12 Spinal cord injury most commonly affects the extremes of age, i.e. the young and the elderly, and its effects can be lifelong. Trauma-related spinal cord injuries affect between 280 and 320 people in every million in Western Europe, and 25–50% of those involve the cervical spinal cord. Patients with C-spine injuries have the highest reported early mortality rate in spinal trauma as, owing to the anatomy, trauma to this section of the spine commonly causes cord damage. Prompt spinal immobilisation and detection of these injuries is paramount in avoiding additional spinal cord injury. There are seven cervical vertebrae which enclose the spinal cord in the neck. It is the same anatomical arrangement that allows us to flex, extend, and rotate our neck that gives rise to cervical cord injuries in trauma: cord damage tends to occur at the junction of the mobile C-spine and the relatively fixed thoracic spine (C5, C6, C7 and T1). Fractures of the odontoid peg of C2 are also extremely common. Four key mechanisms of injury – often in combination – are responsible: hyperflexion, hyperextension, rotation and compression of the spine. Half of all C-spine injuries follow road traffic accidents, in which these four mechanisms are often involved. Casualties with C-spine injuries are a high-risk group, and damage to the high cervical spine may even prove immediately fatal due to paralysis of the muscles of respiration. Most cases of cord injury are partial, affecting solely individual motor or sensory tracts, resulting in varying degrees of disability. It is now recognised that in an increasing proportion of cases, considerable neurological recovery is possible, provided that the injured C-spine is managed appropriately. The spinal canal is relatively wide within the C-spine, and so the cord has room to move and hence undergo further damage from unstable axial fractures. As a result, effective spinal immobilisation can prevent any further injury and optimise spinal recovery. Therefore, it is imperative to rapidly identify C-spine injury on approaching the scene of any trauma patient.
Cervical spine injuries
Identifying cervical spine injury
Assessing the cervical spine
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