Cervical spine fracture,neck fracture - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes spinal cord injury and possible death from a broken neck.

The bones in the neck are called cervical vertebrae. There are seven cervical vertebrae. These vertebrae are the bony structures that protect the spinal cord. The nerve roots arise from the spinal cord and give branches that supplies sensation, motor function and movement to a specific muscle or a specific group of muscles.
A broken neck does not always mean death will occur, however injury to the spinal cord may cause death. The actor Christopher Reeve suffered a broken neck and he became a quadriplegic. He survived his injury because the problem was recognized and treated quickly and appropriately.
There are three types of injury that may occur with a broken neck:
1-Broken vertebra, spinal cord is OK. The vertebral fracture is treated with or without surgery. Dislocations are usually treated with surgery. The patient has to be handled carefully to avoid any further spinal injury.
2-Broken vertebra- spinal cord injury is incomplete (partial injury).
There are four syndromes that can occur:
a-Central cord syndrome: it is caused by hyperextension injury. It has a favorable prognosis but poor recovery of the hand function. The lesion occurs in the central part of the spinal cord and the grey matter. The injury can be caused by minimal trauma in the elderly, usually caused by osteophytes. Motor weakness is more severe in the upper extremities compared to the lower extremities.
b-Anterior cord syndrome: there will be complete motor paralysis and impairment of the sensory functions. Anterior cord syndrome has the worst prognosis.
c-Brown-Sequard syndrome has the best prognosis with 90% recovery. It is caused by hemisection of the spinal cord usually due to penetrating trauma. There will be ipsilateral deficit of the motor function, proprioception, vibration, and deep touch. There will be contralateral loss of pain and temperature, because the spinothalamic tract crosses at the spinal cord. This syndrome is very rare and is associated with loss of proprioception, deep touch and vibration.
3-Broken vertebra- complete spinal cord injury: if the patient has no movement below the level of the injury immediately after a suspected neck injury, it does not mean that the patient’s lesion is complete (totally paralyzed). The physician may have to wait 24-72 hours until the bulbocavernosus reflex returns which means the end of the spinal shock. Then the neurological status of the patient will be precisely assessed. If the spinal cord is severely damaged, quadriplegia will occur. There will be no movement or sensation below the lesion after the return of the bulbocavernosus reflex, however if the injury is at or above the level of C4, then the diaphragm will be affected and breathing will be affected. If injury to the cervical spine occurs below C4, paralysis alone may occur and breathing may not be badly affected.
How a person dies from a neck injury that severs the spinal cord?
1-The patient may also die from other associated injuries such as head injury, liver, spleen, lung, or pelvis. Checking the ABC’s (airway, breathing and circulation) is important to identify other significant injuries. Increased emergency medical training and first aid is important.
2-Diaphragmatic paralysis at or above the level of C4 can cause asphyxiation. Patient will probably require urgent intubation.
3-Look for other injuries! The cervical spine is known to have more fractures in different levels. Transport the patient carefully no matter if you are in the field or at the scene. The treatment begins at the scene with proper spine immobilization. Immobilization is usually done with a cervical collar.
4-Neurogenic shock: the nerve supply to the heart and blood vessels will be affected. Bradycardia (slow heart beat), hypotension (drop in blood pressure) will occur. Circulatory collapse due to loss of the sympathetic tone.
5-Manipulation of the neck may injure the vertebral arteries with acute brain infarction and stroke.
6-Autonomic dysreflexia : potentially fatal and presents with headache, agitation, hypertension. It is caused by unchecked visceral stimulation. Check the folley catheter. Disimpact the patient.

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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step

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