While the prospect of walking around with a 'broken neck' is worrisome and frightful, the details of neck fractures and cervical spine trauma is quite complex. The injuries that can result from from trauma to the head and neck region can vary from a very small muscular strain that only causes some short term pain to catastrophic life threatening paralyzing conditions such as occipitocervical dissociation. The evaluation and management of neck injuries is thus a very thorough and meticulous process designed to prevent any aggravation or worsening of a potentially life-threatening situation. In these cases more caution is always better than less caution.
The most common area of injury in the cervical spine is in the lower cervical spine at the C5/C6 and C6 /C7 levels because of the biomechanical forces that are placed on the lower cervical region. Most significant neck fractures and injuries take place at this level. Thus, this is the level that is most thoroughly assessed on a preliminary review of a CT, MRI, or x-rays of a patient who has undergone cervical trauma.
The types of injuries that can result at these levels range from minor insignificant fractures to complete dislocation of the cervical spine. Depending on the injury, these injuries are managed accordingly with a treatment plan that can vary from observation, to use of a rigid collar, to use of a halo device, to possible surgery. Each situation requires an evaluation by the orthopedic spine surgeon as to the stability of the spine and the risk of catastrophic neurological damage that may result from the particular injury.
While the lower cervical spine is placed at the most risk due to the biomechanics of the spine, it is possible to get injuries to the upper cervical spine as well. This includes the head and neck junction, where injuries are rare and difficult to diagnose by conventional xrays. Thus, any patient that has had a significant injury and complains of neck pain should have his/her cervical spine immobilized and a cervical CT scan should be performed to assess for the possibility of an occult cervical spine injury. Cervical spine CT is very good at determining if the head is indeed sitting on top of the neck as it should be as well as determining if there any minor or major fractures present. The CT scan has thus largely replaced conventional xrays in the evaluation of cervical trauma.
If the patient is managed appropriately at the scene of the injury with cervical spine precautions and cervical spine immobilization, the patient will arrive in the emergency room in a cervical collar and a CT scan will be performed immediately. If the results of the CT scan are abnormal in any way, then an orthopedic spine surgeon is consulted for evaluation and treatment recommendations. If there is no evidence of injury but yet the patient complains of continued neck pain, patient is placed in a cervical collar and re-examined in approximately 2 to 5 days. If at that time the patient is still complaining of neck pain and unable to move his neck without difficulty, then an MRI may be performed to assess for ligamentous injury. These decisions are made by the orthopedic spine surgeon in the clinic.
It is important in the case of cervical trauma to assume the worst case scenario and then work accordingly. If you have any specific questions about your situation please consult a board-certified orthopedic spine surgeon.