Fractures of the cervical spine
Fractures of the cervical spine are common. The mechanism of injury is usually the flexor or extensor. The most common damage to the exposed fourth, fifth and sixth cervical vertebrae, but the most severe conditions occur in fractures of the first and second cervical vertebrae.
Fracture of first cervical vertebra
The first cervical vertebra is called atlas. He seems to be holding on his head. It is situated at the junction of the spine and the occipital bone and looks like a ring. Between the atlas and occipital bone is not cartilaginous pads (intervertebral discs) so when exposed to traumatic force to the skull with the pressure of the occipital bone with no depreciation is transferred to the first cervical vertebra.
The occipital bone is wedged inside the ring of the atlas. At the same time break down the front and rear arch of atlas. This type of fracture is called "bursting" or Jefferson fractured, and it often occurs in the fall on his head. The patient complains of pain in the neck, nape, crown.
X-ray examination by a special technique (anteroposterior radiograph, made through the mouth) is detected by displacement of the atlas arches his usual place. Clarify the diagnosis by computed tomography. Half the patients first vertebral fractures are accompanied by other fractures of the vertebrae or spinal cord injuries, at least of the medulla oblongata, which greatly aggravate the condition of the patient.
Fracture of second cervical vertebra
The second cervical vertebra is called the axis (axis). It looks like a ring, in front of which a massive overhang nazhoditsya – dens of the axis. Fracture of the tooth can occur when sudden neck flexion in any direction. The first cervical vertebra – atlas, which is fixed around the tooth moves forward or backward. On the degree of bias depends on the severity of the patient.
When a fracture of the first degree, bias can not be detected. The patient complained of mild pain when turning head and neck discomfort. This condition may be complicated by repeated injury to the neck, when the offset increases.
Fracture of the second degree. The first cervical vertebra and the broken-off fragment of a tooth displaced anteriorly, and the rear part of the atlas compresses the spinal cord. The patient may lose consciousness during or after the injury. Depending on the degree of compression of the spinal cord may have a variety of neurological disorders from mild sensory disturbances in the neck to the paresis and paralysis of two or all of the limbs (hemiparesis, tetraparesis). When the tooth offset of the second cervical vertebra ago – neurological disorders occur to a lesser extent. For large displacements (fracture of the third degree), most often a condition incompatible with life.
Traumatic spondylolisthesis second cervical vertebra
Spondylolisthesis – a displacement of a vertebra forward, backward or sideways relative to the underlying vertebra. This damage is called a fracture, "the executioner." It occurs when a sudden straightening of the cervical spine, if you receive an obstacle movement. For example, during heavy braking and hitting his head on the windshield. At the same time often broken arc second cervical vertebra, and his body moves forward.
The patient complains of pain in the occipital region, turning the head, the restriction of head movements and neck. Diagnosis is based on an x-ray – lateral and direct radiography of the cervical spine.
Fractures and perelomovyvihi lower cervical vertebrae
Fractures of the lower cervical vertebrae often occur when a sudden, forced flexion of the cervical spine. In this case there are compression fractures of vertebral bodies.
The patient is concerned about pain in the neck, limiting rotation of the head and neck movements. The examination revealed tenderness of the affected spinous processes of vertebrae, the neck muscle tension. Sometimes, if the ligament between the spines broken, you can find the broken line of spinous processes in the form of lightning or a bayonet. In this case, the patient's condition and fracture are unstable because of the potential damage to the spinal cord.
Diagnosis is carried out using X-rays, which are wedge-shaped deformation of the vertebrae. Depending on the degree of displacement of fragments, there may be neurological damage until the compression of the spinal cord.
Sometimes there are dislocations of vertebrae. In this case, the patient's head is turned to the opposite side of the dislocation, the chin is close to the opposite shoulder. At the level of dislocation can occur nerve root compression. The spinal cord is usually not affected. In addition to fractures and dislocations of the cervical vertebrae are found traumatic injuries of ligaments and intervertebral discs. These injuries also occur with pain and limitation of motion in the neck, to prevent fracture is necessary to x-ray.
If you suspect a fracture of the cervical spine patient is placed on a stretcher, her head resting on cotton-gauze round, immobilized, or semi-rigid cervical spine collar. You can not make any turns, stretching the neck to determine the diagnosis.
If the damage ligaments patient wearing a cervical collar is recommended for four weeks. Then assigned to physical therapy and exercise therapy. When fractures without displacement, uncomplicated fractures of the neck impose a hard collar, a corset or plaster polivika type Schantz for up to 4 months. Severe fractures in which there is a risk of displacement and spinal cord injuries treated with traction or hardware loop Glisson traction for the skull. Traction is applied for up to one month, then fix the neck with a hard collar for 3-4 months.
In the most severe cases, compression of the spinal cord is damaged or its fragments, is a surgical treatment. For fixation of the spine using plate clamps transartikulyarnye, laminar contractors.
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