“Breaking your neck” describes a severe traumatic injury involving one or more of the seven bones in the neck, known as the cervical vertebrae (C1 through C7). High-impact trauma, such as landing directly on the head from a backflip, is dangerous due to the risk to the spinal cord that runs through these bones. When vertebrae fracture or become dislocated, bone fragments or instability can compress or damage the neural tissue. Damage to the cervical spinal cord determines the immediate and long-term consequences, not simply the bone fracture itself.
Understanding High-Impact Cervical Injury
A backflip gone wrong often results in an axial load, transmitting the body’s force vertically through the skull onto the cervical spine. This mechanism can cause burst fractures or hyperflexion/hyperextension injuries. Damage is classified based on which of the three structural columns of the spine are disrupted. A fracture is unstable if the trauma compromises two or more columns, increasing the risk of spinal cord damage.
The severity of the resulting Cervical Spinal Cord Injury (CSCI) relates directly to the highest level of the cord damaged. Injury to the upper cervical spine (C1 and C2) can be life-threatening. Damage at the C3, C4, or C5 segments is concerning because these nerve roots control the diaphragm, the main breathing muscle. Higher-level damage can lead to complete or partial paralysis of the diaphragm, requiring immediate respiratory support.
Immediate Medical Consequences of Spinal Cord Damage
Seconds after the injury, the patient experiences a sudden loss of motor and sensory function below the damage level, resulting in paralysis or weakness. This loss can be temporary during “spinal shock,” which is the transient loss of all reflex activity below the injury site and can last for days or weeks.
An immediate risk is respiratory compromise, occurring because signals from the brain to the breathing muscles are blocked. Complete injuries above C3 often cause total diaphragm paralysis, necessitating mechanical ventilation.
The injury can also trigger neurogenic shock, a type of autonomic dysfunction specific to high-level SCI. This results from the interruption of sympathetic nervous system signals that regulate blood vessel tone and heart rate. The result is a dangerous drop in blood pressure and a slow heart rate, which compromises blood flow to the brain and the injured spinal cord. This secondary drop in perfusion can further damage the neural tissue.
Emergency Response and Acute Medical Stabilization
The first and most important step for any bystander is to immediately call emergency medical services and strictly avoid moving the injured person’s head or neck. Unnecessary movement can shift an unstable fracture, leading to further spinal cord damage. Emergency responders establish cervical spine immobilization using specialized collars and backboards.
Upon arrival at a trauma center, the immediate focus is on the ABCs: securing the Airway, supporting Breathing, and maintaining Circulation.
Airway management often involves intubation for patients with high cervical injuries who cannot breathe independently. Maintaining adequate blood pressure is also a priority, often requiring intravenous fluids and vasopressor medications to counteract neurogenic shock and ensure blood flow to the spinal cord.
Physicians use high-resolution imaging, such as CT and MRI scans, to diagnose the fracture, assess spinal stability, and visualize damage to the spinal cord and ligaments.
Definitive treatment may involve surgical decompression to remove bone fragments or tissue pressing on the cord, followed by internal stabilization with rods and screws. For stable injuries, non-surgical stabilization using a halo vest or a rigid collar may be chosen to restrict movement and allow healing.
Rehabilitation and Long-Term Prognosis
Following acute medical stabilization, the patient enters the rehabilitation phase, divided into inpatient and outpatient stages. The inpatient phase focuses on preventing secondary complications like pneumonia, pressure ulcers, and muscle contractures. This phase uses physical therapy (PT) to maintain muscle mass and range of motion, and occupational therapy (OT) to teach new skills for daily living, often involving adaptive equipment.
The long-term prognosis is determined by the severity and completeness of the injury, classified using the American Spinal Injury Association (ASIA) Impairment Scale. This scale ranges from ASIA A (a complete injury with no motor or sensory function below the damage level) to ASIA E (normal function). Patients with incomplete injuries (ASIA B, C, or D) have a better chance of regaining some motor and sensory function, particularly within the first 18 months post-injury. Recovery is a lifelong process involving maximizing functional independence through technology and ongoing therapy to adapt to permanent neurological changes.