Mark W. McFarland, DO
There are seven cervical vertebrae or neck bones in the human body. When one of these bones becomes fractured, commonly due to accidents like diving into shallow water, a car crash, a fall from a ladder or another height, or a collision in sports, or from having weakened bones from aging, we refer to it as having a broken neck. While hearing that term may cause fear and heart palpitations, it doesn’t always mean instant paralysis and a life confined to a wheelchair for those who suffer from this injury. In this article, I will discuss the symptoms, treatment and prognosis for those with cervical spine fractures and how modern medicine has improved outcomes.
Whether a traumatic work accident or sports injury occurs or a tiny woman with a severe case of osteoporosis sneezes violently, a fracture in the cervical spine can occur. Just as the circumstances can vary, so too can the symptoms. Pain can range from mild to severe, and it may radiate down from the neck into the shoulders and arms. There may be stiffness, swelling, bruising or tenderness in the neck area. There may be a loss of sensation or paralysis in the arms, legs or body or difficulty in breathing. In the case of the traumatic accident or sports injury, it will be apparent that medical attention should be sought immediately. In the case of the lady with osteoporosis, her symptoms may not be quite as obvious at first.
Most traumatic injury patients are transported to a Level One Trauma facility where they can be quickly assessed for the severity of their injuries. X-rays (to show dislocations and bone fractures), a CT scan (to confirm no fractures) and a MR scan (to look for neurologic – nerve or spinal cord – damage) will typically be ordered, because they help the ER physicians see different structures of the body. Starting treatment in this first “Golden Hour” after injury can often make a huge difference in the patient’s recovery and overall outcome.
Based on the findings, the orthopaedic physician may make the decision to treat conservatively, which could mean the use of collars, steroid medications or cervical-thoracic orthotics. Conservative treatment also could mean using pins anchored into the skull, stabilized by a padded plastic vest, called halo vest immobilization. These happy patients get to leave the hospital to recover under the watchful eye of their loved ones.
Patients with bone dislocations, spinal instability and issues due to bone impingement on neurologic structures will be headed to surgery. There are many surgical options available to the spine surgeon at this point, but the primary goals will be to stabilize the spine, remove any boney impingement on the spinal cord or spinal nerves and to help restore function and mobility to the spine. Recovery will vary widely based on the patient’s age, general condition, and the severity of injury. Some patients will be discharged from the hospital within days. Others may have to get used to life in a wheelchair, learning how to function with partial or full paralysis.
Believe me, every spine surgeon’s dream is to help someone who is critically injured with a broken neck avoid lifelong paralysis. Sometimes, with God’s help, we can help them make a full recovery. Sometimes, their spinal cord is completely compromised and their injuries too severe for them to fully function again.
Remember our lady friend who has osteoporosis, who sneezed and fractured her neck? Well, she went to her Primary Care Doctor because her neck was causing her pain. He took an x-ray of her neck and found she had a compression fracture. Her doctor sent her to me, for an in-office procedure called a Kyphoplasty. The treatment I performed uses an injection of a special type of cement into the fractured bone in her neck, which creates an internal cast. The cement hardened and in about an hour, she was mostly free from pain and ready to go home. We gave her a local anesthetic; she didn’t have to go in the hospital, and she could go home soon after her procedure.