Teardrop fractures come in a couple of different flavors, namely extension and flexion. This can cause varying degrees of subluxation of C2 on C3 from associated ligamentous injuries and resultant spinal cord injuries. This results in a fracture going through both “pars interarticulari” (that portion connecting the front of the vertebrae to the back). Hangman’s fracture, or “traumatic spondylolisthesis of the axis” if you’re feeling fancy, is typically caused by a forceful hyperextension event (a short drop and a sudden stop, shoutout to any Pirates of the Caribbean fans). However, since the brainstem is a common victim of this injury, many patients with atlanto-occipital dislocation will not survive to the ED. Often, radiologists rely on seeing signs of the injury rather than the injury itself. Since there is a paucity of bony injury, this diagnosis can be difficult to make radiographically. These ligaments can become severed or injured because of a high energy traumatic injury. The cranium is attached to the cervical spine with numerous strong ligamental attachments where the occiput meets the atlas. This injury can occur with severe hyperextension or hyperflexion.Īn atlanto-occipital dislocation can be thought of as internal decapitation. A type I dens is through the tip and is generally considered stable, while type II and III are through the base and body respectively and are unstable. The odontoid can fracture in several different places. A bilateral facet fracture is thought to occur with neck hyperflexion primarily, with possible axial loading and/or a rotational component. The cervical facet joint is part of the postero-lateral spinal canal, where the superior and inferior cervical vertebrae articulate. All these fractures will obviously warrant a neurosurgery or spine surgery consult in your ED.Ī Jefferson fracture, named after Sir Geoffery Jefferson (what a name!), is a burst fracture of the first cervical vertebrae, the atlas, from axial loading.4,5 Common unstable fracture patterns can be remembered by the mnemonic Jefferson Bit Off A Hangman’s Thumb, standing for Jefferson fracture, Bilateral facet fracture, Odontoid fracture, Atlanto-occipital dislocation, Hangman’s fracture, and Teardrop fracture. Cervical fractures that involve the transverse process or extend into the neural foramina may need angiography to evaluate these arteries at risk. The numerous ligaments running up and down the vertebrae bring flexibility and stability.įinally, don’t forget the vertebral arteries passing through the bilateral transverse foramina. The third through seventh cervical vertebrae all share some common features, such as an anterior vertical body, lateral lamina that merge into a posterior spinous process, making a nice, safe home for the spinal cord (Image 4). The axis (Images 2 and 3) is the second cervical vertebrae and has a bony process that projects superiorly to the atlas known as the dens, or odontoid process, providing an axis about which the skull can rotate. This bone is supporting our big globe of a head! As such, the bone has two large lateral masses that articulate with the occipital condyles of the skull but lacks a vertebral body and spinous process (Image 1). The first cervical vertebrae is called the atlas (like Atlas from Greek mythology). Birds have 10 to 26- thank goodness we’re not birds.3 The first two cervical vertebrae are unique. AnatomyĪll mammals have seven cervical vertebrae, even giraffes. Not surprisingly, young men, not known for their excellent decision making, make up most of the injuries, but older adults are also at risk after even minor trauma, especially with other risk factors such as osteoporosis or rheumatoid arthritis. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: Īuthors: Christopher Musselwhite, MD Blake Briggs, MD IntroductionĬervical spine injuries are a commonly tested topic, since 50% of the approximately 17,000 acute traumatic spinal cord injuries involve the cervical spine.1,2 Motor vehicle accidents account for many injuries, followed closely by falls.
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