Cervical Fracture Explained

Cervical Fracture Cartoon

Cervical Fracture Explained

This graphic details a lateral x-ray showing a C4/5 fracture/subluxation, but there’s no bony fracture! How is that possible?

The injury here is through the disk space between the fourth and fifth cervical vertebrae (C4/5). The force of the injury ripped through the soft tissue disk and tore the ligaments front and back at this level. This is a devastating injury for two reasons.

First, with such great disruption of the ligaments, surgery is absolutely necessary to stabilize the bones. Ligaments hold bone to bone and when they tear, there is nothing to check the movement of the bones. In contradistinction, with a bony fracture, the bones will generally knit back together if immobilized in place (with a cast or pins).

Second, and perhaps more important, with such severe disruption and unstable movement of the bones, the spinal cord has been injured. The spinal cord does not heal well; such an injury is likely to result in permanent paralysis.

Think of the spinal cord as a vast cable with millions of wires. The wires carry messages between the brain and body. Compare it to the transatlantic cable, with all its wires. Imagine the cable is damaged, cut in half for instance, midway between the US and England. Imagine all of the wires are the same color and you are tasked with splicing them back together. Ten thousand feet underwater. While holding your breath.

This is the task of the neurosurgeon in repairing a damaged spinal cord (though the cord is rarely transected; it is usually bruised beyond repair). We can’t see the individual nerve fibers in the operating room (we actually don’t even expose the spinal cord in such as injury as experience has proven the cord recovers better if we don’t disturb it), and even if we could we wouldn’t be able to tell which fiber connects to which other fiber—it all looks the same and though we might use a microscope, that’s more for illumination than magnification. No way we could magnify things enough to see the individual cells, or even bundles of cells.

Fortunately, as noted above the cord is rarely transected. What this means is that it is still anatomically intact (though physiologically disrupted). Because it is anatomically intact, in at least some cases there may be potential to regenerate the appropriate connections between damaged fibers. There is much research directed to this end, though success is still many years away. But as long as the cord is anatomically in one piece, the less we manipulate it the better. It might heal—emphasis on MIGHT—but not if we disrupt it still further. Hands off is the order of the day.

In the mean time, the best we can do is realign the bones and replace the ligaments with screws and rods to stabilize everything. This decreases the amount of pain, minimizes any chance of ongoing spinal cord injury, and gets the patient up and about earlier—which minimizes peri-operative complications. Mobilizing a patient as soon as possible after such an injury is key to returning them to a viable lifestyle, both mentally and physically. It also helps to prevent DVT, pneumonia, muscle wasting, nutritional depletion, infection, etc. In short, surgery to stabilize and realign the bones is crucial to optimize the environment around a damaged spinal cord in hopes of getting some eventual healing, or at least in preventing further injury.

Bottom line. The best treatment for a spinal cord injury is not to injure the cord in the first place. NEVER DIVE HEAD FIRST INTO A BODY OF WATER. NEVER.

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