Cervical spine injuries

Amongst patients with cord injury following spinal fractures, the majority are due to cervical spine fractures. Knowledge of both immediate and definitive management of the cervical spine injuries is essential for emergency department doctors and spinal surgeons (orthopaedic and neurosurgery). This article focuses on the in-hospital management of these fractures. It discusses the presentation, evaluation, classification and management of common cervical spine fractures. Broadly speaking, the management of cervical spine injury is influenced by fracture displacement, associated disco-ligamentous injury and the neurological status of the patient. Undisplaced or minimally displaced fractures with no adverse features can be treated conservatively. For ligamentous injuries and significantly displaced fractures surgical management is favoured. This includes atlanto-occipital dislocation, C1 and C2 fractures with transverse atlantal ligament damage, displaced hangman’s fracture with C2/3 disc injury and lower spine fractures with distraction or rotation injuries with accompanying disco-ligamentous damage.