Neck (Cervical)
Cervical Spine Fracture
경추 골절
Emergency condition involving a fracture of the cervical vertebrae
- How common
- Occurs with high-energy trauma
- Typical age
- All ages (in the elderly even low-energy trauma can cause it)
What is it?
A high-energy injury fractures a cervical vertebra, creating an emergency with high risk of spinal cord injury.
Commonly affected: Most common: C1 (Jefferson fracture), C2 (Hangman fracture), and C5–6 (flexion injuries).
How it develops
- High-energy impactDiving, motor-vehicle collisions, or falls transmit a strong force to the cervical spine.
- Vertebral fractureCompressive or flexion–extension forces fracture the cervical vertebra.
- Risk of cord injuryIf bone fragments encroach on the spinal canal, the cord may be injured.
- Neurologic deficitParalysis, sensory loss, and respiratory failure may occur below the level of injury.
Symptoms
- Severe neck painSevere pain even at rest, worsened by movement.
- Limb paralysis / numbnessCord injury may cause quadriparesis or paraparesis with sensory loss.
- Respiratory difficultyInjuries at C3–4 or above can paralyze the diaphragm, impairing respiration.
- Hypotension / bradycardiaNeurogenic shock — a critical emergency sign.
How it is examined
- Immediate immobilizationApply a cervical collar as soon as the injury is suspected to prevent further damage.
- Neurologic examinationRapid assessment of limb strength, sensation, and reflexes.
- ATLS protocolAirway–Breathing–Circulation assessment (emergency management).
Imaging
Three-view X-rays (AP, lateral, open-mouth) are obtained, though CT is more accurate.
- Vertebral fracture line
- Loss of vertebral body height
- Posterior element fracture
- Spinal malalignment
MRI after CT evaluates spinal cord and ligamentous injury.
- Cord contusion or hemorrhage
- Ligamentous disruption
- Epidural hematoma
Non-surgical care
- Stable fracture: bracingCervical collar or halo ring immobilization for 8–12 weeks.
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Unstable fracture, neurologic injury, or failed conservative care.
Procedures that may be discussed
- Anterior decompression and fusion
- Posterior internal fixation
- Halo-vest immobilization (selected cases)
Outlook
With prompt immobilization and treatment the prognosis is good when the cord is spared; concomitant cord injury may cause permanent disability.