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Neck pain after trauma

Laura Avery, MDMassachusetts General Hospital

Harvard Medical School

Boston, MA, USA

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What is wrong?

Did you look at your lines?

Which lines you ask?

anterior spinal line

posterior spinal line

spinolaminar line

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Anterior listhesis

Of C2 on C3

Posterior displacement of

Posterior elements of C2,

Note disruption of spinolaminar

line

Spinolaminar line

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pars interarticularis

Superior articular facet

Of C2

Inferior articular facet of C2

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Hangman's frx / Traumatic

Spondylolisthesis of the Axis frx ofpars interarticularis ofC2 & disruption of C2-C3 junction

- type of traumatic spondylolisthesis - "Hangman's frx"- term "hangman's fracture" is not accurate for the majority of cases,

because mechanism of injury for clinically encountered frxs often lacks largetraction force present in judicial hangings;

- in cases in which there is neurologic injury, there will usually besignificant horizontal translation w/ accompanying damage to the posteriorlongitudinal ligament w/ or w/o damage of the C2-C3 interspace; - mechanism of injury in adults:

- judical lesion: hyperextension and distraction;- hyperextension w/ vertical compression ofposterior column, &

translation ofC2 and C3;- forceful extension of already extended neck is most commonly

described mech of injury, but other causes include

flexion of flexed neck & compression of an extended neck;- a blow on the forehead forcing the neck into extension is a classicmechanism of injury producing fractures thru the pedicles

ofC2 known as traumatic spondyloslisthesis ofC2;

http://www.wheelessonline.com/ortho/anatomy_of_the_axishttp://www.wheelessonline.com/ortho/posterior_columnhttp://www.wheelessonline.com/ortho/anatomy_of_the_axishttp://www.wheelessonline.com/ortho/anatomy_of_the_axishttp://www.wheelessonline.com/ortho/anatomy_of_the_axishttp://www.wheelessonline.com/ortho/anatomy_of_the_axishttp://www.wheelessonline.com/ortho/anatomy_of_the_axishttp://www.wheelessonline.com/ortho/anatomy_of_the_axishttp://www.wheelessonline.com/ortho/posterior_columnhttp://www.wheelessonline.com/ortho/anatomy_of_the_axis

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Schematic lateral view of the cervical spine.

Note the odontoid (dens), the predental space and the

spinal canal. (A=anterior spinal line; B=posterior spinal line;C=spinolaminar line; D=clivus base line)

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http://www.wheelessonline.com/image4/dens1.jpg