Cervical Spine Fractures
Cervical spine fractures are traumatic injuries affecting the neck vertebrae (C1-C7) and account for a substantial portion of spinal trauma. The most common causes are motor vehicle accidents, falls, diving and sports injuries. The cervical spine is divided into upper (C1-C2) and lower (C3-C7) regions, each with characteristic fracture patterns. Treatment may be conservative or surgical depending on fracture type, stability and neurological status.
Última actualización: 2026-06-07
Definition and Anatomy
Cervical fractures are potentially life-threatening injuries that result from high-energy trauma. The cervical spine provides head mobility while housing the most delicate part of the spinal cord. Because the cord at this level controls the respiratory centers (C3-C5 phrenic nerve) and upper limb function, severe cord injury at the cervical level can result in respiratory failure and quadriplegia (tetraplegia). Anatomically the spine is divided into the upper cervical region (C1 atlas, C2 axis) and the lower cervical region (C3-C7).
Fracture Types
In the upper cervical spine, C1 (atlas) fractures usually result from axial loading and are known as the Jefferson fracture. C2 (axis) fractures fall into three main groups: odontoid fractures (Anderson-D'Alonzo types I-II-III; type II carries a high nonunion risk), the hangman fracture (bilateral fracture of the axis pedicles) and axis body fractures. Lower cervical (C3-C7) injuries are graded by the AO Spine classification: type A (compression), type B (distraction) and the most severe group, type C (translation/rotation). Neurological deficit is relatively common in lower cervical fractures.
Symptoms
Principal findings include severe, localized neck pain at the fracture site, posterior cervical tenderness, marked limitation of neck movement and reflex muscle spasm. When the spinal cord or a nerve root is involved, weakness, sensory loss and numbness-tingling may appear in the arms and legs. Acute complete cord injury may present with spinal shock (flaccid paralysis, areflexia, low blood pressure, slow pulse). Injuries at the C3-C5 level can affect the phrenic nerve, leading to breathing difficulty and the need for mechanical ventilation. Loss of bladder-bowel control may also occur.
Diagnosis
Diagnosis requires a high index of suspicion and systematic radiological assessment. All trauma patients are managed with cervical immobilization (rigid collar) until cord injury is excluded. Clinical rules such as NEXUS and the Canadian C-Spine Rule determine which patients require imaging. Computed tomography (CT) is the gold standard for assessing bone anatomy and detecting fractures. Magnetic resonance imaging (MRI) is essential for showing ligamentous injuries, disc herniations and cord contusion, and is also required to diagnose SCIWORA, in which cord injury exists despite normal radiographs. CT angiography is requested when vertebral artery injury is suspected.
Stability Assessment
The treatment decision largely depends on whether the fracture is stable or unstable. The White-Panjabi criteria are used for stability assessment: significant sagittal angulation, vertebral translation and ligamentous injury affecting both the anterior and posterior columns indicate instability. Stable fractures carry a low risk of cord injury and may be suitable for conservative treatment; unstable fractures carry a higher risk of cord injury and raise the question of surgical stabilization.
Treatment
In the acute phase, airway, breathing and circulation are stabilized, and adequate mean arterial pressure is maintained to support cord perfusion. Stable fractures are treated conservatively (immobilization with a Philadelphia/Miami-J collar or halo vest for 6-12 weeks), with radiological follow-up to monitor healing. Surgery is performed for unstable fractures, cord compression or progressive neurological deficit: in the lower cervical spine, anterior cervical discectomy and fusion (ACDF) or posterior lateral mass/pedicle screw fusion; in the upper cervical spine, anterior odontoid screw fixation or posterior C1-C2 fusion. In incomplete cord injury, early decompression may contribute to neurological recovery.
Recovery and Prognosis
After surgery, intensive care monitoring, neurological follow-up and thrombosis prophylaxis are provided in the early period; early mobilization is targeted in neurologically appropriate patients. Bone healing usually takes 3-6 months. In stable fractures without neurological injury the prognosis is good and most patients return to daily activities. In cases with cord injury, outcome varies according to the level of injury and whether it is complete or incomplete; incomplete injuries have a higher recovery potential. Outcomes differ from patient to patient and no result can be guaranteed.
Referencias
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1153-1200.
- Vaccaro AR, Koerner JD, Radcliff KE, et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J. 2016;25(7):2173-2184.
- Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma (NEXUS). N Engl J Med. 2000;343(2):94-99.
Este artículo es informativo y no sustituye un examen médico. Las decisiones de diagnóstico y tratamiento son individuales.