What treatments should I consider?
The goal of treatment for a fractured neck is to protect the spinal cord and nerves. The broken bones themselves heal well. Once they do, the injury becomes much more stable and less dangerous. Treatment is aimed at keeping the bones in good position, preventing instability and holding everything still until bone healing occurs. The spectrum of treatment runs from symptom relief and a soft collar - to surgery to reduce the fractures and stabilize the neck with wires, plates and screws.
Stable fractures, such as the simple anterior compression fractures and spinous process fractures may only require symptomatic support. The soft collar is commonly used. The soft collars are made of foam rubber. They fit snugly round the neck and improve comfort, but they do not support the head or protect the neck from further injury.
For more significant, but stable fractures, a hard collar may be a better choice. It is not possible to completely immobilize the neck with a hard collar, but you can limit flexion, extension and rotation. Stable patterns of C1 and C2 fractures (Type I Odontoid, C2 Pedicle fracture, Extension Teardrop Fracture) can often be treated in this fashion. These devices are made of rigid materials and are adjustable to fit against the back of the head and under the chin. They essentially prevent major movements of the neck. They may also be used after surgery.
Traction is commonly used immediately after a spinal fracture to stabilize the cervical spine. Traction is applied by placing special tongs into the skull under local anesthetic. The tongs are made of two parts: a C-shaped metal brace that will be placed over the skull, and two metal pins threaded through the ends of the tongs. The metal pins are inserted through the skin and into the bone of the skull, one on either side of the head just above the ear. The tongs grip the skull so that traction can be applied pulling the head away from the body.
A cord is placed from the tongs to a pulley at the head of the bed and weights applied. Traction is usually a temporary measure to assist with reduction of fractures or dislocation of the neck, or to keep the neck stable while assessment is made or a treatment plan. Traction is often followed by immobilization in a halo thoracic brace or by definitive surgery to maintain position while the bones heal.
A Halo is used when an unstable fracture requires immobilization of the cervical spine. The "halo" gets its name from the metal ring which is fixed to the skull with screw pins. It is attached by metal bars to a vest which goes around the chest (thorax). This arrangement means that the weight of the head is not transferred to the neck but is diverted through the brace. The brace also reduces movement of the neck. The upper end of the neck is held more stationary than the lower end where there is movement between the vest and the chest. This option is used for more unstable patterns of upper cervical injury and post operation to protect the area while the bone heals.
Surgery is avoided where possible. Surgery is undertaken without hesitation in an unstable fracture with risk of causing or worsening SCI.
Surgery is required for many unstable cervical spine fractures. If an unstable fracture shifts position in a brace or traction, or if the patient's neurological condition gets worse, then surgery is undertaken to restore stability. Some fracture patterns are so unstable that deterioration is very likely. Surgery may be recommended as a preventive measure to prevent spinal cord damage. The surgeon analyzes the fracture pattern to determine whether the most serious disruption is in front or behind. If the main problem is in front the neck is exposed from the front and stability restored by fixing the bones with screws, wires, or metal plates. When the damage is at the back, then surgery is undertaken through the back of the neck.
Fusion means joining one vertebra to another and allowing the two (or more) vertebrae grow together, or fuse, into one bone. When the vertebrae are fused, the motion between the two vertebrae is eliminated permanently and stability is restored. This type of operation may be undertaken for burst fractures and some unstable odontoid fractures. The metal implants inserted to hold the bone usually remain in place forever. It is unusual for wires, screws, or plates to cause any symptoms in this region.