Skip to main content
SpringerLink
Log in
Book cover

Cervical Spine pp 215–236Cite as

Injuries of the Middle and Lower Cervical Spine

  • Chapter

  • 2171 Accesses

Abstract

The unique anatomy of the cervical column exposes it to a higher risk of traumatic injuries.

The treatment of these injuries represents still a matter of debate and a challenge also for expert surgeons.

The most important surgical anatomy of the low neck territories are outlined in this chapter for a better comprehension of the surgical techniques.

We illustrate the first care giving options to the patient with low cervical injuries describing the prevailing current thoughts.

The chapter discusses the key aspects of the diagnostically pathways and the guiding principles of the decision making process.

The reader gets the instruments to pose the treatment indication individualized on the patient and to address the condition with the appropriate technique.

The surgical techniques are exposed thoroughly in an operator-optimized description according to the chosen surgical approach.

The main aspects of the rehabilitation in cervical injured patients are highlighted at the end of the chapter.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Holly LT, Kelly DF, Counelis GJ, Blinman T, McArthur DL, Cryer HG. Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics. J Neurosurg. 2002;96(3 Suppl):285–91.

    PubMed  Google Scholar 

  2. Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, Group N. Epidemiology of cervical spine injury victims. Ann Emerg Med. 2001;38(1):12–6. doi:10.1067/mem.2001.116149.

    Article  CAS  PubMed  Google Scholar 

  3. Kwon BK, Vaccaro AR, Grauer JN, Fisher CG, Dvorak MF. Subaxial cervical spine trauma. J Am Acad Orthop Surg. 2006;14(2):78–89.

    Article  PubMed  Google Scholar 

  4. Vollmer DG, Eichler ME, Jenkins III AL. Assessment of the cervical spine after trauma. In: Youmans neurological surgery. 6th ed. Philadelphia: Saunders/Elsevier; 2011.

    Google Scholar 

  5. Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR, Group N. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med. 2001;38(1):17–21. doi:10.1067/mem.2001.116150.

    Article  CAS  PubMed  Google Scholar 

  6. Spielmann RP, Meenen NM, Maas R, Bittrich A. Radiological diagnosis of cervical trauma at the level C7/T1. Arch Orthop Trauma Surg. 1989;108(2):122–4.

    Article  CAS  PubMed  Google Scholar 

  7. Blauth MT, Harald T. Untere Halswirbelsäule. Tscherne Unfallchirurgie Wirbelsäule. Berlin etc: Springer; 1998.

    Google Scholar 

  8. Schünke M, Ross LM, Lamperti ED, Schulte E, Schumacher U, Rude Jr J, Voll M, Wesker K, Taub E, Telger T. Thieme atlas of anatomy. Stuttgart/New York: Thieme; 2006.

    Google Scholar 

  9. Hoppenfeld S, DeBoer P, Buckley R, R2 Library (Online service). Surgical exposures in orthopaedics the anatomic approach. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2009.

    Google Scholar 

  10. Zilles K, Tillmann B. Anatomie. Heidelberg: Springer-Lehrbuch; 2010.

    Book  Google Scholar 

  11. Moore TA, Vaccaro AR, Anderson PA. Classification of lower cervical spine injuries. Spine. 2006;31(11 Suppl):S37–43. doi:10.1097/01.brs.0000217942.93428.f7; discussion S61.

    Article  PubMed  Google Scholar 

  12. Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman Jr RA, Anderson P, Harrop J, Oner FC, Arnold P, Fehlings M, Hedlund R, Madrazo I, Rechtine G, Aarabi B, Shainline M, Spine Trauma Study G. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine. 2007;32(21):2365–74. doi:10.1097/BRS.0b013e3181557b92.

    Article  PubMed  Google Scholar 

  13. Pitzen T, Lane C, Goertzen D, Dvorak M, Fisher C, Barbier D, Steudel WI, Oxland T. Anterior cervical plate fixation: biomechanical effectiveness as a function of posterior element injury. J Neurosurg. 2003;99(1 Suppl):84–90.

    PubMed  Google Scholar 

  14. White AA, Panjabi MM. Clinical biomechanics of the spine. 2nd ed. Philadelphia: Lippincott; 1990.

    Google Scholar 

  15. Bono CM, Vaccaro AR, Fehlings M, Fisher C, Dvorak M, Ludwig S, Harrop J. Measurement techniques for lower cervical spine injuries: consensus statement of the Spine Trauma Study Group. Spine. 2006;31(5):603–9. doi:10.1097/01.brs.0000201273.39058.dd.

    Article  PubMed  Google Scholar 

  16. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969;7(3):179–92. doi:10.1038/sc.1969.30.

    Article  CAS  PubMed  Google Scholar 

  17. Waring 3rd WP, Biering-Sorensen F, Burns S, Donovan W, Graves D, Jha A, Jones L, Kirshblum S, Marino R, Mulcahey MJ, Reeves R, Scelza WM, Schmidt-Read M, Stein A. 2009 review and revisions of the international standards for the neurological classification of spinal cord injury. J Spinal Cord Med. 2010;33(4):346–52.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am. 1970;52(8):1534–51.

    CAS  PubMed  Google Scholar 

  19. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8(8):817–31.

    Article  CAS  PubMed  Google Scholar 

  20. White 3rd AA, Panjabi MM. Update on the evaluation of instability of the lower cervical spine. Instr Course Lect. 1987;36:513–20.

    PubMed  Google Scholar 

  21. Daffner RH, Deeb ZL, Goldberg AL, Kandabarow A, Rothfus WE. The radiologic assessment of post-traumatic vertebral stability. Skeletal Radiol. 1990;19(2):103–8.

    Article  CAS  PubMed  Google Scholar 

  22. Roberge RJ, Wears RC. Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims. J Emerg Med. 1992;10(5):539–44.

    Article  CAS  PubMed  Google Scholar 

  23. Daffner RH. Evaluation of cervical vertebral injuries. Semin Roentgenol. 1992;27(4):239–53.

    Article  CAS  PubMed  Google Scholar 

  24. Rizzolo SJ, Vaccaro AR, Cotler JM. Cervical spine trauma. Spine. 1994;19(20):2288–98.

    Article  CAS  PubMed  Google Scholar 

  25. Mace SE. Emergency evaluation of cervical spine injuries: CT versus plain radiographs. Ann Emerg Med. 1985;14(10):973–5.

    Article  CAS  PubMed  Google Scholar 

  26. Keene JS, Goletz TH, Lilleas F, Alter AJ, Sackett JF. Diagnosis of vertebral fractures. A comparison of conventional radiography, conventional tomography, and computed axial tomography. J Bone Joint Surg Am. 1982;64(4):586–94.

    CAS  PubMed  Google Scholar 

  27. Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma. 2005;58(5):902–5.

    Article  PubMed  Google Scholar 

  28. Friedman D, Flanders A, Thomas C, Millar W. Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. AJR Am J Roentgenol. 1995;164(2):443–7. doi:10.2214/ajr.164.2.7839986; discussion 448–49.

    Article  CAS  PubMed  Google Scholar 

  29. Kaye JJ, Nance Jr EP. Thoracic and lumbar spine trauma. Radiol Clin North Am. 1990;28(2):361–77.

    CAS  PubMed  Google Scholar 

  30. Glaser JA, Jaworski BA, Cuddy BG, Albert TJ, Hollowell JP, McLain RF, Bozzette SA. Variation in surgical opinion regarding management of selected cervical spine injuries. A preliminary study. Spine. 1998;23(9):975–82; discussion 983.

    Article  CAS  PubMed  Google Scholar 

  31. Wuermser LA, Ho CH, Chiodo AE, Priebe MM, Kirshblum SC, Scelza WM. Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury. Arch Phys Med Rehabil. 2007;88(3 Suppl 1):S55–61. doi:10.1016/j.apmr.2006.12.002.

    Article  PubMed  Google Scholar 

  32. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012;1:CD001046. doi:10.1002/14651858.CD001046.pub2.

  33. Ducker TB, Russo GL, Bellegarrique R, Lucas JT. Complete sensorimotor paralysis after cord injury: mortality, recovery, and therapeutic implications. J Trauma. 1979;19(11):837–40.

    Article  CAS  PubMed  Google Scholar 

  34. Murphy KP, Opitz JL, Cabanela ME, Ebersold MJ. Cervical fractures and spinal cord injury: outcome of surgical and nonsurgical management. Mayo Clin Proc. 1990;65(7):949–59.

    Article  CAS  PubMed  Google Scholar 

  35. Caroli GC, Parisini P, Laguardia AM, Ranocchi R, Salfi C. Reduction and early surgical stabilization of fractures and fracture-luxations in cervical vertebral and spinal cord injuries. Minerva Anestesiol. 1989;55(3):99–102.

    CAS  PubMed  Google Scholar 

  36. Gambardella G, Staropoli C, Toscano S, Tomasello F. Early stabilization in severe cervical vertebral and spinal cord injuries. Minerva Anestesiol. 1989;55(3):95–7.

    CAS  PubMed  Google Scholar 

  37. Levi L, Wolf A, Rigamonti D, Ragheb J, Mirvis S, Robinson WL. Anterior decompression in cervical spine trauma: does the timing of surgery affect the outcome? Neurosurgery. 1991;29(2):216–22.

    Article  CAS  PubMed  Google Scholar 

  38. Aebi M, Zuber K, Marchesi D. Treatment of cervical spine injuries with anterior plating. Indications, techniques, and results. Spine. 1991;16(3 Suppl):S38–45.

    Article  CAS  PubMed  Google Scholar 

  39. Goffin J, Plets C, Van den Bergh R. Anterior cervical fusion and osteosynthetic stabilization according to Caspar: a prospective study of 41 patients with fractures and/or dislocations of the cervical spine. Neurosurgery. 1989;25(6):865–71.

    Article  CAS  PubMed  Google Scholar 

  40. Razack N, Green BA, Levi AD. The management of traumatic cervical bilateral facet fracture-dislocations with unicortical anterior plates. J Spinal Disord. 2000;13(5):374–81.

    Article  CAS  PubMed  Google Scholar 

  41. Lifeso RM, Colucci MA. Anterior fusion for rotationally unstable cervical spine fractures. Spine. 2000;25(16):2028–34.

    Article  CAS  PubMed  Google Scholar 

  42. Do Koh Y, Lim TH, Won You J, Eck J, An HS. A biomechanical comparison of modern anterior and posterior plate fixation of the cervical spine. Spine. 2001;26(1):15–21.

    Article  CAS  PubMed  Google Scholar 

  43. Ianuzzi A, Zambrano I, Tataria J, Ameerally A, Agulnick M, Goodwin JS, Stephen M, Khalsa PS. Biomechanical evaluation of surgical constructs for stabilization of cervical teardrop fractures. Spine J. 2006;6(5):514–23. doi:10.1016/j.spinee.2005.12.001.

    Article  PubMed  Google Scholar 

  44. Toh E, Nomura T, Watanabe M, Mochida J. Surgical treatment for injuries of the middle and lower cervical spine. Int Orthop. 2006;30(1):54–8. doi:10.1007/s00264-005-0016-4.

    Article  PubMed  Google Scholar 

  45. Dvorak MF, Fisher CG, Fehlings MG, Rampersaud YR, Oner FC, Aarabi B, Vaccaro AR. The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine. 2007;32(23):2620–9. doi:10.1097/BRS.0b013e318158ce16.

    Article  PubMed  Google Scholar 

  46. Bailey RW, Badgley CE. Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg Am. 1960;42-A:565–94.

    CAS  PubMed  Google Scholar 

  47. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A(3):607–24.

    CAS  PubMed  Google Scholar 

  48. Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602–17. doi:10.3171/jns.1958.15.6.0602.

    Article  CAS  PubMed  Google Scholar 

  49. Flynn TB. Neurologic complications of anterior cervical interbody fusion. Spine. 1982;7(6):536–9.

    Article  CAS  PubMed  Google Scholar 

  50. Bohler J. [Immediate and early treatment of traumatic paraplegias]. Z Orthop Ihre Grenzgeb. 1967;103(4):512–29.

    CAS  PubMed  Google Scholar 

  51. Morscher E, Sutter F, Jenny H, Olerud S. Anterior plating of the cervical spine with the hollow screw-plate system of titanium. Chirurg. 1986;57(11):702–7.

    CAS  PubMed  Google Scholar 

  52. Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii Y. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine. 1983;8(7):693–9.

    Article  CAS  PubMed  Google Scholar 

  53. Abumi K, Itoh H, Taneichi H, Kaneda K. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord. 1994;7(1):19–28.

    Article  CAS  PubMed  Google Scholar 

  54. Kotani Y, Cunningham BW, Abumi K, McAfee PC. Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine. 1994;19(22):2529–39.

    Article  CAS  PubMed  Google Scholar 

  55. Karaikovic EE, Daubs MD, Madsen RW, Gaines Jr RW. Morphologic characteristics of human cervical pedicles. Spine. 1997;22(5):493–500.

    Article  CAS  PubMed  Google Scholar 

  56. Reinhold M, Magerl F, Rieger M, Blauth M. Cervical pedicle screw placement: feasibility and accuracy of two new insertion techniques based on morphometric data. Eur Spine J. 2007;16(1):47–56. doi:10.1007/s00586-006-0104-1.

    Article  CAS  PubMed  Google Scholar 

  57. Hojo Y, Ito M, Abumi K, Kotani Y, Sudo H, Takahata M, Minami A. A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J. 2011;20(6):890–8. doi:10.1007/s00586-010-1590-8.

    Article  PubMed  Google Scholar 

  58. Maynard Jr FM, Bracken MB, Creasey G, Ditunno Jr JF, Donovan WH, Ducker TB, Garber SL, Marino RJ, Stover SL, Tator CH, Waters RL, Wilberger JE, Young W. International standards for neurological and functional classification of spinal cord injury. American spinal injury association. Spinal Cord. 1997;35(5):266–74.

    Article  PubMed  Google Scholar 

  59. Pickett GE, Campos-Benitez M, Keller JL, Duggal N. Epidemiology of traumatic spinal cord injury in Canada. Spine. 2006;31(7):799–805. doi:10.1097/01.brs.0000207258.80129.03.

    Article  PubMed  Google Scholar 

  60. Munce SE, Wodchis WP, Guilcher SJ, Couris CM, Verrier M, Fung K, Craven BC, Jaglal SB. Direct costs of adult traumatic spinal cord injury in Ontario. Spinal Cord. 2013;51(1):64–9. doi:10.1038/sc.2012.81.

    Article  CAS  PubMed  Google Scholar 

  61. Nas K, Yazmalar L, Sah V, Aydin A, Ones K. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8–16. doi:10.5312/wjo.v6.i1.8.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Dupont-Versteegden EE, Houle JD, Dennis RA, Zhang J, Knox M, Wagoner G, Peterson CA. Exercise-induced gene expression in soleus muscle is dependent on time after spinal cord injury in rats. Muscle Nerve. 2004;29(1):73–81. doi:10.1002/mus.10511.

    Article  CAS  PubMed  Google Scholar 

  63. Norton JA, Gorassini MA. Changes in cortically related intermuscular coherence accompanying improvements in locomotor skills in incomplete spinal cord injury. J Neurophysiol. 2006;95(4):2580–9. doi:10.1152/jn.01289.2005.

    Article  PubMed  Google Scholar 

  64. Thomas SL, Gorassini MA. Increases in corticospinal tract function by treadmill training after incomplete spinal cord injury. J Neurophysiol. 2005;94(4):2844–55. doi:10.1152/jn.00532.2005.

    Article  PubMed  Google Scholar 

  65. Jacobs PL, Nash MS. Exercise recommendations for individuals with spinal cord injury. Sports Med. 2004;34(11):727–51.

    Article  PubMed  Google Scholar 

  66. Guest RS, Klose KJ, Needham-Shropshire BM, Jacobs PL. Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 4. Effect on physical self-concept and depression. Arch Phys Med Rehabil. 1997;78(8):804–7.

    Article  CAS  PubMed  Google Scholar 

  67. Hillen BK, Abbas JJ, Jung R. Accelerating locomotor recovery after incomplete spinal injury. Ann N Y Acad Sci. 2013;1279:164–74. doi:10.1111/nyas.12061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Knikou M, Conway BA. Effects of electrically induced muscle contraction on flexion reflex in human spinal cord injury. Spinal Cord. 2005;43(11):640–8. doi:10.1038/sj.sc.3101772.

    Article  CAS  PubMed  Google Scholar 

  69. Al-Majed AA, Tam SL, Gordon T. Electrical stimulation accelerates and enhances expression of regeneration-associated genes in regenerating rat femoral motoneurons. Cell Mol Neurobiol. 2004;24(3):379–402.

    Article  CAS  PubMed  Google Scholar 

  70. Lavrov I, Gerasimenko YP, Ichiyama RM, Courtine G, Zhong H, Roy RR, Edgerton VR. Plasticity of spinal cord reflexes after a complete transection in adult rats: relationship to stepping ability. J Neurophysiol. 2006;96(4):1699–710. doi:10.1152/jn.00325.2006.

    Article  PubMed  Google Scholar 

  71. Dobkin BH. Do electrically stimulated sensory inputs and movements lead to long-term plasticity and rehabilitation gains? Curr Opin Neurol. 2003;16(6):685–91. doi:10.1097/01.wco.0000102622.38669.ac.

    Article  PubMed  Google Scholar 

  72. Kim SJ, Fairchild MD, Iarkov Yarkov A, Abbas JJ, Jung R. Adaptive control of movement for neuromuscular stimulation-assisted therapy in a rodent model. IEEE Trans Biomed Eng. 2009;56(2):452–61. doi:10.1109/TBME.2008.2008193.

    Article  PubMed  Google Scholar 

  73. Jung R, Belanger A, Kanchiku T, Fairchild M, Abbas JJ. Neuromuscular stimulation therapy after incomplete spinal cord injury promotes recovery of interlimb coordination during locomotion. J Neural Eng. 2009;6(5):055010. doi:10.1088/1741-2560/6/5/055010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Fairchild MD, Kim SJ, Iarkov A, Abbas JJ, Jung R. Repetetive hindlimb movement using intermittent adaptive neuromuscular electrical stimulation in an incomplete spinal cord injury rodent model. Exp Neurol. 2010;223(2):623–33. doi:10.1016/j.expneurol.2010.02.011.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Spinal Unit, Department of Orthopedics Surgery, Fribourg Cantonal Hospital, Fribourg, Switzerland

    Riccardo Ciarpaglini MD, Paolo Fornaciari MD & Gianluca Maestretti MD

Authors
  1. Riccardo Ciarpaglini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Fornaciari MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianluca Maestretti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Riccardo Ciarpaglini MD .

Editor information

Editors and Affiliations

  1. Spine Center, Rome American Hospital, Rome, Italy

    Pier Paolo Maria Menchetti

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Ciarpaglini, R., Fornaciari, P., Maestretti, G. (2016). Injuries of the Middle and Lower Cervical Spine. In: Menchetti, P. (eds) Cervical Spine. Springer, Cham. https://doi.org/10.1007/978-3-319-21608-9_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21608-9_18

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21607-2

  • Online ISBN: 978-3-319-21608-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation