Cervical Spine Injury

MECHANISM

• Fold
• Compression
• Stretch.

CLASSIFY

Two large groups are high cervical spine injuries (C1, C2) and low cervical spine injuries (C3 → C7).

+ Type I: subsidence fracture

+ Type II: broken in many pieces

+ Type III: broken

- Treatment:

+ Type I - II: stable: neck brace - headband (3 months)

+ Type III: unstable: 3 months headband or occipital-neck welding surgery

Figure 11.1. Neck occipital welding surgery

High cervical spine injury

Include fracture and skull dislocation (C0) with C1 and C1 with C2. These injuries include: skull fracture (C0), dislocation C0C1, dislocation or subluxation of C1C2, fracture C1, fracture of the cranium, fracture of arcuate C2.

C0 clubhead fracture: Classify

C1 . fracture

• Classify:
  • + Broken posterior bow
  • + Fracture 4 pieces (Jefferson)
  • + Broken anterior bow
  • + Fracture of transverse trowel
  • + Fracture of the lateral block

Figure 11.2. Classification of C1 . fractures

• Treatment:
  • + From 2 to 7 mm: 3 months head circumference
  • + Over 7mm:
    • Conservation: pull the neck for 4-6 weeks, the shirt around the head for 2 months
    • Surgery: rarely done, neck pulling + welding C1 – C2 (or C0 – C1)

Figure 11.3. Classification of fractures according to Anderson and Alonzo

Figure 11.4. Horizontal displacement C1 – C2: X + Y

Broken tooth root

• Anderson and Alonzo classification
  • + Type I: fracture of the crown of the tooth
  • + Type II: broken tooth root
  • + Type III: broken body C2.
• Treatment
  • + Type I: 3 months neck brace
  • + Type II: surgery + C2 screw removal (Figure 11.6A)
    • Tie the steel thread and weld the C1 – C2 bones at the back (Figure 11.6B)
  • + Type III: 3 weeks of neck pulling, a stiff neck brace or a full headband for 3 months

Figure 11.6. Catch the C2 (A) tooth screw, tie the steel thread and weld the C1 - C2 bone at the back (B)

Hangman's fracture C2

• – Classification (Figure 11.7)
  • + Type I: fracture without displacement < 3 mm
  • + Type II: fracture – displacement > 3 mm
  • + Type III: fracture - dislocation C2 - C3.

Figure 11.7. Classification of C2 . arch fracture

 Figure 11.8. C2 . arthroplasty

• Treatment
  • + Type I: neck brace - headband for 3 months
  • + Type II - type III: conservation: pull - neck brace, headband
• Surgery: piercing the C2 trochanteric block (Figure 11.8)

Low cervical spine injury

• Classify:
  • + Damage to the posterior column
    • Fracture: spine, vertebral column, transverse node (Figure 11.12)
    • Injury to ligaments: (Figure 11.9)
      • Sprains light
      • Severe sprain
    • Extensor fracture with nerve damage (Figure 11.15)
  • + Injury to the joints
    • Broken 1 joint or 1 arch
    • Dislocation of 1 joint (Figure 11.13)
    • Dislocated 2 joints
  • + Anterior column damage
    • Subsidence fracture
    • Compression fracture with posterior ligamentous injury
    • Disc-ligament injury
    • Supine tear tear (fracture of vertebral body)
    • Posterior sliding injury (Figure 11.14)
    • Stable multi-fragmentation fracture (Figure 11.6A)
    • Unstable multi-fragmentation fracture (Figure 11.6B)
    • Broken tear drops.

• Treatment:
  • + Goals:
    • Extra injury protection: first aid correct
    • Fix and fix
    • Release pressure when there is pressure and keep it for a long time.
  • + Principle:
    • Recovery
    • Assessment and classification of injuries
    • Strong assessment – unsustainable
    • Pinch early if possible
    • Injury treatment
      • Conserve
      • Surgery: decompression – bone grafting – fixation.
  • + Specific treatment: assess instability when greater than 5 points.

WHITE AND PANZABI STANDARDS

See also the White-Panjabi standard: White-Panjabi classification – WebNeurosurg

Treatment of stable fractures C3 – C7: stiff neck brace for 6-8 weeks (Figure 11.7)

X-ray after wearing the brace and every 2 weeks until heal bones (6 - 8 weeks)

Common types of stable fractures:

• Unsustainable standards White and Panzabi below 5 points
• Subsidence fracture
• Fracture at the front longitudinal wire attachment
• Broken tear stretch
• Mild sprain
• Isolated damage to the following components

Treatment of unstable fractures:

• Unstable, not oppressive:
  • + Back bone welding + posterior bone fusion device (Figure 11.18)
  • + Or intervertebral bone graft + anterior screw splint (Figure 11.19)
• Unstable with spinal cord compression:
  • + Decompression + Intervertebral bone graft + anterior screw splint (Figure 11.20)

Figure 11.17. Rigid neck brace Figure 11.18. Rear steel thread presser and back welding

Figure 11.19. Decompression – anterior bone grafting

Figure 11.20. Front door screws