William Herring, M.D.

© 2002

Fractures
Fractures and
and Dislocations
Dislocations
of
of the
the Cervical
Cervical Spine
Spine

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 3 rules of 3

O The predentate space should be < 3mm

O The prevertebral soft tissue at C3 is
usually 3 mm
O Anterior wedging of 3mm or more
suggests a fx
Atlanto-axial Dislocation

O Hyperextension injury
O Children>adults
O Head slips forward on C1
O Usually fatal
Neural Arch Fracture of C1

O Most common fracture of C1

O Hyperextension injury
O Not associated with neurologic deficit
O Confused with congenital anomaly
 Jefferson Fracture of C1

O Burst fracture
O Caused by compressive force
O Bilateral breaks in anterior and posterior
arches
O Open mouth view shows bilateral offset of
C1 on C2
O Not associated with neurologic deficit
 Hangman’s Fracture of C2

O Most common fracture of C2

Q Most common cervical spine fracture
O Hyperextension/compression fracture
O Fractures through the pedicles of C2 with
anterior slip of C2 on C3
O Not associated with neurologic deficit
O Teardrop fracture of inferior aspect of C2
or C3 is clue to dx of Hangman’s fx
 Dens Fractures

O Hyperextension injuries
O Most associated with forward
subluxation of C1 on C2
O High incidence of non-union (60%)
O Stable
 Dens Fractures
Types

O Tip of dens Rare (5%)

O Base of dens Common (65%)
O Sub-dentate Uncommon (30%)
 Dens Fractures
Pitfalls in Diagnosis

O Mach line
O Congenital non-union
O Non-union of previous fracture
 Flexion-Teardrop Fracture

O Combination of flexion and compression,

e.g. MVA
O Teardrop fragment comes from
anteroinferior aspect of body
O Remainder of body displaced backward
into spinal canal
Flexion-Teardrop Fracture

O Facet joint and interspinous distances

usually widened
O Disk space may be narrowed
O 70% have associated neurologic deficit
Simple Compression Fracture

O Flexion injury
O Anterior wedging of 3mm or more
suggests fracture
O Usually involves superior endplate of
vertebral body
 Clay-Shoveler’s Fracture

O Avulsion fracture of spinous process of

C6 or C7
O Occurs as result of rotation of trunk
relative to neck
O No neurologic deficit
 Ligamentous Injuries

O Mechanism is flexion/distraction
O Disk space narrower anteriorly than
posteriorly
O Widening of the interspinpous distance
O Widening of the facet joint
Q Usually the posterior aspect
 Ligamentous Injuries

O Subluxation of vertebral body

O Perched facet
O Locked facets
Q At least 50% subluxation
O 85% neurologic deficits with locked facets
Unilateral Locked Facets

O Mechanism is flexion/distraction and

rotation
O Only 30% associated with neurologic
defect
O On lateral, some bodies appear lateral,
some oblique
O Spinous processes do not line up on
frontal film
Unstable Fractures

O Jefferson fracture
O Hangman’s fracture
O Flexion teardrop fracture
O Extension teardrop fracture
O Bilateral locked facets