Comprehensive Cervical Spine and Spinal Trauma Review: Mechanisms, Ligamentous Injury, Fracture Patterns, Neurological Implications, Imaging, and Management of Flexion, Extension, Axial, and Hyperflexion Injuries Verified Questions Complete with A+ Grade

Comprehensive Cervical Spine and Spinal Trauma Review: Mechanisms, Ligamentous Injury, Fracture Patterns, Neurological Implications, Imaging, and Management of Flexion, Extension, Axial, and Hyperflexion Injuries Verified Questions Complete with A+ Graded Rationales Latest Updated 2026 stable spinal injury the vertebra will not be displaced by normal movements - no additional damage will occur with normal movements **if neural elements are undamaged they'll pretty much remain that way unstable spinal injury the vertebra has a significant risk of displacement and further damage of neural tissue with movement - risk of damage with movement Denis 3 column concept Posterior column - interspinous and supraspinous ligaments Middle column - posterior intervertebral disc & posterior longitudinal ligament Anterior column - anterior intervertebral disc & anterior longitudinal ligament what ligaments are found in the posterior column? interspinous and supraspinous what ligaments are found in the middle column? posterior longitudinal ligament posterior intervertebral disc what ligaments are found in the anterior column? anterior longitudinal ligament anterior half of the vertebral body what is considered an unstable spinal injury? damage to at least TWO columns - usually middle column and at least one other column direct injury of the spine penetrating injuries to the spine EX: fire arms, knives indirect injury of the spine different motions of the spine that go beyond where the spine normally goes (most common cause) EX: compression, flexion/rotation, shear, extension What is the initial management of a potential spinal injury? check ABCs (airway, breathing, circulation) IMMOBILIZE the spine - unstable injury should be assumed until proven otherwise Jefferson fracture compression fracture of C1 and transverse ligament tear - the head is compressed onto C1 and causes the ring to burst & expand Signs: - On odontoid view lateral parts of C1 will go beyond the margins of C2 (because it expanded) ***usually no cord damage for this reason ***Neck pain without neurological signs EX: diving into shallow water A PT presents to the ER with severe neck pain after diving into shallow water at a party with friends. Despite the neck pain, his neuro exam is normal. On Xray you see that the lateral positions of C1 expand beyond the margins of C2. What kind of fracture? What ligament may be affected? Jefferson fracture - caused by compression of head onto C1 Transverse ligament **PT will also need to get a CT What ligament can be injured in a Jefferson fracture? transverse ligament What Xray view is best for Jefferson fracture? odontoid view Hangman's fracture (HY/TQ) bilateral fracture through pedicles at pars interarticularis at C2 due to hyperextension injury Signs: - anterior dislocation of C2 vertebra - rupture of anterior longitudinal ligament - prevertebral soft tissue swelling EX: hyperextension injuries in MVA or hangings What kind of injury is a Hangman's fracture? hyperextension - causes bilateral fracture of C2 pedicles A PT comes into the ER following a MVA. They have pre vertebral swelling and severe neck pain. You do an Xray of the neck and find an anterior displacement of C2 onto C3. what fracture is this? Hangman's fracture - bilateral fracture of pedicle in pars interarticularis of C2 what ligament can be involved in a Hangman's fracture? anterior longitudinal ligament Odontoid fracture