Fact-sheet: Luxation of cervical spine
Updated on 04/24/2020 at 9:22 AM
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Definition
Rare (-2%) and complex lesion with severe injury of the spinal motion segment, manifesting as decoaptation of one or both posterior articular masses.
The mechanism is hyperflexion associated with distraction (frontal car collision with abrupt deceleration).
These are severe injuries, often accompanied by neurologic deficits (tetraplegia).
Clinical features
Spontaneous pain and tenderness on palpation, which also reveals an anteroposterior interspinous step-off.
Neurologic presentation of tetraplegia.
Radiography
Anterior spondylolisthesis with facet locking (the inferior articular processes of the vertebra above come to lie anterior to the superior articular processes of the vertebra below).
Two radiographic patterns:
1) severe bilateral involvement of the articular masses, which fracture (fracture-separation), resulting in increased cervical lordosis.
2) spontaneous flexion of the spine caused by the weight of the head, pulling the fractured posterior articular processes forward.
CT
See radiograph.
Search for associated lesions: fracture of one or both articular masses
Management
Surgical management:
- In case of neurologic signs (tetraplegia, partial spinal cord syndrome), surgery is urgent.
- In the absence of neurologic signs, traction is maintained for 24 to 48 hours until reduction is confirmed by bedside radiographs.