C3-C7 Spine Fractures
Fractures, C3-C7 Spine
Articular mass fractures
| Mechanism | Stable |
|---|---|
| Flexion-rotation | Yes |
- Associated with transverse process and vertebral body fractures
- Uncommon
Burst fractures
| Mechanism | Stable |
|---|---|
| Axial compression | Yes/No |
- Compressive fracture of the anterior and posterior vertebral body
- Complication: Spinal cord injury because of retropulsed vertebral body fragment (especially anterior cord syndrome)
Spinous process fracture (“Clay Shoveler’s" fracture)
| Mechanism | Stable |
|---|---|
| Flexion | Yes |
- Spinous process fracture from forceful neck flexion
- Most commonly occurs in lower cervical levels (C7)
- Not associated with neurologic injury
Extension teardrop fracture
| Mechanism | Stable |
|---|---|
| Extension | No |
- See Fracture, C1 and C2 spine topic
- Most commonly occurs at C2
Facet dislocation, bilateral
| Mechanism | Stable |
|---|---|
| Flexion | No |
- Significant anterior displacement (>50%) of spine when bilateral inferior facets displace anterior to the superior facets below
- At risk for injuring anterior and posterior longitudinal ligament, disk, vertebral arteries, and spinal cord
Flexion dislocation, unilateral
| Mechanism | Stable |
|---|---|
| Flexion-rotation | Yes |
- Usually causes 25-50% anterior displacement of spine
- Complication: Vertebral artery injury (CT angiography recommended)
Flexion teardrop Fracture
| Mechanism | Stable |
|---|---|
| Flexion and axial load | No |
- Fracture and anterior displacement of anteroinferior vertebral body (appears similar to extension teardrop fracture, except much more unstable)
- Rupture of both anterior & posteior ligamentous complexes
- Unique findings for flexion (versus extension) teardrop fx: Same-level fxs, displacement of posterior structures
- Regarded as ONE OF THE MOST UNSTABLE FX's in the lower cervical spine, because involves both columns
- Usually occurs at C5 or C6
Subluxation, anterior
| Mechanism | Stable |
|---|---|
| Flexion | No |
- Ruptured posterior ligamentous complex, such that anterior and posterior vertebral lines are disrupted
- Complication: vertebral artery dissection (CT angiography recommended)
- May only be evident during flexion views by conventional xray; the interspinous distance widens and the vertebral body subluxes anteriorly
Transverse Process Fracture
| Mechanism | Stable |
|---|---|
| Lateral flexion | Yes |
- Complication: Vertebral artery injury, because travels within the transverse foramina (CT angio recommended)
- Complication: Cervical radiculopathy and brachial plexus injuries associated in 10% of cases
Wedge Fracture
| Mechanism | Stable |
|---|---|
| Flexion | Yes |
- Compression fracture of only the anterosuperior vertebral body endplate
- Disruption of anterior vertebral line
| Injury (Mechanism) | Stable |
|---|---|
| Articular mass fx (Flexion-rotation) | Yes |
| Burst fx (Axial compression) | Yes/No |
| Spinous process fx (Flexion) | Yes |
| Extension teardrop fx (Extension) | No |
| Facet dislocation, bilateral (Flexion) | No |
| Flex dislocation, unilateral (Flexion-rotation) | Yes |
| Flexion teardrop fx (Flexion and axial load) | No |
| Subluxation, anterior (Flexion) | No |
| Transverse process fx (Lateral flexion) | Yes |
| Wedge fx (Flexion) | Yes |
References
- Lin M and Mahadevan S. “Spine and Spinal Cord Injuries” in Adams J et al (eds), Emergency Medicine Clinical Essentials. New York: Elsevier, 2007
