Cervical Fractures

Overview:

The vertebral column, also known as the spinal column or simply spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum’s five bones and the coccyx’s four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulpous).

The cervical spine, commonly referred to as the neck, is a delicate, but yet flexible and well-engineered structure of bones, muscles, nerves, tendons and ligaments.  The cervical spine houses the spinal cord which sends messages from the brain to control all aspects of the body. The neck connects the base of the skull to the thoracic spine, which is the upper back, through a series of seven vertebral segments. The cervical spine is at risk for developing a number of painful conditions due to the complicated structure and the amount of stress and pressure placed on the neck through a traumatic event or even the day-to-day demands.

 A cervical fracture, commonly called a broken neck, is a fracture of any of the seven vertebrae in the neck. A cervical fracture is usually caused by a traumatic event such as a motor vehicle accident or a major fall. Athletes and other individuals participating in sports like football, hockey, or gymnastics are also at a higher risk for a fracture. An injury to the vertebrae can have serious consequences such as temporary or permanent paralysis since the spinal cord is a critical component of controlling the rest of the bodily functions.

Symptoms:

A cervical fracture is usually associated with the following signs and symptoms:

  • Pain, swelling, tenderness, or muscle spasms in the neck
  • Inability or difficulty in moving the neck
  • Trouble swallowing liquid or solid food
  • Double vision or loss of consciousness

A cervical fracture is considered an emergency situation; therefore, it is highly recommended to seek immediate medical attention if an individual experiences the symptoms mentioned above or suspects a cervical fracture.

Diagnosis:

A cervical fracture is diagnosed with a combination of patient history discussion, physical examination and imaging studies.  After discussing the individual's symptoms, the physician will examine the neck for pain, and test the neurological system. The physician may then order a C-spine X-ray to look for broken bones or any other neck problems. In some cases, the physician may also order a CT scan or MRI scan to look for damage to the skull, brain, or the spinal cord.

Treatment:

Treatment of a cervical fracture will depend on the severity of the fracture and which of the seven vertebrae are affected. A minor fracture can be treated with the use of a cervical brace worn around the neck until the bone heals, whereas a more complex fracture might require other non-operative and/or operative treatment.

Medication – Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling. If these are deemed insufficient by your physician, they might prescribe stronger medication to relive pain and reduce inflammation.

Cervical Brace – A cervical brace may be used to keep the head and the neck from moving, allowing for the fracture to heal on its own. Immobilizations will limit the movement for several months depending on how long the fracture takes to heal. The physician will recommend the appropriate brace based on the location and nature of the fracture, but some of the most common ones are:

  • Halo Brace – This brace is attached to the head with pins and cannot be removed for the entire treatment period.
  • Semi-rigid Collar – This collar uses plastic plates to stop side-to-side and up-and down motions of the neck.
  • Soft Collar – This collar is a flexible brace and is commonly worn after the use of a more rigid collar.

Physical Therapy – Physical Therapists will often prescribe specific strengthening and range of motion exercises for the hands, arms, and legs. In some cases, the individual may require a speech therapist to help teach how to swallow or talk.

Surgery – If the non-operative treatments have been exhausted and the fracture hasn’t healed, the physician may recommend an operative approach. The exact procedure will vary based on the severity of the fracture as well as the location of the fracture. 

Recovery:

Recovery will vary based on the severity of the cervical fracture as well as the chosen treatment approach. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity they would like to return to. A brace is typically worn for six to eight weeks or until the bones heal. A more complex treatment approach might require two to three months in a rigid brace or cast.