bubble_chart Overview

A fracture of the cervical vertebral body accompanied by severe dislocation of the vertebral segment is called a fracture of cervical vertebrae dislocation. This is a typical complete injury. It is not uncommon clinically and is often associated with spinal cord injury, frequently occurring at the three intervertebral spaces of C_4–5 and C_6–7.

bubble_chart Pathogenesis

The mechanism of this fracture dislocation is not fundamentally different from that of a flexion-type cervical spine injury, except that the force is stronger, the damage more severe, and the clinical symptoms more pronounced. It commonly occurs in flexion injuries, where compression fractures of the vertebral body and facet joint dislocations happen almost simultaneously. It can also result from vertical forces, causing burst fractures of the vertebral body along with subluxation or locking of the facet joints. Such complete cervical spine injuries are usually severe, with most cases involving spinal cord injuries, except for a few "lucky injuries" where the sagittal diameter is wider.

bubble_chart Clinical Manifestations

Neck symptoms Neck pain, movement disorders, neck muscle spasms, widespread tenderness in the neck, severe local symptoms.

Spinal injury Except for a few lucky individuals, most have varying degrees of paralysis signs, and the proportion of complete spinal injuries is relatively high.

Imaging examination X-ray plain films can show fractures and dislocations. The shadow of the vertebral external genitalia widens. CT scans can reveal whether there is displacement of bone fragments. The extent and severity of spinal cord and other soft tissue injuries require MRI imaging.

bubble_chart Diagnosis

The patient has a clear and strong history of trauma, making the diagnosis straightforward based on clinical manifestations.

bubble_chart Treatment Measures

First Aid Due to the force of impact often being concentrated on the top of the head, the patient may sometimes experience unconsciousness. On-site assessment should first consider whether there are combined injuries to the cranium or other vital organs. Care must be taken to protect the neck during movement to avoid exacerbating the injury.

Maintain Airway Patency Especially in cases of complete spinal cord injury above the C₆ level, respiratory muscle paralysis may lead to breathing difficulties, inability to expel phlegm from the lungs, and respiratory failure. Tracheostomy and mechanical ventilation should be performed as early as necessary.

Restore Spinal Canal Morphology The normal shape of the spinal canal should be restored as quickly as possible through traction reduction or surgical reduction to eliminate spinal cord compression, prevent worsening of spinal cord edema, and maintain alignment through traction.

Remove Intraspinal Compressive Factors Although traction can restore alignment, factors such as fractured vertebral fragments, collapsed lamina, or herniated intervertebral discs may continue to encroach on the spinal canal and compress the spinal cord. Any confirmed compressive factors identified via CT or MRI should be removed as early as possible, with surgical approaches (anterior or posterior) chosen based on the direction of compression. Surgery should be performed under traction, but may be delayed in cases of poor general condition or complete paralysis.

Promote Spinal Cord Functional Recovery Following decompression, efforts should focus on resolving spinal cord edema and trauma-related reactions. The use of dehydrating diuretics and high-dose steroids can be beneficial. Early hyperbaric oxygen therapy may also be effective. Medications such as naloxone and gangliosides are still in experimental and clinical trial stages, with their efficacy yet to be confirmed. Currently, neurotrophic agents and drugs to improve blood circulation are commonly administered. For complete spinal cord injuries, emphasis should be placed on restoring and reconstructing hand function, including nerve root decompression (partial wrist function may be preserved) and tendon transfer surgery. Although spinal canal decompression may not aid in the recovery of complete spinal cord injuries, localized decompression may reduce the injury level by 1–2 segments, improving hand function.

Late-Stage (Third-Stage) Cases The primary focus is surgical removal of bony or soft tissue compressive factors hindering further spinal cord functional recovery, while utilizing residual limb function for functional reconstruction.

Cervical Vertebrae Fracture-Dislocation This is the most severe type of lower cervical spine injury, often accompanied by serious spinal cord damage, resulting in a poor prognosis—except in cases of so-called "lucky injuries" without spinal cord involvement.

bubble_chart Complications

Due to the severity of the injury, when the paralysis level is high, a fracture dislocation at the C4 level may cause respiratory difficulties due to respiratory muscle paralysis, leading to secondary hypostatic pneumonia; abdominal distension and fullness, bedsores, and urinary tract infections are also quite common.