A cervical spine dislocation, commonly called a dislocated neck, is a severe traumatic injury involving the upper seven vertebrae. This injury occurs when the ligaments and joint capsules connecting the vertebrae are severely damaged, causing the bony alignment to be displaced. Because the cervical spine protects the spinal cord, any dislocation is an emergent medical situation. This displacement can result in permanent neurological deficits or even death. The violent nature of the trauma required means a dislocated neck is always treated with the highest level of caution.
Mechanisms of Injury
A cervical spine dislocation results from high-energy trauma that overwhelms the structural integrity of the vertebrae. The most common mechanism is a combination of severe flexion and rotation, often seen in motor vehicle collisions where the head is violently thrown forward and twisted. This force can cause a unilateral or bilateral facet dislocation, where the small joints between the vertebrae slip out of their normal position. A bilateral dislocation is much more unstable than a unilateral one and often results in significant spinal displacement.
Extreme vertical force, known as axial loading, can also lead to dislocation, such as when a person dives into shallow water and hits their head. This force compresses the spine, potentially causing burst fractures that lead to instability and misalignment. Extreme hyperextension injuries, where the head is violently snapped backward, can tear the anterior ligaments and cause a dislocation. All these mechanisms disrupt the ligamentous structures that hold the neck together, leading to instability that threatens the spinal cord.
Recognizing the Symptoms
Recognizing the symptoms involves identifying both localized pain and signs of spinal cord involvement. The most immediate localized sign is severe neck pain. The muscles surrounding the injury may go into intense spasm, and in severe cases, the head may be visibly held in an unusual or deformed position. Swelling or bruising may also be present at the injury site.
Signs of neurological involvement indicate that the displaced vertebrae are compressing the spinal cord or nerve roots. These symptoms include numbness, tingling, or weakness in the arms or legs, which may progress rapidly to paralysis. A patient might also experience difficulty walking or a complete loss of sensation below the injury level. Displaced vertebrae in the upper neck (C1-C4) can affect the nerves controlling the diaphragm, potentially leading to difficulty breathing. Loss of control over bladder and bowel function is another grave sign of spinal cord injury.
Immediate Medical Response
Responders to a suspected cervical dislocation require absolute immobilization of the head and neck. If an injury is suspected due to trauma or neurological symptoms, the patient must not be moved. Immediately call emergency services and inform them that a severe neck injury is suspected. While waiting for help, a bystander should use their hands to gently maintain the head in the position found.
Heavy towels or rolled sheets can be placed on both sides of the neck, but only if this does not require moving the patient’s head. If the patient is not breathing or lacks a pulse, CPR should be started, but the standard head-tilt-chin-lift maneuver must be avoided. Instead, a modified jaw-thrust technique should be used to lift the jaw forward without tilting the head backward. Once first responders arrive, they will apply a rigid cervical collar and secure the patient to a full-length backboard before transport to maintain spinal alignment.
Definitive Medical Treatment
Definitive treatment focuses on two main phases: reduction and stabilization. Reduction is the process of realigning the displaced vertebrae, often accomplished non-surgically using closed reduction with skeletal traction. This involves placing cranial tongs into the skull and applying weight to pull the vertebrae back into alignment, thereby relieving pressure on the spinal cord. This procedure is often performed while the patient is awake to allow for continuous neurological monitoring, as rapid realignment can improve function.
Following successful reduction, or if closed reduction is unsuccessful, surgical stabilization is necessary. This typically involves an internal fixation and fusion procedure, where the surgeon joins the affected vertebrae. Metal instrumentation, such as plates, screws, and rods, holds the segments rigidly in place while the bone graft fuses the vertebrae into a single, stable unit. Depending on the nature of the injury and whether a herniated disc is compressing the spinal cord, the approach may be from the front (anterior) or the back (posterior). Post-operative recovery includes bracing and rehabilitation of physical and occupational therapy to restore strength and function.