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J Am Acad Orthop Surg, Vol 14, No 2, February 2006, 78-89.
© 2006 the American Academy of Orthopaedic Surgeons
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Subaxial Cervical Spine Trauma

Brian K. Kwon, MD, PhD, FRCSC, Alexander R. Vaccaro, MD, Jonathan N. Grauer, MD, Charles G. Fisher, MD, MPH, FRCSC and Marcel F. Dvorak, MD, FRCSC

Dr. Kwon is Assistant Professor, Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. Dr. Vaccaro is Professor, Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, and Codirector, The Delaware Valley Regional Spinal Cord Injury Center, Thomas Jefferson University, Philadelphia, PA. Dr. Grauer is Assistant Professor, Department of Orthopaedics, Yale University, New Haven, CT. Dr. Fisher is Assistant Professor, Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia. Dr. Dvorak is Associate Professor, Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Kwon, Dr. Vaccaro, Dr. Grauer, Dr. Fisher, and Dr. Dvorak.

Reprint requests: Dr. Kwon, Vancouver General Hospital, D-6 Heather Pavilion, 2733 Heather Street, Vancouver, BC, V5Z 3J5 Canada.

Subaxial cervical spine injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracture-dislocation with bone and ligament failure, resulting in severe spinal cord injury. Understanding the epidemiology, anatomy, biomechanics, and classification of subaxial cervical spine injuries is important. Emergent management of such injuries is based on obtaining an accurate clinical history, careful physical examination, and organized radiographic evaluation. Attaining a unified approach to the wide spectrum of subaxial cervical injuries is difficult. In addition, controversy exists regarding the safety of closed reduction in certain injury patterns and the administration of methylprednisolone for acute spinal cord injury. Definitive management (surgical or nonsurgical) is based on the assessment of the mechanical instability of the injury, the presence or absence of neurologic impairment, and various patient factors that may influence outcome. Several complications, including the deterioration of neurologic status, may occur with either surgical or nonsurgical management, but the most frequent mistake made is missing the injury on initial evaluation.






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Copyright © 2006 by the American Academy of Orthopaedic Surgeons.