Cervical spine injuries are a persistant problem in trauma, from detection to initial management and then definitive treatment. This is compounded by the unique anatomy of the upper cervical spine which thus responds in a different way to trauma. This article examines the anatomy, initial management, including how to clear the spine, and then discusses each level of the spine with regards to mechanism of injury, classification and treatment.
Allen BL, Ferguson RL, Lehmann TR, O’Brien RP.1982. A mechanistic classification of closed indirect fractures and dislocations of the lower cervical spine. Spine7: 1-27.
2.
American College of Surgeons Committee on Trauma. 1997. Advanced trauma life support for doctors.
3.
Anderson LD, D’Alonzo RT.1974. Fractures of the odontoid process of the axis. JBJS56A: 1663-1674.
4.
Anderson PA.2002. Upper cervical spine trauma. In: Bulstrode C, Buckwater JA eds. Oxford textbook of orthopaedics and trauma. Oxford: Oxford University Press, 2082-2101.
5.
Anderson PA, Montesano PX.1988. Morphology and treatment of occipital condyle fractures, Spine13: 731-736.
6.
Anderson PA, Montesano PX.1992. Traumatic injuries of the occipitocervical articulation. In: MB Camins, PF O’Leary eds. Disorders of the cervical spine. Baltimore MD: Williams and Wilkins, 273-284.
7.
Beyer CA, Cabanela ME, Berquist TH.1991. Unilateral facet dislocation and fracture dislocations of the cervical spine. JBJS73B: 6977-6981.
8.
Bell C.1817. Surgical observations. Middlesex Hospital Journal4: 469-469.
9.
British Trauma Society. 2002. Guidelines for initial management and assessment of spinal injury. Injury, Int J Care Injured34: 405-425.
10.
Clark RC, Hart RA.2002. Upper cervical spine trauma. In: Bulstrode C, Buckwater JA eds. Oxford textbook of orthopaedics and trauma. Oxford: Oxford University Press, 2102-2113.
11.
Clarke CR, White AA III. 1985. Fractures of the dens: a multicentre study. JBJS67A: 1340-1348.
12.
Cohn SM, Lyle WG, Linden CH, Lancey RA.1991. Exclusion of cervical spine injury: a prospective study. J Trauma31: 570-574.
13.
Dickman CA, Greene KA, Santay VKH.1996. Injuries involving the transverse atlantal ligament. Classification and treatment guidelines based on experience with 39 injuries. Neurosurgery38: 44-50.
14.
Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA.1981. Fractures of the ring of the axis. A classification based on 131 cases. JBJS63B: 319-327.
15.
Fielding JW, Hawkins RJ.1977. Atlantoaxial rotatory fixation (fixed rotatory subluxations of the atlantoaxial joint)JBJS59A: 37-44.
16.
Fisher CG, Dvorak MF, Leith J, Wing PC.2002. Comparison of outcomes for unstable lower cervical flexion teardrop fractures managed with halo thoracic vest versus anterior corpectomy and plating. Spine27: 160-166.
17.
Fujimura Y, Nisha Y, Kobayashi K.1996. Classification and treatment of axis body fractures. J Orthop Trauma10: 536-540.
18.
Greaves I, Porter K, Ryan J (eds). 2001. Trauma care manual. London: Arnold, 124-141.
19.
Grob D, Jeanneret B, Aebi M, Marcwalder TM.1991. Atlanto axial fusion with transarticular screw fixation. JBJS73B: 972-976.
20.
Hadley NN.1988. Axis fractures new subtype of acute odontoid fracture type IIANeurosurgery22: 67-71.
21.
Hadley MN.2002a. Diagnosis and management of traumatic atlanto-occiptal dislocation injuries. Neurosurgery50 (Suppl 3): S105-S113.
Harris JR, Carson GC, Wagner LK.1994. Radiographic diagnosis of traumatic occipitovertebral dissociation: normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR162: 881-886.
29.
Heller JG, Viroslav S, Hudson T.1993. Jefferson fractures: the role of magnification artefact in assessing transverse ligament integrity. J Spinal Disorders6: 392-396.
30.
Jefferson G.1920. Fractures of the atlas vertebra. Report on 4 cases and those previously reported. Br J Surg7: 407-422.
31.
Jenkins JD, Coric D, Branch CL.1998. A clinical comparison of one or two screw odontoid fixation. J Neurosurgery89: 366-370.
32.
JRCALC (Faculty of Pre-hospital Care of the Royal College of Surgeons of Edinburgh and Joint Royal Colleges Ambulance Service Liaison Committee). 1998. Joint position statement on spinal immobilisation and extrication. Pre-hospital Immediate Care2: 169-172.
33.
Lee TT, Green BA, Petrin DR.1998. Treatment of unstable burst fractures of the atlas with a rigid collar. Spine23: 1963-1967.
34.
Levine AM, Edwards CC.1991. Fracture of the atlas. JBJS73A: 680-691.
35.
Levine AM, Edwards CC.1985. The management of traumatic spondylolisthesis of the axis. JBJS67A: 216-226.
36.
McQuire RA, Harkey HL.1995. Primary treatment of unstable Jefferson fractures spinal disorders 8: 233-236.
37.
Philips WA, Housinger RN.1989. The management of rotary atlantoaxial subluxation in childrenJBJS71A: 664-668.
38.
Polin RS, Szabo T, Bogaev CA, Replogle RE, Jane JA.1996. Non-operative management of type II and III odontoid fractures. The Philadelphia collar versus halo vest. Neurosurgery38: 450-457.
39.
Ryan MD, Taylor TKF.1982. Odontoid fractures a rational approach to treatment. JBJS64B: 416-421.
40.
Scott-Young M, Hegde H, Brown MF.1999. The spine. In: Pynsent PB, Fairbank JCT, Carr AJ eds. Classification of Musculoskeletal Trauma. Oxford: Butterworth Heinemann, 70-83.
41.
Southwich WO.1980. Current concepts review. Management of fractures of the dens/odontoid process. JBJS62A: 482-486.
42.
Spence KF.1970. Bursting atlantal fracture associated with rupture of the transverse ligament. JBJS52A: 543-549.
43.
Star AM, Jones AA, Cotler JM, Balderston RA, Sinha R.1990. Immediate closed reduction of cervical spine dislocations using traction. Spine15: 1068-1072.
44.
Vaccaro AR, Blam OG, Anderson DC, Albert TJ.2002. Cervical spine trauma. In: Fitzgerald RH, Kaufer H, Malkani AL eds Orthopaedics. Oxford: Mosby Inc., 446-461.
45.
Wardrope J, Ravichandran G, Locker T.2004. Risk assessment for spinal injury after trauma. BMJ328: 721-723.
46.
White AA, Punjabi MM.1987. Update on the evaluation of instability of the lower cervical spine. Instru Course Lect36: 499-520.
