 (10/level) | 50 (10/level) | 60 (12/level) |
C5 | Yes | Yes/Yes | 50 (10/level) | 50 (10/level) | 60 (12/level) |
C6 | Yes | Yes/Yes | 50 (10/level) | 50 (10/level) | 60 (12/level) |
C7 (VP) | No (95%) | Yes/No | 50 (10/level) | 50 (10/level) | 60 (12/level) |
Total motion | ㅤ | ㅤ | 110 | 100 | 68 |