Steroids are used to try and prevent this secondary injury by improving perfusion and decrease free radical formation leading to decreased inflammation. The secondary trauma comes from injury to the adjacent tissue/structures, leading to an abundant inflammatory response causing decreased local perfusion, cytokine release, apoptosis, lipid peroxidation, and hematoma formation. The secondary injury to the spinal cord can be as important or more important than the initial injury. The primary injury to the cord occurs by damaging the neural tissue from direct trauma. In the setting of trauma, cervical dislocations may lead to compression and injury to the spinal cord. Atlantoaxial dislocation typically occurs from degenerative conditions such as rheumatoid arthritis, Down syndrome, or via trauma from odontoid fractures (C2), atlas fractures (C1), or transverse ligament injury. Traumatic occipitocervical dislocation is a severe injury in which patients rarely survive because of brainstem destruction. Atraumatic or acquired occipitocervical instability is typically seen in patients with Down syndrome and is rarely symptomatic. Patients younger than 8 years old are more susceptible to cervical spine injury due to larger head size, weaker muscles, and increased ligamentous laxity.Īxial cervical dislocations can occur from traumatic or atraumatic etiologies. Special consideration should be given to the pediatric population in the setting of cervical trauma due to the increase in the likelihood of spinal cord injury and lethality associated with cervical trauma. However, cervical dislocations are commonly associated with low energy mechanisms in the elderly population, such as falling from standing height. Most subaxial dislocations are associated with males, high energy mechanisms in younger patients, such as a motor vehicle collision. However, The majority of these dislocations are secondary to a traumatic event, and about 75% occur in the subaxial spine. Acquired instability causing dislocations can occur in the axial spine and can be seen in the pediatric population. In the setting of a traumatic event, the osseous and soft tissue structures injured will determine the stability of the cervical spine and the treatment needed.Ĭervical dislocations can occur in two locations axial, consisting of the occipitocervical (occiput/C1) and atlantoaxial articulation (C1/C2), and subaxial, which includes from C2/C3 to C7/T1. The posterior column consists of the pedicles, lamina, spinous process, and the posterior ligamentous complex (PLC). The PLC is considered a critical predictor of spinal stability, including the ligamentum flavum, facet joint/capsule, interspinous ligament, and the supraspinous ligament. The anterior column consists of the anterior longitudinal ligament (ALL) and the anterior two-thirds of the vertebral body and disc. The middle column consists of the posterior longitudinal ligament (PLL), posterior one-third of the vertebral body and disc, and the posterior vertebral wall. The spine can be broken up into 3 distinct columns, each contributing to cervical stability. These structures function to provide physiological motion and protect neural elements. C1 (atlas) articulates with the occiput and C2 (axis), which is considered the axial spine, and C2-C7, which is considered the sub-axial spine. From C2-C7, the cervical spine has a resting lordotic curve. The cervical spine consists of 7 vertebral bodies.
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