- See:
-
Central Cord Syndrome:
-
Extension Teardrop Fracture of C2
-
Hangman's frx
-
Jefferson Fracture
-
Lower Cervical Burst Fractures
-
Hyperextension fracture dislocation
-
Prevertebral Soft Tissues
- Discussion:
- hyperextension injuries may include:
- hyperextension sprain;
-
Hyperextension dislocation;
- traumatic spondylolisthesis (
Hangman's frx of
C2);
- avulsion injury of the
Atlas or
Axis;
- isolated laminar fractures;
- may occur from a blow to the face (& accompanied w/ fascial frx)
- mechanism involves distractive anterior forces and compressive
Posterior column forces;
- pts w/ severe
Spondylosis may suffer neurologic deficit w/ no
radiographic fractures or subluxations;
- cord is pinched between posteriorly projecting osteophytes & thickened,
bulging ligamentum flavum;
-
C2 Laminar Frx:
- isolated laminar frx of
Axis have also been described & may be
confused w/ traumatic spondylolisthesis;
- laminar frx occurs posterior to the pars interarticularis, & unlike
Hangman's frx, is considered a stable injury;
- because of diffus sclerosis in pts w/
Spondylosis, laminar frx
may be difficult to detect on plain films;
- while they are stable, fragments may compromise canal & impinge on
cervical cord resulting in deficits;
- injuries resulting in anterolisthesis include:
-
unilateral facet subluxation (shows > 3-6 mm of anterior offset)
- hyperflexion strain - results in less offset;
- Radiographs:
- unilateral articular mass frx are seen on
AP film as disruption
of undulating lataeral margin;
-
lateral film:
-
oblique film:
-
prevertebral soft tissue swelling;
- widening of intervertebral disc space;
- fractures of the posterior elements;
- Treatment:
- pts with cord or nerve root dysfunction due to hyper-extension injuries are
managed non surgically with an orthosis, & their neurologic status is
carefully monitored;
----------------------------
Hyperextension-dislocation of the cervical spine. Ligament injuries
demonstrated by magnetic resonance imaging.
