Subaxial Cervical Spine Injuries

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Subaxial Cervical Spine Injuries: Introduction

Common cause of disability
Most common causes:–  RTA, Fall, Penetrating trauma, Sports
Highly prone to traumatic injury:
Mobile, relatively unprotected, and its high position
60% of all spinal injuries occur in the cervical spine
Subaxial cervical spine injuries include:
- 2/3rd of all cervical fractures
- 75% of all cervical dislocations
One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

Subaxial Spine: C3 – C7 segments
Denis’ 3 columns- Anterior, middle and Posterior
- Anterior- ALL, Ant 2/3 rd body & disc
- Middle- Post 1/3rd of body & disc, PLL
- Posterior- Pedicle, lamina, facet, transverse process, spinous process, Ligaments-Interspinous, lig.flavum
Posterior column most important for stability
Encasement of the vertebral arteries generally from C1 through C6 via the transverse foramina
C7 has a transverse foramen, but the paired vertebral arteries generally do not course through them
Exiting root corresponds to the lower vertebra (C6 root exits the C5-6) foramen
C6 transverse process harbors an anterior tubercle : chassaignac tubercle –> carotid artery
Most common injury happen at C6 or C7 level :
- exposed to great axial compression and ﬂexion loads due to its location
- transition from a very mobile cervical to a rigid thoracic spine.

Initially described by Pang et al, in 1982
Spinal cord dysfunction without the presence of any fracture, dislocation, or ligamentous injury on x-rays or CT scans
20% to 35% of all paediatric spinal injuries
Due to elastic ligamentous laxity and the immaturity of osseous structures
can be an indication for MRI when there is a persisting, objective myelopathy after a traumatic event with normal plain film and CT findings
Other related terms used to describe specific situations with advent of new imaging techniques
- Spinal cord injury without radiographic evidence of trauma (SCIWORET)
- SCIWOCTET (spinal cord injury without CT evidence of trauma)
- spinal cord injury without neuroimaging abnormality (SCIWONA): patients without traumatic signs using radiographs, CT and MRI.
- more accepted general term SCIWORA is usually used to describe all variants of clinico-radiological mismatches.

All trauma patients are considered to have a cervical spine injury until proven otherwise
Cervical spine clearance : confirming the absence of cervical spine injury
It is important to clear cervical spine and remove collar in an efficient manner
delayed clearance associated with increased complication rate
cervical clearance can be performed with
- physical exam
- radiographically

Cervical spine imaging recommended for all pts with trauma

�EXCEPT�

No midline tenderness
No intoxication
Normal alertness
No FND
No distracting injuries (eg Upper torso injuries may be sufficiently painful to distract from a reliable cervical spine examination)

*Hoffman JR et al. Ann Emerg Med 1998;32:461-469 �

may lead to permanent disability
careful clinical and radiographic evaluation is paramount
high rate of missed cervical spine injuries due to
- inadequate imaging of affected level
- loss of consciousness
- multisystem trauma
cervical spine injury necessitates careful examination of entire spine
noncontiguous spinal column injuries reported in 10-15% of patients