Editing Cervical fracture (section)

==Diagnosis==
[[File:Cervical fracture dislocation C6-C7.jpeg|thumb|Sagittal reconstruction of a CT scan showing a cervical fracture with dislocation at the level of C6/7]]
[[File:TeardropFractureC3CTMarked.png|thumb|Teardrop fracture of C3 (sagittal CT)]]
[[File:TreadropfractureC3.png|thumb|Teardrop fracture of C3 (lateral X ray)]]

===Physical examination===
{{See|Clearing the cervical spine}}
A [[medical history]] and [[physical examination]] can be sufficient in [[clearing the cervical spine]]. Notable [[clinical prediction rule]]s to determine which patients need [[medical imaging]] are [[Canadian C-spine rule]] and the National Emergency X-Radiography Utilization Study (NEXUS).<ref name="SaragiottoMaher2018">{{cite journal| vauthors = Saragiotto BT, Maher CG, Lin CW, Verhagen AP, Goergen S, Michaleff ZA |title=Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma|journal=Cochrane Database of Systematic Reviews|year=2018|volume=2018 |issue=4 |pages=CD012989 |issn=1465-1858|doi=10.1002/14651858.CD012989|url=https://opus.lib.uts.edu.au/bitstream/10453/128267/1/Saragiotto_et_al-2018-Cochrane_Database_of_Systematic_Reviews.pdf|hdl=10453/128267|hdl-access=free | pmc = 6494628 }}</ref>

===Choice of medical imaging===
* In ''children'', a [[CT scan]] of the neck is indicated in more severe cases such as neurologic deficits, whereas [[projectional radiography|X-ray]] is preferable in milder cases, by both US<ref name=UpToDateChildren>{{cite web|url=https://www.uptodate.com/contents/evaluation-and-acute-management-of-cervical-spine-injuries-in-children-and-adolescents|title=Evaluation and acute management of cervical spine injuries in children and adolescents|author=Julie C Leonard|date=2018-02-12|website=UpToDate}}</ref> and UK<ref name=NICE>{{cite web|url=https://www.nice.org.uk/guidance/CG176|title=Head injury: assessment and early management|date=2014|website=National Institute for Health and Care Excellence (NICE)}} Updated in June 2017</ref> guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.<ref>{{cite web|url=https://vardgivare.skane.se/vardriktlinjer/medicinska-omraden/akutsjukvard/vardprogram-riktlinjer/traumamanual/#Nackskada|website=Region Skåne|title=Traumamanual}} Last updated: 2018-03-29</ref>
* In ''adults'', UK guidelines are largely similar as in children.<ref name=NICE/> US guidelines, on the other hand, recommend CT in all cases where medical imaging is indicated, and that X-ray is only acceptable where CT is not readily available.<ref>{{cite web|url=https://www.uptodate.com/contents/evaluation-and-acute-management-of-cervical-spinal-column-injuries-in-adults|title=Evaluation and acute management of cervical spinal column injuries in adults|date=2018-05-24|author=Amy Kaji, Robert S Hockberger}}</ref>

===Radiographic detection===
On [[CT scan]] or [[projectional radiography|X-ray]], a cervical fracture may be directly visualized. In addition, indirect signs of injury by the vertebral column are incongruities of the [[vertebral lines]],<ref name="RanigaMenon2014">{{cite journal | vauthors = Raniga SB, Menon V, Al Muzahmi KS, Butt S | title = MDCT of acute subaxial cervical spine trauma: a mechanism-based approach | journal = Insights into Imaging | volume = 5 | issue = 3 | pages = 321–338 | date = June 2014 | pmid = 24554380 | pmc = 4035495 | doi = 10.1007/s13244-014-0311-y }}</ref> and/or increased thickness of the [[prevertebral space]]:<ref name=Rojas2009>{{cite journal | vauthors = Rojas CA, Vermess D, Bertozzi JC, Whitlow J, Guidi C, Martinez CR | title = Normal thickness and appearance of the prevertebral soft tissues on multidetector CT | journal = AJNR. American Journal of Neuroradiology | volume = 30 | issue = 1 | pages = 136–141 | date = January 2009 | pmid = 19001541 | pmc = 7051716 | doi = 10.3174/ajnr.A1307 | doi-access = free }}</ref>

<gallery widths="185" heights="240">
File:X-ray of vertebral lines.jpg|[[Projectional radiography|X-ray]] of normal congruous [[vertebral lines]]
File:Vertebral lines.png|[[CT scan]] of normal congruous vertebral lines<ref name="RanigaMenon2014"/>
File:CT of prevertebral space.jpg|[[CT scan]] with upper limits of the thickness of the prevertebral space at different levels<ref name=Rojas2009/>
</gallery>

===Classification===
{{See|Spinal fracture}}
There are proper names for several types of cervical fractures, including:
* Fracture of ''[[Atlas (anatomy)|C1]]'', including [[Jefferson fracture]]
* Fracture of ''[[Axis (anatomy)|C2]]'', including [[Hangman's fracture]]
* [[Flexion teardrop fracture]] – a fracture of the anteroinferior aspect of a [[Cervical vertebrae|cervical vertebra]]

The [[AO Foundation]] has developed a descriptive system for cervical fractures, the ''AOSpine subaxial cervical spine fracture classification system''.<ref>{{cite web|url=https://www2.aofoundation.org/wps/portal/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAx8jfULsh0VAdAsNSU!/?bone=Spine&segment=TraumaLowerCervical&soloState=lyteframe&contentUrl=srg/popup/additional_material/52/X001_Classification.jsp|title=Classification|website=[[AO Foundation]]|access-date=2019-05-08}}</ref>

===Surgery indication===
The indication to surgically stabilize a cervical fracture can be estimated from the ''Subaxial Injury Classification'' (SLIC). In this system, a score of 3 or less indicates that [[conservative management]] is appropriate, a score of 5 or more indicates that surgery is needed, and a score of 4 is equivocal.<ref name=Brockmeyer2016>[https://books.google.com/books?id=r_gTDgAAQBAJ&pg=PA94 Page 94] and [https://books.google.com/books?id=r_gTDgAAQBAJ&pg=PA126 Page 126] in: {{cite book|title=Adult and Pediatric Spine Trauma, An Issue of Neurosurgery Clinics of North America|volume=28|issue=1|author=Douglas L. Brockmeyer, Andrew T. Dailey|publisher=Elsevier Health Sciences|year=2016|isbn=9780323482844}}</ref> The score is the sum from 3 different categories: morphology, discs and ligaments, and neurology:<ref name=Brockmeyer2016/>

{|class="wikitable"
|+SLIC system<ref name=Brockmeyer2016/>
! colspan=2 style="text-align:right"| Points
|-
!colspan=2|Morphology
|-
| No abnormality || 0
|-
| [[Vertebral compression fracture|Vertebral compression]] || 1
|-
| [[Burst fracture|Burst]] || +1 (=2)
|-
| Distraction (facet joint perch, hyperextension) || 3
|-
| Rotation / translation (facet joint dislocation, unstable [[Flexion teardrop fracture|teardrop]], advanced flexion-compression || 4
|-
!colspan=2| [[Intervertebral disc|Discs]] and ligaments
|-
| Intact || 0
|-
| Indeterminate (isolated widening between [[spinous process]]es, [[magnetic resonance imaging|magnetic resonance]] change) || 1
|-
| Disrupted (widened disc space, facet perch, dislocation) || 2
|-
!colspan=2| Neurology
|-
| No neurological symptoms || 0
|-
| Damaged [[nerve root]] || 1
|-
| Complete [[spinal cord injury]] || 2
|-
| Incomplete spinal cord injury<br> (risk of worsening without surgery) || 3
|-
| Continuous cord compression with neurological deficit || +1
|}