Acute cervical spine trauma - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute cervical spine trauma requires a high index of suspicion and thorough investigation to detect bone or ligament damage that can otherwise result in spinal cord injury.
All patients with suspected trauma should be assessed and stabilized using the Advanced Trauma Life Support protocol, starting with a primary survey using a <C>ABCDE approach.
Assessment for spinal injury should be done immediately after the patient's cervical spine has been protected with manual inline spinal motion restriction.
Patients with acutely altered level of consciousness (Glasgow Coma Scale [GCS] <15), neurological deficit, high-risk injury mechanism, distracting injuries, neck pain or tenderness, or decreased range of motion of the cervical spine, require a cervical collar, spinal precautions and urgent cervical spine imaging.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

$CT reconstruction demonstrating undisplaced odontoid fracture$
CT reconstruction demonstrating undisplaced odontoid fracture
$Common fracture patterns with severe cervical spine trauma. Top row: cervical burst fracture at C5 l$
Common fracture patterns with severe cervical spine trauma. Top row: cervical burst fracture at C5 level; left: axial CT image showing a fracture of C5 vertebral body; right: mid-sagittal T2-weighted MRI showing retropulsion of the body of C5 with spinal cord compression, T2-weighted signal changes within the spinal cord and T2-weighted signal changes within the posterior ligamentous complex indicating disruption of these ligaments. Bottom row: fracture dislocation C6-C7 level. From left to right: lateral x-ray, axial CT through C6/C7 facet level, and T2-weighted mid-sagittal MRI demonstrating spinal cord compression and T2-weighted signal change within the spinal cord
Normal cervical spine: lateral, AP, and open-mouth odontoid view

Citations

Key Articles

American College of Surgeons. Best practices guidelines: spine injury. Mar 2022 [internet publication].[Full Text]
Fischer PE, Perina DG, Delbridge TR, et al. Spinal motion restriction in the trauma patient - a joint position statement. Prehosp Emerg Care. 2018 Nov-Dec;22(6):659-61.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: suspected spine trauma. 2018 [internet publication].[Full Text]

Other Online Resources

AOSpine Injury Classification System
ASIA: International standards for neurological classification of SCI (ISNCSCI) worksheet

Referenced Articles

1. Anderson LD, D'Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974 Dec;56(8):1663-74.[Abstract]
2. Levine AM, Edwards CC. Traumatic lesions of the occipitoatlantoaxial complex. Clin Orthop Relat Res. 1989 Feb;(239):53-68.[Abstract]
3. Vaccaro AR, Koerner JD, Radcliff KE, et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J. 2016 Jul;25(7):2173-84.[Abstract]
4. Singh A, Tetreault L, Kalsi-Ryan S, et al. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014 Sep 23;6:309-31.[Abstract][Full Text]
5. U.S. Department of Transportation, National Highway Traffic Safety Administration. The economic and societal impact of motorvehicle crashes, 2019 (revised). Feb 2023 [internet publication].[Full Text]
6. Freeman MD, Leith WM. Estimating the number of traffic crash-related cervical spine injuries in the United States; an analysis and comparison of national crash and hospital data. Accid Anal Prev. 2020 Jul;142:105571.[Abstract][Full Text]
7. Chappuis G, Soltermann B. Number and cost of claims linked to minor cervical trauma in Europe: results from the comparative study by CEA, AREDOC and CEREDOC. Eur Spine J. 2008 Oct;17(10):1350-7.[Abstract][Full Text]
8. Pirouzmand F. Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006. J Neurosurg Spine. 2010 Feb;12(2):131-40.[Abstract]
9. Dolinis J. Risk factors for 'whiplash' in drivers: a cohort study of rear-end traffic crashes. Injury. 1997 Apr;28(3):173-9.[Abstract]
10. Thompson WL, Stiell IG, Clement CM, et al; Canadian C-Spine Rule Study Group. Association of injury mechanism with the risk of cervical spine fractures. CJEM. 2009 Jan;11(1):14-22.[Abstract][Full Text]
11. National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. Feb 2016 [internet publication].[Full Text]
12. Freeman MD, Nystrom A, Centeno C. Chronic whiplash and central sensitization: an evaluation of the role of myofascial trigger points in pain modulation. J Brachial Plex Peripher Nerve Inj. 2009 Apr 23;4:2.[Abstract][Full Text]
13. Kaneoka K, Ono K, Inami S, et al. Motion analysis of cervical vertebrae during whiplash loading. Spine (Phila Pa 1976). 1999 Apr 15;24(8):763-9.[Abstract]
14. American College of Surgeons. Best practices guidelines: spine injury. Mar 2022 [internet publication].[Full Text]
15. Malik SA, Murphy M, Connolly P, et al. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. Eur Spine J. 2008 Apr;17(4):585-91.[Abstract][Full Text]
16. Eskesen TG, Baekgaard JS, Peponis T, et al. Cervical spinal cord injury after blunt assault: just a pain in the neck? Am J Surg. 2019 Apr;217(4):648-52.[Abstract]
17. Rhee P, Kuncir EJ, Johnson L, et al. Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault. J Trauma. 2006 Nov;61(5):1166-70.[Abstract]
18. Siegmund GP, Winkelstein BA, Ivancic PC, et al. The anatomy and biomechanics of acute and chronic whiplash injury. Traffic Inj Prev. 2009 Apr;10(2):101-12.[Abstract]
19. Iida H, Tachibana S, Kitahara T, et al. Association of head trauma with cervical spine injury, spinal cord injury, or both. J Trauma. 1999 Mar;46(3):450-2.[Abstract]
20. Inaba K, Byerly S, Bush LD, et al. Cervical spinal clearance: a prospective Western Trauma Association Multi-institutional Trial. J Trauma Acute Care Surg. 2016 Dec;81(6):1122-30.[Abstract][Full Text]
21. Svensson MY, Isaksson-Hellman I, Jakobsson L, et al. Analysis of different head and neck responses in rear-end car collisions using a new humanlike mathematical model. Proceedings of the 1994 International Conference on the Biomechanics of Impacts (IRCOBI), Lyon, France. SAE Technical Paper 1994-13-0007, 1994. Bron, France: International Research Council on Biokinetics of Impact; 1994.
22. Sturzenegger M, DiStefano G, Radanov BP, et al. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology. 1994 Apr;44(4):688-93.[Abstract]
23. Khan S, Bannister G, Gargan M, et al. Prognosis following a second whiplash injury. Injury. 2000 May;31(4):249-51.[Abstract]
24. Bunc G, Vorsic M. Presentation of a previously asymptomatic Chiari I malformation by a flexion injury to the neck. J Neurotrauma. 2001 Jun;18(6):645-8.[Abstract]
25. Fischer PE, Perina DG, Delbridge TR, et al. Spinal motion restriction in the trauma patient - a joint position statement. Prehosp Emerg Care. 2018 Nov-Dec;22(6):659-61.[Abstract][Full Text]
26. Committee on Trauma, American College of Surgeons. ATLS: advanced trauma life support program for doctors. 10th ed. Chicago, IL: American College of Surgeons; 2018.
27. Todd NV. Priapism in acute spinal cord injury. Spinal Cord. 2011 Oct;49(10):1033-5.[Abstract][Full Text]
28. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8.[Abstract][Full Text]
29. Hoffman JR, Mower WR, Wolfson AB, et al; National Emergency X-Radiography Utilization Study Group. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000 Jul 13;343(2):94-9.[Abstract][Full Text]
30. American College of Radiology, American Society of Neuroradiology, American Society of Spine Radiology, Society of Pediatric Radiology. Practice parameter for the performance of computed tomography (CT) of the spine. 2022 [internet publication].[Full Text]
31. Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma. 2005 May;58(5):902-5.[Abstract]
32. Mathen R, Inaba K, Munera F, et al. Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. J Trauma. 2007 Jun;62(6):1427-31.[Abstract]
33. Griffen MM, Frykberg ER, Kerwin AJ, et al. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan? J Trauma. 2003 Aug;55(2):222-6; discussion 226-7.[Abstract]
34. Schenarts PJ, Diaz J, Kaiser C, et al. Prospective comparison of admission computed tomographic scan and plain films of the upper cervical spine in trauma patients with altered mental status. J Trauma. 2001 Oct;51(4):663-8; discussion 668-9.[Abstract]
35. Bailitz J, Starr F, Beecroft M, et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009 Jun;66(6):1605-9.[Abstract]
36. Panczykowski DM, Tomycz ND, Okonkwo DO, et al. Comparative effectiveness of using computed tomography alone to exclude cervical spine injuries in obtunded or intubated patients: meta-analysis of 14,327 patients with blunt trauma. J Neurosurg. 2011 Sep;115(3):541-9.[Abstract]
37. Sim V, Bernstein MP, Frangos SG, et al. The (f)utility of flexion-extension C-spine films in the setting of trauma. Am J Surg. 2013 Dec;206(6):929-33; discussion 933-4.[Abstract][Full Text]
38. Duane TM, Scarcella N, Cross J, et al. Do flexion extension plain films facilitate treatment after trauma? Am Surg. 2010 Dec;76(12):1351-4.[Abstract]
39. American College of Radiology. ACR appropriateness criteria: suspected spine trauma. 2018 [internet publication].[Full Text]
40. Zhuge W, Ben-Galim P, Hipp JA, et al. Efficacy of MRI for assessment of spinal trauma: correlation with intraoperative findings. J Spinal Disord Tech. 2015 May;28(4):147-51.[Abstract][Full Text]
41. Fehlings MG, Martin AR, Tetreault LA, et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the role of baseline magnetic resonance imaging in clinical decision making and outcome prediction. Global Spine J. 2017 Sep;7(3 suppl):221S-230S.[Abstract][Full Text]
42. Payabvash S, McKinney AM, McKinney ZJ, et al. Screening and detection of blunt vertebral artery injury in patients with upper cervical fractures: the role of cervical CT and CT angiography. Eur J Radiol. 2014 Mar;83(3):571-7.[Abstract][Full Text]
43. Cothren CC, Moore EE, Biffl WL, et al. Cervical spine fracture patterns predictive of blunt vertebral artery injury. J Trauma. 2003 Nov;55(5):811-3.[Abstract][Full Text]
44. Vertinsky AT, Schwartz NE, Fischbein NJ, et al. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 2008 Oct;29(9):1753-60.[Abstract][Full Text]
45. Biffl WL, Ray CE Jr, Moore EE, et al. Noninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report. J Trauma. 2002 Nov;53(5):850-6.[Abstract][Full Text]
46. Wang AC, Charters MA, Thawani JP, et al. Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury. J Trauma Acute Care Surg. 2012 Jun;72(6):1601-10.[Abstract][Full Text]
47. Patel MB, Humble SS, Cullinane DC, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015 Feb;78(2):430-41.[Abstract][Full Text]
48. Duane TM, Young AJ, Vanguri P, et al. Defining the cervical spine clearance algorithm: A single-institution prospective study of more than 9,000 patients. J Trauma Acute Care Surg. 2016 Sep;81(3):541-7.[Abstract]
49. Healey CD, Spilman SK, King BD, et al. Asymptomatic cervical spine fractures: Current guidelines can fail older patients. J Trauma Acute Care Surg. 2017 Jul;83(1):119-25.[Abstract]
50. American College of Surgeons Trauma Quality Improvement Program. Best practices guidelines in imaging. Oct 2018 [internet publication].[Full Text]
51. Parizel PM, van der Zijden T, Gaudino S, et al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J. 2010 Mar;19 Suppl 1(suppl 1):S8-17.[Abstract][Full Text]
52. Jentzsch T, Singh A, Fehlings MG. Chapter 2 - epidemiology. In: Fehlings MG, Kwon BK, Vaccaro AR, eds. Neural repair and regeneration after spinal cord injury and spine trauma. London: Academic Press; 2022:13-35.
53. Brown C, Elmobdy K, Raja AS, et al. Scapular fractures in the pan-scan era. Acad Emerg Med. 2018 Jul;25(7):738-43.[Abstract][Full Text]
54. Williams J, Jehle D, Cottington E, et al. Head, facial, and clavicular trauma as a predictor of cervical-spine injury. Ann Emerg Med. 1992 Jun;21(6):719-22.[Abstract]
55. Ditunno JF, Little JW, Tessler A, et al. Spinal shock revisited: a four-phase model. Spinal Cord. 2004 Jul;42(7):383-95.[Abstract]
56. American College of Radiology, American Society of Neuroradiology, Society of Computed Body Tomography and Magnetic Resonance, Society for Skeletal Radiology. Parameter for the performance of magnetic resonance imaging (LRI) of the adult spine. 2018 [internet publication].[Full Text]
57. American Association of Neuromuscular and Electrodiagnostic Medicine. Ten things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2022 [internet publication].[Full Text]
58. Hadley MN, Walters BC. Introduction to the guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2013 Mar;72 Suppl 2:5-16.[Abstract][Full Text]
59. British Orthopaedic Association. Cervical spine clearance in the trauma patient. May 2021 [internet publication].[Full Text]
60. West JL, Palma AE, Vilella L, et al. Occipital condyle fractures and concomitant cervical spine fractures: implications for management. World Neurosurg. 2018 Jul;115:e238-43.[Abstract][Full Text]
61. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012 Apr 22;(1):CD001046.[Abstract][Full Text]
62. Fehlings MG, Wilson JR, Tetreault LA, et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinate. Global Spine J. 2017 Sep;7(3 suppl):203S-211S.[Abstract][Full Text]
63. Frampton AE, Eynon CA. High dose methylprednisolone in the immediate management of acute, blunt spinal cord injury: what is the current practice in emergency departments, spinal units, and neurosurgical units in the UK? Emerg Med J. 2006 Jul;23(7):550-3.[Abstract][Full Text]
64. Fehlings MG, Tetreault LA, Wilson JR, et al. A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (≤24 hours versus >24 hours) of decompressive surgery. Global Spine J. 2017 Sep;7(3 suppl):195S-202S.[Abstract][Full Text]
65. Badhiwala JH, Wilson JR, Witiw CD, et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol. 2021 Feb;20(2):117-26.[Abstract][Full Text]
66. Caron T, Bransford R, Nguyen Q, et al. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010 May 15;35(11):E458-64.[Abstract]
67. Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. 1954 Nov;11(6):546-77.[Abstract]
68. Lenehan B, Fisher CG, Vaccaro A. The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976). 2010 Oct 1;35(21 Suppl):S180-6.[Abstract]
69. Fehlings MG, Arun R, Vaccaro AR, et al. Predictors of treatment outcomes in geriatric patients with odontoid fractures: AOSpine North America multi-centre prospective GOF study. Spine (Phila Pa 1976). 2013 May 15;38(11):881-6.[Abstract][Full Text]
70. Lamb SE, Gates S, Williams MA, et al; Managing Injuries of the Neck Trial (MINT) Study Team. Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomised controlled trial. Lancet. 2013 Feb 16;381(9866):546-56.[Abstract]
71. National Institute for Health and Care Excellence. Head injury: assessment and early management. September 2019 [internet publication].[Full Text]
72. Nolet PS, Côté P, Cassidy JD, et al. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. Eur Spine J. 2010 Jun;19(6):972-81.[Abstract][Full Text]
73. Walton DM, Macdermid JC, Giorgianni AA, et al. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013 Feb;43(2):31-43.[Abstract][Full Text]
74. Tomlinson PJ, Gargan MF, Bannister GC. The fluctuation in recovery following whiplash injury 7.5-year prospective review. Injury. 2005 Jun;36(6):758-61.[Abstract]
75. Daenen L, Nijs J, Raadsen B, et al. Cervical motor dysfunction and its predictive value for long-term recovery in patients with acute whiplash-associated disorders: a systematic review. J Rehabil Med. 2013 Feb;45(2):113-22.[Abstract][Full Text]
76. Karnezis IA, Drosos GI, Kazakos KI. Factors affecting the timing of recovery from whiplash neck injuries: study of a cohort of 134 patients pursuing litigation. Arch Orthop Trauma Surg. 2007 Oct;127(8):633-6.[Abstract]
77. Sterling M, Jull G, Vicenzino B, et al. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain. 2003 Aug;104(3):509-17.[Abstract]
78. Kasch H, Qerama E, Kongsted A, et al. Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study. Pain. 2008 Nov 15;140(1):65-73.[Abstract]
79. Michaleff ZA, Maher CG, Lin CW, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet. 2014 Jul 12;384(9938):133-41.[Abstract]
80. American College of Radiology. ACR appropriateness criteria: chronic neck pain. 2013 [internet publication].[Full Text]
81. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013 Apr;16(2 Suppl):S49-283.[Abstract][Full Text]
82. Hurley RW, Adams MCB, Barad M, et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Reg Anesth Pain Med. 2022 Jan;47(1):3-59.[Abstract][Full Text]
83. Engelter ST, Grond-Ginsbach C, Metso TM, et al; Cervical Artery Dissection and Ischemic Stroke Patients Study Group. Cervical artery dissection: trauma and other potential mechanical trigger events. Neurology. 2013 May 21;80(21):1950-7.[Abstract]
84. American College of Surgeons; Trauma Quality Improvement Program. Best practices guidelines: spine injury. Mar 2022 [internet publication].[Full Text]