Fracture of the cervical spine: symptoms, treatment, consequences

What is a cervical vertebra fracture

A cervical vertebra fracture is a fairly common injury. Despite this, it poses a great danger - an accident can result in disability or death for the victim. The reason is that in about 60% of cases, a person's spinal cord is damaged.

Vertebrae can be damaged by compression and decompression. In the first case, the cause of the injury is severe compression, and in the second, stretching. There is also a great danger of the appearance of fragments - their presence can transfer the injury to the active category.

The damage to the body caused by a fracture of the cervical spine largely depends on the actions taken within the framework of first aid. A person may have problems with breathing or the swallowing reflex, or pain shock. Therefore, it is important not to give him any painkillers in tablets, to fix his head and make sure that vomit does not accumulate in his mouth.

Understanding Decompression Surgery

Surgical decompression techniques can be performed using an anterior or posterior approach to the spine, depending on how and where the nerve tissue compression has occurred.

In decompression, the tissue pressing on the nerve root or spinal cord is surgically removed or more space is created so that the nerve tissue is not impacted in any way. The main types of surgical decompression procedures are:

• Foraminotomy:
  If the intervertebral disc material or osteophyte puts pressure on the root at the exit from the foraminal opening, then a foraminotomy may be performed. Foraminotomy is used to enlarge the intervertebral foramen and thus relieve compression.
• Laminotomy:
  Similar to a foraminotomy, but involves creating a hole in the plate to create more space for the spinal cord.
• Laminectomy
  : An ectomy is the medical term for removal. A laminectomy removes part or all of the plate to relieve pressure on the spinal cord.
• Facetectomy:
  involves removing the facet joint to relieve pressure on the nerve root exiting the spine.
• Laminoplasty:
  Laminoplasty means shaping an anatomical structure to restore form or function. In the case of the cervical spine, laminoplasty is the surgical shaping of a plate to create more space for the spinal cord.
• Each of the above decompression techniques is performed from the back (back) of the spine.
• However, sometimes the surgeon needs to perform decompression from the front of the spine. For example, if an intervertebral disc bulges into the spinal canal, it sometimes cannot be removed from behind because the spinal cord interferes with access. In such cases, decompression is usually performed from an anterior approach to the neck.

Anterior decompression techniques:

• Discectomy:
  surgical removal of part or all of a herniated disc.
• Corpectomy:
  Sometimes disc material becomes interposed between the vertebral body and the spinal cord and cannot be removed by discectomy alone. In other cases, bone spurs (osteophytes) form between the vertebral body and the spinal cord. In these situations, access to the disc may require removal of the entire vertebral body. This procedure is called corpectomy (corpus means and ectomy means removal).
• Transcorporeal microdecompression
  (TCMD): TCMD is a minimally invasive procedure that is performed in the cervical spine from an anterior approach. The procedure is performed through a small channel made in the vertebral body to access and decompress the spinal cord and nerve. TCMD can be performed as a stand-alone procedure or in combination with anterior discectomy and fusion (ACDF) and/or total disc replacement.
• Spinal stabilization
• Discectomy and corpectomy usually result in instability in the cervical spine. Instability means abnormal movement of the vertebrae, increasing the likelihood of serious neurological damage. In these situations, it is often necessary to surgically restore spinal stability.

Basic surgical methods of stabilization:

• Fusion (fusion)
  is the fusion of bones, usually with the help of a bone graft or biological substance. Spinal fusion stops excess motion between two vertebrae and provides long-term stabilization. The procedure is somewhat similar to the consolidation of bone tissue after a fracture.
• With fusion in the cervical spine, both adjacent vertebral bodies and facet joints or laminae can be connected.
• If the fusion is performed posteriorly, the surgeon will usually place strips of bone graft from one lamina or lateral (lateral) mass onto the lamina or lateral mass below. Typically, the bone graft grows into the tissue of the fixed structures over time and stabilizes the two vertebrae. The surgeon can use a similar technique to simultaneously fix the facet joints.
• Instrumentation:
  Posterior cervical fusions can be supplemented with specially designed fixation devices such as staples, screws, rods and plates. These devices increase stability and facilitate fusion.

Structure of the cervical spine

There are seven vertebrae in the cervical spine:

• First. Also called "Atlas". It is injured very often because it does not have a special shock-absorbing substrate at the junction with other bones. Damage to it can affect the pituitary gland, the inner ear, and the symptomatic nervous system.
• Second. Injury to this segment can cause damage to vision and hearing.
• Third. If there are problems in this department, the patient may often experience paralysis of the facial muscles.
• Fourth. A fracture occurring in this area can result in paralysis of the mouth.
• Fifth. The vertebra is very severe in terms of the consequences of damage. It is responsible for the throat ligaments and can potentially cause breathing and swallowing problems.
• Sixth. A blow here leads to a spasm of the muscles of the forearm and neck, and the person begins to suffer from suffocation.
• Seventh. The patient will feel numbness in the shoulders and arms.

Symptoms and signs

Clinical symptoms of cervical osteochondrosis of the spine are the same for all ages. Many people put off visiting a doctor because they have mild symptoms. Only when the disease becomes obsessive and is accompanied by corresponding symptoms does one seek medical help.

The equipment at the Yusupov Hospital makes it possible to accurately determine the degree of development of cervical osteochondrosis. Thanks to this, the correct treatment is prescribed, relieving symptoms in the shortest possible time. The main clinical signs of the disease include:

• neck pain accompanied by a crunching sound;
• tingling or numbness in the upper extremities;
• dizziness;
• headache;
• noise in ears;
• panic attacks;
• stiffness of movements;
• limited mobility;
• weakness, sudden loss of strength;
• nausea;
• violation of orientation in space;
• unsteady gait;
• decreased visual acuity.

Causes of cervical vertebrae injury

Symptoms of a cervical spine fracture may well occur in those who engage in extreme sports or have received a severe blow to the head. There are two main forces that contribute to damage:

Squeezing. The result is a dangerous and difficult to treat compression fracture. Depending on the level of compression of the vertebral body, the spinal cord may be affected. Often such injuries lead to disability and death.

Stretching. In this case, the vertebrae are often intact. Ligaments, nerves and intervertebral discs suffer more. The damage is dangerous because there is a violation of the connections that hold the spine in the correct position. Treatment may require surgery.

The cause of such effects can be different, for example, a car accident or an unsuccessful jump into the water. The most difficult situation is when the integrity of the vertebra is broken and sharp fragments are separated from it.

Degree of development of cervical osteochondrosis

Cervical osteochondrosis is characterized by several stages. They determine the severity of the condition and the presence of certain clinical symptoms.

• First. In the early stages, there is a slight smoothing of the lordosis of the neck. Clinically, this is expressed in pain, which intensifies when turning the head. Patients complain of muscle tension, headache, and stiffness of movement. The first stage is treated without the use of drugs. It is enough to adhere to a certain diet and do exercises.
• Second. At this stage, instability of the cervical vertebrae appears. This is expressed in increased pain, radiating to the shoulders or arms. The pain intensifies when performing movements. The second stage is characterized by a decrease in the height of the intervertebral discs. This leads to pinched nerves. Patients complain of headaches, confusion, and fatigue.
• Third. Accompanied by severe deformation and destruction of the vertebral structure. The pain syndrome becomes permanent. Intervertebral hernias begin to form. Clinically, this is expressed in the appearance of dizziness, darkening of the eyes, and unsteadiness of gait.
• Fourth. The destroyed tissues of the intervertebral discs are replaced by connective tissue. Several segments are involved in the pathological process. Patients complain of lack of coordination, severe dizziness and headaches. There is constant noise in the ears.

Signs of a fracture

We have listed many signs of fractures of the cervical vertebrae in our description of the structure of this part of the spinal column. Among the main symptoms:

• severe pain in the neck;
• inability to hold head straight;
• severe muscle tension;
• loss of sensation in the arms or area near the injury;
• the appearance of hematoma or swelling;
• deterioration of vision and hearing;
• loss of consciousness from severe painful shock.

In such a situation, it is important to work correctly: fix the person’s head, do not allow him to move - this will worsen the condition and lead to the danger of even more severe damage to internal tissues. Please note that you need to call an ambulance as soon as possible.

Damage to the first vertebra

Since the first vertebra is called the “atlas” and is responsible for maintaining the correct position of the human head, damage to it leads to instability in the neck. There may be loss of sensation in the tissue near the affected area. Place the victim on a flat, hard surface as soon as possible.

Damage to the second vertebra

The consequences of a fracture of the 2nd cervical vertebra can be no less terrible than with damage to the atlas. In the axis, damage to the odontoid process and Cruvelier's joint may occur. This is a fairly severe case due to damage to the nerve fibers.

At the initial stage, a person may not realize that he has a fracture because his head moves freely and the pain is not so severe. However, over time or with even minimal exposure, serious damage can occur, ranging from paralysis to blindness. At the first suspicion of such damage, an x-ray should be taken as soon as possible.

Other vertebrae

Fractures of the 4th and 5th cervical vertebrae are not so common, but the spinal cord in them is also susceptible to damage. In this case, a person may feel a decrease in the sensitivity of the limbs, paralysis of the fingers or severe muscle tension in the neck.

The consequences of a fracture of the 7th cervical vertebra, as already described above, lead to difficulty breathing and swallowing, and this is no less dangerous.

Seventh vertebra: characteristics

Located below the base of the neck, closer to the center of the shoulder blades, the seventh vertebra forms the transition of the sphere of influence from the neck to the sternum area. For this reason, nature has endowed it with an unusual dual structure. Its top structure is similar to the cervical vertebrae, and the bottom looks like a thoracic vertebra.

Differences between the seventh and other vertebrae.

1. Attached to it is a horizontally thick and long process, which is an unbifurcated spine. It can be palpated in a normal state, called protruding, and other segments of the spine are counted from it (not above or below, but up and down from the seventh).
2. It also has another difference - transverse holes. In other vertebrae they are large, but here they are small. This happens because the vertebral artery passes through these openings in the vertebrae from the first to the sixth. The transverse vein runs through the foramina of the seventh vertebra.
3. The lower edge, which already belongs to the sternum area, is designated by the lateral costal fossa. This is the junction of the vertebra with the head of the first rib.
4. It is the only one that contains two pairs of nerve roots. They directly regulate the functioning of the index and middle fingers.

The seventh cervical vertebra, or protruding vertebra, vertebra prominens

There are people, and there are many of them, in whom this vertebra merges with the so-called cervical ribs - a pathological pair of small sizes. Then it is difficult to feel it. And this indicates that compression of the subclavian artery or damage to the brachial nerves may occur, which leads to numbness of the arms and impairment of their motor functions, as well as pain and tingling in the muscles.

Symptom of accessory cervical rib

Another reason why it can be difficult to detect the seventh vertebra is that it is overgrown with fat. In this case, it forms the withers, and its protruding part cannot be felt.

By the way. This is where salts are most often deposited. And for those who have increased flexibility of the spine or engage in yogic and similar practices, the seventh vertebra is almost completely smoothed out and becomes invisible.

Deposition of salts on the neck, or calcification of soft tissues, is a pathological degeneration of the connective tissues of the cervical spine

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Treatment

The first serious step towards the patient’s recovery is a detailed diagnosis of his condition using modern technology - MRI and X-rays. There may be two treatment options - a conservative approach or surgical intervention.

Conservative method

Used if the fracture is not severe. In this case, the pain is relieved with the use of analgesics, and the patient is put on a special collar during recovery. It keeps the neck in the correct position and limits mobility.

You will need to move with caution for several weeks. To ensure that the consequences of a fracture of the cervical vertebrae are not so serious, a special diet rich in calcium and nutrients is prescribed.

Surgical intervention

Surgery is needed if there is a strong compression fracture or sharp fragments have separated from the vertebra. In this case, the consequences of a cervical fracture can result in paralysis and disability, and loss of vision. Just one large fragment can cause serious damage.

The surgeon removes the fragments and places a special titanium pad. After the recovery period, mobility returns to the neck.

Types of treatment

Like diagnosis, treatment of cervical osteochondrosis requires an integrated approach. The therapeutic volume is selected individually. It depends on the segment of the lesion, the severity of the disease and the severity of clinical symptoms. The main treatment methods are:

• taking medications;
• physiotherapy;
• Healing Fitness;
• massage;
• surgery.

Among the medicinal methods of treatment, several groups of drugs are used:

• Painkillers. They are used to reduce the severity of pain.
• Nonspecific anti-inflammatory drugs. Used to reduce tissue swelling and inflammatory syndrome. Prescribed in various forms (tablets, products for external use).
• Antispasmodics. Relieves spasms and reduces pain.
• Chondroprotectors. Restore the structure of intervertebral discs.
• B vitamins. Positively affect the state of the nervous system.