Cervical Spine Fracture

The subaxial cervical spine can break in several ways, and the pattern determines how serious the injury is. Isolated fractures of the lateral masses or facets may be relatively stable, whereas burst fractures — where the vertebral body shatters and can push bone into the spinal canal — and flexion teardrop fractures are high-energy, unstable injuries with a real risk of spinal cord injury. Fractures also matter more in certain people: those with a stiff, fused spine from ankylosing spondylitis or DISH can sustain very unstable fractures from apparently minor falls, and fractures in older people carry higher risks. The key questions I always ask are whether the fracture is stable, whether the spinal cord or nerves are threatened, and whether the alignment is maintained.

Assessment starts with a careful neurological examination and imaging. A CT scan defines the bony injury in detail, while an MRI shows the ligaments, discs and spinal cord and reveals injuries that plain films and CT can miss. I use validated classification systems — principally the Subaxial Injury Classification (SLIC) and the AO Spine subaxial system — which grade the fracture by its shape, the integrity of the ligaments and the neurological findings, and help decide between non-operative and surgical treatment. This structured approach makes the decision consistent and evidence-based, particularly in the grey-zone injuries such as isolated, non-displaced facet fractures where opinions have historically differed.

Many stable fractures without displacement or neurological problems heal well in a rigid collar, or occasionally a halo, with a period of protection and monitoring. Unstable fractures, fractures that compress the cord, and injuries where the alignment is lost usually need surgery to decompress the nerves, realign the spine and hold it with plates, screws and rods — from the front, the back, or both, depending on the pattern. Where the vertebral body is destroyed, it may need to be rebuilt with a cage. Fractures in a stiff, fused spine almost always need surgical stabilisation because of their instability. The right treatment is chosen individually, guided by the classification, the neurology and your general health.

For stable fractures treated in a collar, healing usually takes place over a period of weeks to a few months, with imaging to confirm the bone has united. After surgery, the metalwork provides immediate stability while the fracture and any fusion consolidate over the following months, supported by rehabilitation. The single most important factor in the overall outlook is whether the spinal cord was injured: where it was not, most people recover well; where it was, recovery is more variable and specialist rehabilitation is central. My aim is always prompt, accurate assessment, protection of the cord, and a treatment plan matched to the specific fracture.

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