Sports Medicine

Cervical Fracture (Broken Neck)

Anatomy

The spinal column is made up of small bones (vertebrae) stacked on top of one another, creating the natural curves of the back. Between the vertebrae are flat, round, rubbery pads (intervertebral disks) that act as shock absorbers and allow the back to flex or bend. Muscles and ligaments connecting the vertebrae allow motion while providing support and stability for the spine and upper body. Each vertebra has an opening (foramen) in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal. Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement. Like all joints, cartilage covers the surface where facet joints meet.

The spine contains three segments: lumbar, thoracic and cervical. The lumbar spine consists of five vertebrae located in the lower back; lumbar vertebrae are larger because they carry more of the body's weight. The thoracic spine consists of 12 vertebrae and begins at the upper chest, extending to the middle back and connecting to the rib cage. The cervical spine includes the neck and consists of seven small vertebrae, beginning at the base of the skull and ending at the upper chest. Disks in the lumbar spine are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine, disks are similar but smaller in size. The cervical spine supports the weight of the head and connects it to the shoulders and body. It is less protected than the rest of the spine, making it more vulnerable to injury and disorders that produce pain and restricted motion.

Description

A cervical fracture (broken neck) is a fracture or break that occurs in one of the seven cervical vertebrae. Like any injury to the vertebrae, a cervical fracture can damage the cervical spinal cord and impair the central nervous system's connection between the brain and body. Cervical spinal cord injuries can have serious consequences, including temporary or permanent paralysis, or even death.

Symptoms

Following an acute neck injury, patients may experience shock and/or paralysis, as well as bruising or swelling at the back of the neck. Conscious patients may experience severe neck pain, but this is not necessarily the case. Pain that spreads from the neck to the shoulders or arms may be the result of a vertebra compressing a nerve.

Emergency Response

In a trauma situation, the neck should be immobilized until X-rays can be taken and reviewed by a physician. Emergency medical personnel will assume that an unconscious individual has suffered a neck injury and respond accordingly. A neurological examination will be performed to enable the physician to assess nerve function and damage. Additional imaging studies, such as magnetic resonance images (MRI) or computed tomography (CT), may be required to determine the full extent of the injuries.

Causes

A cervical fracture is typically the result of high-energy trauma, such as an automobile crash, severe fall or athletic accident.

Immediate Treatment

Treatment will depend on which of the seven cervical vertebrae are damaged and what type of fracture is sustained. A minor compression fracture may be treated with a cervical brace worn for 6 to 8 weeks until the bone heals. A more complex or extensive fracture may require traction, surgery, 2 to 3 months in a rigid cast, or a combination of these treatments.

Prevention

Due to improved athletic equipment and updated rules, incidents of sports-related cervical fractures have declined over the past 20 years. Other ways to protect yourself and your family include:

• Always wear a seat belt, whether you're the driver or a passenger.
• Never dive in a shallow pool area.
• Be sure young people are always properly supervised when swimming and diving.
• Wear the proper protective equipment for your sport and follow all safety regulations, such as having a spotter and appropriate cushioning mats.