Trauma to the cervical spine encompasses a wide spectrum of injury, ranging from muscular strain, capsular or ligament sprain/tear, to facet subluxations or dislocations with or without fracture. Cervical dislocations have classically been associated with traumatic spinal cord injuries. These injuries can cause spinal cord compression and dramatic neurological deficits, and the severity of the injury depends on multiple factors. These can include the force applied to cause the injury, the extent of damage to the stabilizing osseous and soft tissue structures of the cervical spine, patient age, syndromic issues, bone quality, and underlying patient comorbidities.
The cervical spine consists of 7 vertebral bodies. C1 (atlas) articulates with the occiput and C2 (axis), which is considered the axial spine, and C2-C7, which is considered the sub-axial spine. From C2-C7, the cervical spine has a resting lordotic curve. These structures function to provide physiological motion and protect neural elements. The spine can be broken up into 3 distinct columns, each contributing to cervical stability. The anterior column consists of the anterior longitudinal ligament (ALL) and the anterior two-thirds of the vertebral body and disc. The middle column consists of the posterior longitudinal ligament (PLL), posterior one-third of the vertebral body and disc, and the posterior vertebral wall. The posterior column consists of the pedicles, lamina, spinous process, and the posterior ligamentous complex (PLC). The PLC is considered a critical predictor of spinal stability, including the ligamentum flavum, facet joint/capsule, interspinous ligament, and the supraspinous ligament. In the setting of a traumatic event, the osseous and soft tissue structures injured will determine the stability of the cervical spine and the treatment needed.
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