Cervical Spine Fracture-Dislocation

Abstract

Traumatic cervical spine injuries are a major cause of morbidity and mortality. They should be expected after any high-energy injury and are often seen in the multiply injured patient. Failure of the cervical spine can occur with bony injury (fracture), ligamentous injury (leading to a dislocation) or a combination of both (fracture-dislocation). Due to the unique anatomy of the articulation of the head with the cervical spine, cervical injuries are separated into occipito-cervical (occiput to C2) and subaxial (C3-7) injuries. This chapter considers the assessment and surgical treatment of fracture-dislocations of the subaxial spine. Initial assessment of patients with a suspected cervical spine injury includes a careful clinical evaluation with consideration of the mechanism of injury and a well-documented assessment of neurology. CT and MRI imaging are required to identify fracture patterns and any extruded disc material. Injuries can then be classified according to the anatomy or mechanism of injury, and this helps to guide the immediate and long-term treatment strategy. Acute management includes reduction of dislocated facet joints and realignment of the dislocated levels. This can be achieved with closed reduction and axial traction or with open surgical reduction and decompression. Rigid stabilisation is required to hold the reduction and can be achieved with surgical stabilisation of the anterior column and posterior column or a combined fixation of both anterior and posterior columns.