Cervical Spine Trauma - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated illustrates spine concepts associated the cervical spine - trauma.
Transverse ligament:
- It provides the C1-C2 stability
- It is behind the odontoid and it anchors the odontoid to the ring of C1 so it prevents an abnormal movement between C1 and C2.
- A.D.I. in adults is 3.5 mm.
- Of the transverse ligament is injured, C1 and C2 will be free to move & there will be an increase in the A.D.I.
- Isolated traumatic injury to the transverse ligament is probably rare.
- Jefferson fracture
Three types:
- Type II: fracture at the base of the odontoid process, most common, troublesome fracture.
- Nonunion rate is 20-80% due to interruption of the blood supply.
- High nonunion rate in:
- More than 5 mm of displacement.
- Patients older than 50 years of age.
- Other risk factors:
- Delay in treatment
- Posterior displacement of the fracture
- Diabetes
- Do not use halo in early patients, risk of death from pneumonia
- Treatment of young patients:
• Halo: halo traction may be needed initially to reduce fracture, halo for up to 3 months, 30% non-union rate in halo.
• When do you do surgery? Displaced fracture in older patients, risk factors for no-union.
• Odontoid screw is preferred in the young patient.
• Need to preserve C1-C2 motion.
• Do not do fusion in young patients.
• Can use C1- C2 fusion in older patients.
• For older patients:
- Orthosis or Fusion of C1- C2 if there is an indication for surgery and if there is a clearance for surgery.
Type III:
- Fracture through the body of C2.
- Treatment:
• Cervical orthosis
• Halo: if displaced
• Hangman’s fracture is a bilateral fracture of the pars interarticularis
• The spinal canal is wider and there will be a low risk for spinal cord injury.
Levine and Edwards classification:
- Type I: stable fracture with less than 3 mm displacement, no angulation, treatment: cervical orthosis.
- Type II: most common type, significant translation and some angulation, unstable fracture, treatment: cervical traction and extension to improve the displacement, immobilization in halo vest for about 3 months.
- Type IIa: severe angulation and slight translation seen in flexion distraction injuries with tearing of the posterior longitudinal ligament, the fracture is unstable, treatment: do not use traction when there is severe angulation of the fracture.
- Type III: surgical type, C2-C3 facet dislocation, rare fracture of the pedicles in addition to the anterior facet dislocation, it has some neurological deficit association, treatment: surgery for reduction of the facet dislocation and stabilization of the injury, open reduction and posterior spine fusion.
• Facet dislocations: the association of disk herniation and facet involvement is very high, so watch out for a herniated disc in addition to the bony injury.
- Unilateral facet dislocation will usually have less than 50% translation on x-ray and it may affect a nerve root.
- Bilateral facet dislocation will have more than 50% translation and probably a spinal cord injury.
- Treatment: immediate closed reduction, get an MRI, then do surgery, if the patient has a change in mental status, then get the MRI first, and immediately followed by open reduction and surgical fixation.
- When do you go anteriorly?
- Go anteriorly if there is a disc herniation, incidence is about 10%-30% in cervical facet dislocation.
- If you try to do reduction, the disc fragment may stay in the canal causing spinal cord injury.
- When do you do posterior?
- If reduction of the dislocation failed and there was no disc herniation.
- When do you combined anterior and posterior procedures?
- Need to go anteriorly to remove the disc
- Need to go posteriorly because the dislocation cannot be reduced by a closed method or by an open anterior technique.
• Important points:
1- Get the MRI before surgery: make sure there is not a disc herniation.
2- Ligament injuries do not heal: will need fusion surgery.
3- Know the arrangement of the facets: superior and inferior facets in normal, subluxed, and dislocated positions.
Know the “naked facet” or the “empty facet”.
Train yourself to know this, especially for exam questions.
Naked Facet.
Cervical Spine MRI
Facet Fracture
Ligamentous Injury OF THE Cervical Spine
Burst Fracture of Lower Cervical Spine
Tear Drop Fracture

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[steph]

I broke the c1, c2 and base of the odontoid process, I was in traction in the spinal unit for a couple of months. I was going to then have the halo but was given a Somi brace for about 6 weeks. As the fractures never healed i had a Gallie Fusion done where they take out some of your hip bone to fuse it with wires in your neck. I was about 16 and yes have lost about 50% of movement in turning my head but I'm forever grateful as I just missed my spinal cord by a 1/4 Of a millimetre.

[sarahreynolds]

Thank you for your video. You do a great job!
I want to add that C1-2 can become unstable with connective tissue disorders such as Ehlers Danlos Syndrome without any trauma or with trauma due to faulty ligaments because of the connective tissue disorder. CT scan with 90•rotation shows this as most often static imaging doesn’t show how unstable it truly is. I walked around for 3 years disabled and felt like I was dying with many neurological symptoms. I had 10mm to the left and 8mm right translation because static imaging did not show this. I was dismissed for 3 years because of static imaging!! It’s so important to to add that rotation into the imaging. I’m lucky to be alive today because I didn’t give up searching for answers.

[katet]

Dr. Ebraheim you are a GODSEND, thank you for your video!

[MrYugiohCollecter]

Currently sitting in the hospital. Had a c1 fracture cause of a car accident. I can walk and everything fine and have all my senses. Luckily it wasn't as bad as it could have been

[kolbanno]

I've been watching Dr.Ebraheims videos for about a month now trying to learn more about my sons unfused dens. Over a year ago we rushed him to the emergency room at a local hospital & after physical evaluation & xrays the emergency physician recommended that we take him to UC Davis here in sacramento ca. for a CAT SCAN & MRI due to his finding the unfused dens on xray.
After 24 hours spent in a hospital room we were introduced to 12 physicians from the UC Davis spinal center. We were told that nothing was hurt or injured & his physical test came out great. I then asked what about his unfused dens? and the lead physician said that it was just imaging that a lot of people have it yet go on with a normal life.The only thing they wanted us to do was refrain our son from any contact sport for 2 weeks than he may start back as he feels. My son plays youth football & does well at it but my wife wanted a 2nd opinion so she took him to shriners than a 3rd opinion from Stanford sports medicine & both Shriners & Stanford agreed that he can no longer play football due to his unfused dens even though the rest of his team might have unfused dens being that they are all the same age but that is a parents choice i was told. Last month we went for a yearly check up & yes his dens are fusing but still no clearance for any kind of sports activity. Dr.Ebraheim you are a renowned spinal specialist is this really the end for my 9 year old sons future in sports? pls advise my son has not stopped his training which consist of 2 /12 hours of physical training 5 days a week all year since he was told he could not play anymore, But keeps asking when can he play again & its hard for me as a parent that i can not give him an answer.

[MelanCholy]

Love it. You sure don't sugar-coat anything, but that's how it should be.

[mundarradrew]

Yess it was you learn something every DAY 💯💯

[geojor]

super graphics, and great medical information especially for a non-medical person ...

[quadruplelatte]

My 70-year-old father just fell down his stairs and ended up with fractured C1 and C2 along with a skull fracture. An aneurism was found in the MCA adjacent to his skull fracture. The doctor didn’t make much out of it (5mm) but said to follow up down the road after the fractures are healed. If this is actually a traumatic aneurism or pseudoaneurism, is that something that needs more careful attention than just ‘we’re going to refer you to a vascular neuro in a few weeks’? Thank you for this video and your time.

[ebrahimpeer]

Another brilliant video. Informative and interesting

[unknownsourceofficial]

Nabil ibrahim best dr for ever l seen
How cervical affect brain stem

[fnuparamjit]

Very informative, concise excellent vedios

[RobertLongM]

Need a video on Alar and Accessory ligaments for C1/C2

[osso]

Thank you very much this is the best vido

[MrBuddydance]

What about facet joint pain in cervical C1 C2? There is a lot of arthritis. Why do facet joints hurt there? Are there nerves inside the cervical facet joint?

[m.huzaifa]

Hello! Can it Cause Hemihypertrophy? Can Hemihypertrophy be Treated?

[Yeahwecanplaythat]

I love your videos! Just one minor (audio) mistake at 6:53 you said "pedicle" of C2 but have it written correctly as pars interarticularis. Great video nonetheless! Keep them coming

[papiyadas]

Is there any restriction on nack movement after c1 C2 screw rod fixsation

[jackiesicilian]

Are you aware of prolotherapy to heal ligaments?

[carltonjimburton]

Please doctor Ebraheim how can one see you ? I am having neurological symptoms and I have been to many doctors with no answers. How can you help me ? Please I need your help