Cervical spine injury

Cervical spine injury is a traumatic disruption of the cervical vertebrae, intervertebral discs, or cervical spine ligaments, which can result in spinal cord compression or transection leading to transient or permanent loss of motor, sensory, and autonomic functions.

The pathophysiology of cervical spine injury involves the initial mechanical trauma, which can cause spinal cord compression, transection, or both. This is followed by a secondary injury phase characterized by spinal cord ischemia, edema, and hemorrhage. The extent of the injury depends on the severity of the trauma and the level of the spinal cord affected.

The annual incidence of traumatic cervical spine injury in Western populations is reported at 4-17 per 100,000 person-years. Spinal cord injuries in the US are reported to represent 3% of hospital trauma admissions.

Risk factors for cervical spine injury include high-energy trauma, such as motor vehicle accidents and falls from height, as well as certain medical conditions, such as rheumatoid arthritis and ankylosing spondylitis. Other risk factors include violence, alcohol use, diving, and sports-related injuries.

The clinical course of cervical spine injury can vary widely. Initial presentation often includes neck pain, stiffness, and tenderness, along with neurological deficits such as weakness or numbness in the limbs. In severe cases, the condition can progress to quadriplegia, respiratory failure, and autonomic dysfunction. Patients can also have associated injuries, such as head trauma, atlanto-occipital dissociation, occipital condyle fracture, anterior subluxation, facet joint dislocation, spinal epidural hematoma, and vertebral artery injury.

The prognosis of cervical spine injury is generally poor for complete spinal cord injuries. During the initial hospital stay, over 50% of patients with spinal cord injury develop multisystem complications. The 30-day mortality rate is reported to be 9.4%. Early surgical intervention can help decrease the instantaneous death risk, especially in early surgery.