Cervical Spine Injury (Neck Spine Injury)

First aid for a suspected neck injury

1. Call 911 or your local emergency number.
2. Keep the person still. Ask them not to move their head. Kneel behind their head and gently hold it in the position you found it, supporting both sides with your hands.
3. Do not move them unless they are in immediate danger, such as fire, traffic or water. If you must move them, keep the head, neck and body aligned and move them as one unit.
4. Do not remove a helmet unless the airway is blocked and you are trained to do so.
5. If they are not breathing, start CPR. Breathing takes priority over the neck.
6. If they vomit, roll them onto their side while keeping the head and body in line, ideally with help ("log roll").
7. Keep them warm and reassure them.

In the water after a diving accident, float the person face-up and support their head in line with the body until help arrives.

How cervical spine injuries happen

Older adults are at high risk: falls from standing height can fracture the upper neck, especially the C2 vertebra (odontoid or "dens" fracture). People with osteoporosis, ankylosing spondylitis or diffuse spinal arthritis have stiff, brittle spines that break more easily, often with seemingly minor trauma.

Types of injury

• Soft tissue injury: muscle and ligament strain without fracture, including whiplash.
• Stable fractures: the spine remains aligned and unlikely to shift. Examples include some spinous process or compression fractures.
• Unstable fractures and dislocations: bones or ligaments are disrupted, risking movement that damages the spinal cord. See fracture of the neck.
• Spinal cord injury: complete (no function below the level of injury) or incomplete (some function preserved). See spinal cord injury.

Spinal cord injury patterns

• Central cord syndrome: weakness greater in the arms than legs, often in older adults after a fall onto the face. The most common incomplete pattern.
• Anterior cord syndrome: loss of movement and pain sensation, with preserved position sense.
• Brown-Sequard syndrome: weakness on one side, loss of pain sensation on the other, usually after penetrating injury.

Injuries at C3 to C5 can affect the diaphragm and breathing.

Symptoms

• neck pain, especially in the midline over the spine
• tenderness when the back of the neck is pressed
• stiffness or reluctance to move the head
• numbness, tingling or burning in the arms or legs
• arm weakness, or weakness of the legs
• loss of bladder or bowel control
• difficulty breathing
• low blood pressure and slow heart rate (neurogenic shock) in severe cord injury

Diagnosis

Paramedics and ER doctors use clinical decision rules (NEXUS criteria and the Canadian C-Spine Rule) to decide who needs imaging. People who are alert, not intoxicated, have no midline tenderness, no neurological symptoms and no distracting injuries may not need scans.

• CT scan: the first-line imaging test; highly accurate for fractures.
• MRI: for spinal cord, disc and ligament injuries, or symptoms not explained by CT.
• CT angiography: if an injury to the vertebral or carotid arteries is suspected.
• X-rays: used less often now, mainly for follow-up.

Treatment

• Immobilization: a rigid collar is used until injury is ruled out or treated.
• Stable injuries: a hard collar or brace for 6 to 12 weeks, with follow-up X-rays.
• Unstable injuries: surgery to realign and stabilize the spine with screws, rods or plates (fusion), or a halo vest in selected cases.
• Spinal cord compression: urgent surgical decompression, often within 24 hours. Blood pressure is supported to protect the cord.
• Rehabilitation: physical and occupational therapy, and for spinal cord injuries, specialized inpatient rehabilitation.

Outlook

Soft tissue injuries and stable fractures usually heal well, with most people returning to normal activities within 3 to 6 months. Outcomes after spinal cord injury depend on the level and completeness of the injury. Incomplete injuries often improve significantly in the first 6 to 12 months. Complications can include chronic pain, stiffness, blood clots, pressure sores, and bladder, bowel and breathing problems.

Prevention

• Always wear a seat belt, and use appropriate car seats for children.
• Never dive headfirst into shallow or unknown water; enter feet first.
• Use proper tackling technique and protective equipment in sports.
• Reduce fall risk in older adults: remove trip hazards, use handrails and grab bars, and review medicines that cause dizziness.

Frequently asked questions

What are the signs of a broken neck?

Signs include severe neck pain after an injury, tenderness over the spine, stiffness, and numbness, tingling or weakness in the arms or legs. Some people with a neck fracture can still walk. Anyone with neck pain after significant trauma should be kept still and assessed in the ER.

Can you move after a cervical spine injury?

Some people with stable fractures can move normally, which is why neck injuries are easy to underestimate. Moving with an unstable fracture can damage the spinal cord. If an injury is suspected, keep the neck still until doctors have ruled out an unstable injury.

How long does a cervical spine fracture take to heal?

Most cervical fractures heal in 6 to 12 weeks with a collar, brace or surgery. Return to full activity often takes 3 to 6 months. Recovery from associated spinal cord injury can continue for a year or longer.

Is whiplash a cervical spine injury?

Yes, whiplash is a soft tissue injury of the cervical spine caused by sudden back-and-forth movement, usually in car crashes. It typically involves muscles and ligaments without fractures, and most people recover within weeks to months.