Sagittal reconstruction of a CT scan showing a<unk>  with dislocation at the level of C6/7 Teardrop fracture of C3 (sagittal CT) Teardrop fracture of C3 (lateral X ray) Physical examination A medical history and physical examination can be sufficient in clearing the cervical spine. Notable clinical prediction rules to determine which patients need medical imaging are Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS). Choice of medical imaging * In children, a CT scan of the neck is indicated in more severe cases such as neurologic deficits, whereas X-ray is preferable in milder cases, by both US and UK guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5. * In adults, UK guidelines are largely similar as in children. US guidelines, on the other hand, recommend CT in all cases where medical imaging is indicated, and that X-ray is only acceptable where CT is not readily available. Radiographic detection On CT scan or X-ray, a<unk>  may be directly visualized. In addition, indirect signs of injury by the vertebral column are incongruities of the vertebral lines, and/or increased thickness of the prevertebral space: File:X-ray of vertebral lines.X-ray of normal congruous vertebral lines File:Vertebral lines.CT scan of normal congruous vertebral lines. File:CT of prevertebral space.CT scan with upper limits of the thickness of the prevertebral space at different levels. Classification There are proper names for several types of<unk> s, including: * Fracture of C1, including Jefferson fracture * Fracture of C2, including Hangman's fracture * Flexion teardrop fracture – a fracture of the anteroinferior aspect of a cervical vertebra The AO Foundation has developed a descriptive system for<unk> s, the AOSpine subaxial cervical spine fracture classification system. Surgery indication The indication to surgically stabilize a<unk>  can be estimated from the Subaxial Injury Classification (SLIC). In this system, a score of 3 or less indicates that conservative management is appropriate, a score of 5 or more indicates that surgery is needed, and a score of 4 is equivocal. The score is the sum from 3 different categories: morphology, discs and ligaments, and neurology: +SLIC system Points Morphology No abnormality 0 Vertebral compression 1 Burst +1 (=2) Distraction (facet joint perch, hyperextension) 3 Rotation / translation (facet joint dislocation, unstable teardrop, advanced flexion-compression 4 Discs and ligaments Intact 0 Indeterminate (isolated widening between spinous processes, magnetic resonance change 1 Disrupted (widened disc space, facet perch, dislocation) 2 Neurology No neurological symptoms 0 Damaged nerve root 1 Complete spinal cord injury 2 Incomplete spinal cord injury (risk of worsening without surgery) 3 Continuous cord compression with neurological deficit +1
Cervical fracture
Cervical dislocation
Skull fracture
Spinal fracture
Mandibular fracture
Hyoid bone fracture
Zygoma fracture
Crus fracture