From the Guidelines
Immediate medical attention is crucial for cervical neck fractures to prevent spinal cord damage and life-threatening complications, and treatment should prioritize minimizing morbidity, mortality, and improving quality of life. When managing cervical neck fractures, it is essential to consider the potential risks and benefits of different treatment approaches. According to the study by Stelfox et al. 1, clearing the cervical spine based on MDCT was associated with less delirium and less ventilator-associated pneumonia (VAP), both of which have been associated with increased mortality in critically ill patients.
Key Considerations
- The risks of prolonged immobilization, beyond 48–72 h, are poorly appreciated and exceed those of a serious missed cervical spine injury 1.
- Strategies with high sensitivity but low specificity will inevitably result in liberal collar application and prolonged immobilisation, the risks of which must be balanced against the risks of missed injuries 1.
- The Cochrane group found little evidence that spinal immobilisation improves outcomes following unstable spinal injury 1.
Treatment Approach
- For stable fractures without neurological symptoms, conservative management may include immobilization with a cervical collar or brace for a limited period, pain management with medications like acetaminophen or NSAIDs, and gradual physical therapy once healing begins.
- Unstable fractures or those with neurological deficits typically require surgical intervention, such as spinal fusion or vertebroplasty, to stabilize the spine and prevent further damage, as suggested by the study by Morris and McCoy 1.
- Surgery should be considered promptly to minimize the risk of secondary neurological injury, which can occur in up to 10.5% of cases with delayed diagnosis 1.
Warning Signs and Recovery
- Warning signs requiring immediate emergency care include neck pain, numbness or tingling in the arms or legs, weakness, or difficulty breathing.
- Recovery time varies from weeks to months depending on fracture severity, with some patients experiencing long-term complications like chronic pain or limited mobility, highlighting the importance of early and appropriate treatment to improve quality of life.
From the Research
Cervical Neck Fracture Overview
- A cervical neck fracture refers to a break in one or more of the seven cervical vertebrae in the neck 2.
- The unique anatomy and flexibility of the cervical spine predispose it to a risk of injury, with trauma to the cervical spine encompassing a wide range of injuries from minor muscular strains to life-threatening fracture-dislocations associated with spinal cord lesions 3.
Causes and Risk Factors
- Road traffic accidents are a common cause of cervical spine injuries, accounting for 92% of cases in one study 2.
- The majority of patients with cervical spine fractures are young males, and 96% of patients have no neurological deficit 2.
- Older age, obtunded or temporary non-assessable status, cervical spondylosis, polytrauma, and neurologic deficit are predisposing factors for further injury found on MRI but missed on computed tomographic scan alone 4.
Diagnosis and Management
- Initial assessment and management of cervical spine fractures should follow the Advanced Trauma Life Support (ATLS) protocols with adequate protection of the cervical spine through triple immobilisation to prevent any unnecessary movement 3.
- Clinical decision rules such as the Canadian C-Spine Rule are frequently used to risk-stratify patients needing radiography 3.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used imaging modalities for diagnosing cervical spine fractures, with CT being highly sensitive in detecting unstable injuries in obtunded patients 5.
- MRI can provide additional findings that affect management in acute cervical spine fractures, particularly in older patients, those with neurologic deficits, and those with polytrauma 4.
Treatment and Outcomes
- Unstable fractures of the cervical spine often require surgical intervention, which can lead to early and complete healing 2.
- Conservative management may be appropriate for stable fractures, with close monitoring and follow-up 2.
- The majority of patients with cervical spine fractures can be managed conservatively, with only a small proportion requiring surgical intervention 2.