Cervical Fractures

The cervical spine is the upper part of the spine. It consists of seven stacked vertebrae (C1 through C7), located between the base of the skull and the upper back. These vertebrae serve two functions: protecting the spinal cord and enabling head movements (rotation, tilting, and flexion).

There are two main regions:

• The C1 and C2 vertebrae (known as axial or “upper” fractures) form the joint between the skull and the spine. C1, called the atlas, and C2, called the axis, are uniquely shaped vertebrae that allow the head to rotate.
• The C3 through C7 vertebrae (known as “lower” or subaxial fractures) make up the mobile portion of the neck and are more frequently exposed to trauma related to daily life and sports.

The spinal cord, which runs through these vertebrae, transmits information between the brain and the rest of the body. It is the proximity of this structure that makes cervical fractures serious and requires specialized care.

Most cervical fractures occur as a result of trauma and present immediately. The most common signs are:

• Acute, localized pain in the neck that worsens with movement
• Torticollis or an instinctive protective head posture
• Muscle spasms in the neck
• Numbness, tingling, or weakness in the arms or legs, if the spinal cord or a nerve root is affected.
• Coordination problems or loss of bladder or bowel control in the most severe cases
• Breathing difficulties in cases of high-level fractures involving the C1-C2 vertebrae

When a fracture occurs in a weakened bone, symptoms may be more subtle: gradual pain, discomfort during movement, sometimes without any apparent trauma. Any unusual and persistent neck pain warrants a medical evaluation.

The vast majority of cervical fractures result from violent trauma that subjects the spine to forces exceeding the bone’s strength:

• Falls from heights, bicycle accidents, or falls down stairs
• Traffic accidents
• Diving into shallow water
• Sports-related injuries

In a smaller proportion of cases, the fracture occurs without major trauma, in a bone whose strength is already compromised by an underlying medical condition; this is referred to as a pathological fracture.

Certain conditions increase bone fragility and can lead to a cervical fracture following a minor impact, or even spontaneously:

• Osteoporosis (decreased bone density, common after age 60, especially in women)
• The presence of vertebral metastases (cancer cells that have spread to the bone)
• A vertebral infection (spondylodiscitis)

In addition, participating in sports that carry a risk of falls or collisions (skiing, rugby, horseback riding, water sports) and driving without a seatbelt are risk factors for injury.

The diagnosis is based on imaging and clinical examination.

Imaging Tests

• A cervical CT scan is the first-line imaging test. It provides a precise visualization of the bone lesion, the fracture line, and any displacement.
• A cervical MRI is performed as a follow-up when there is a neurological deficit, a suspected ligament or disc injury, or to assess the condition of the spinal cord.
• Dynamic X-rays (in flexion and extension) can be useful for assessing the stability of the injury under controlled conditions.

Neurological Examination

A comprehensive neurological evaluation is routinely performed. It assesses muscle strength, sensation, reflexes, and sphincter function. This evaluation is essential for guiding treatment decisions and monitoring the course of the disease.

Treatment is always tailored to the individual. It takes into account the type and stability of the fracture, the patient’s neurological status, age, bone quality, and overall health. It involves a team of specialists, including neurosurgeons (neurosurgeons and orthopedic surgeons), radiologists, anesthesiologists, rehabilitation physicians, and physical therapists.

Conservative Treatment (Without Surgery)

Many stable, non-displaced cervical fractures heal without surgery. Treatment includes:

• Wearing a soft or rigid neck brace for several weeks
• Appropriate pain medication to manage pain
• Regular imaging follow-up is necessary to confirm bone healing.

Surgical treatment

Surgery is indicated when the fracture is unstable, displaced, or compresses the spinal cord or nerve roots. It is also recommended in cases of neurological deficits, failure of conservative treatment, or fractures involving osteoporotic bone.

Two surgical approaches are possible depending on the location and nature of the injury:

• The anterior approach (through the front of the neck) allows for the removal of a bone fragment or a damaged disc, followed by stabilization of the spine using a cage and a plate. This is often the preferred option for fractures of the C3 through C7 vertebrae.
• The posterior approach (through the back) allows for fixation using screws and metal rods. It is indicated for complex fractures, lesions of the C1–C2 vertebrae, and instabilities affecting multiple vertebral levels.

Recovery After Treatment

The average hospital stay is 3 to 7 days for a fracture stabilized via the anterior approach, and may be longer in cases of complex fractures or neurological involvement. Early mobilization is encouraged starting the day after surgery. Physical therapy begins during or immediately after hospitalization.

Resuming Activities:

• Driving: generally possible after a few weeks
• Sedentary work: generally resumed between 4 and 6 weeks
• Low-impact sports (walking, cycling) can be resumed quickly.
• Contact sports or sports involving a risk of falling should be avoided for 3 to 6 months.

The prognosis for cervical fractures is generally favorable when the diagnosis is made promptly and appropriate treatment is initiated. Uncomplicated fractures without significant neurological involvement heal in the vast majority of cases, often with full functional recovery.

If the spinal cord or nerve roots are affected prior to surgery, recovery is more variable and may take several months.

Possible complications related to surgery

Like any surgical procedure, cervical spine surgery carries risks, which will be explained in detail during the preoperative consultation:

• Wound infection or, more rarely, deep-seated infection
• Postoperative hematoma, which may require further surgery
• Deep vein thrombosis or pulmonary embolism
• Difficulty swallowing or temporary changes in the voice following an anterior approach
• Injury to a nerve root or, in exceptional cases, to the spinal cord
• A leak of cerebrospinal fluid (the fluid surrounding the brain and spinal cord) is addressed during the procedure.
• Failure of bone union or displacement of the implant material, which may occur later

The overall risk of permanent neurological complications is low. Neuronavigation, intraoperative imaging, and neurophysiological monitoring help reduce these risks.

Go to the emergency room immediately if you have the following symptoms:

• Severe neck pain following an injury (fall, accident, diving)
• Tingling, numbness, or weakness in the arms or legs
• Difficulty walking or coordinating your movements
• Incontinence (urinary or fecal)
• Difficulty breathing

Except in emergency situations, see your doctor immediately if you experience unusual and persistent neck pain, even without obvious trauma, especially if you are being treated for a bone disease or cancer.

La Tour Hospital has a team specializing in spinal neurosurgery and a comprehensive set of technical resources to treat cervical fractures, from the simplest to the most complex.

Several technologies are routinely used to ensure the safety of every procedure:

• Intraoperative 2D and 3D imaging allows us to monitor the position of implants during surgery and make immediate corrections if necessary.
• Surgical navigation, comparable to an operating room GPS, guides screw placement in real time based on images of the patient.
• Neurophysiological monitoring continuously checks the proper functioning of the spinal cord and nerves throughout the operation.
• The high-definition surgical microscope is used for delicate decompression procedures.

In cases of recent and acute fractures, the emergency department is available 24 hours a day. For scheduled appointments, the neurosurgery and orthopedics team is available.

Do all cervical fractures require surgery?

No. Many stable, non-displaced fractures heal with the use of a neck brace and regular monitoring. Surgery is reserved for unstable fractures, displaced fractures, or those causing nerve compression.

How long must a cervical collar be worn?

The duration depends on the type of fracture and the rate of healing. It is determined on a case-by-case basis by the medical team, generally for several weeks, with follow-up imaging.

Can there be lasting effects after a cervical fracture?

Uncomplicated fractures generally heal very well. If the spinal cord or nerves are affected, lasting effects are possible, but partial or complete recovery is common, especially when treatment is prompt.

Is cervical surgery dangerous?

Like any surgery, it carries risks. However, these risks have been significantly reduced thanks to modern technologies such as intraoperative imaging, surgical navigation, and neurophysiological monitoring. Your surgeon will explain the risks specific to your situation.

When can you return to work after cervical surgery?

For sedentary work, a return to work usually takes between 4 and 6 weeks. It takes longer for physically demanding activities. Your surgeon will provide you with a timeline tailored to your situation.

How long does bone healing take?

Healing generally takes several weeks to a few months, depending on the type of fracture and individual factors (age, bone quality, smoking). Progress is monitored through regular X-rays or CT scans.

Does smoking affect healing?

Yes. Smoking significantly delays bone healing and increases the risk of postoperative infection. Quitting smoking before and after surgery is strongly recommended.