A broken neck, or cervical fracture, is a fracture of one or more of the seven bones that make up the neck portion of the spine, known as the cervical vertebrae. This injury is serious because the cervical spine surrounds and protects the spinal cord, the body’s main pathway for nerve signals. Any break or displacement of these bones can compromise the spinal cord, leading to severe neurological consequences. This article explains the mechanisms of this injury and the immediate steps required following a suspected fracture.
Understanding the Cervical Spine
The cervical spine consists of the first seven vertebrae, labeled C1 through C7. These bones are designed to provide stability for the head and a wide range of motion for the neck. The first two vertebrae, C1 (atlas) and C2 (axis), are unique, allowing for the majority of head movement, including nodding and rotation. The primary function of the entire cervical column is to support the weight of the head while providing a protective canal for the spinal cord.
A cervical fracture typically occurs from high-impact trauma that forces the neck beyond its normal range of motion, such as during a motor vehicle accident or a fall. Mechanisms of injury include extreme flexion (forward bending), hyperextension (backward bending), axial compression (a strong downward force), or a combination of rotation and bending. Fractures are classified as stable or unstable. A stable fracture maintains the structural integrity of the spinal column and is less likely to damage the spinal cord. An unstable fracture involves significant bone or ligament damage that risks further displacement and neurological injury.
Immediate Neurological Consequences
The most concerning result of a cervical fracture is damage to the spinal cord, known as a spinal cord injury (SCI). This occurs if fractured bone fragments compress, bruise, or crush the nerve tissue. Since the cervical spine controls nerve signals for the entire body below the neck, the immediate symptoms can be severe. Patients typically experience severe pain at the injury site, followed by sensory changes like numbness, tingling, or altered sensation in the arms and legs.
The extent of functional loss depends on the level of the injury and whether the SCI is complete or incomplete. A complete SCI results in a total loss of motor function and sensation below the injury level, often leading to quadriplegia (paralysis of all four limbs) if the fracture is high in the neck. An incomplete SCI means the spinal cord is only partially damaged, allowing some signals to pass and retaining some movement or sensation below the injury site.
A fracture high in the cervical spine, particularly at C1 through C4, can be life-threatening due to the loss of respiratory function. The nerves that control the diaphragm, the primary breathing muscle, originate from the C3, C4, and C5 levels. Damage to these segments can lead to the inability to breathe without mechanical assistance. Even if the spinal cord is not fully severed, swelling and bleeding within the spinal canal can cause temporary neurological deficits, including muscle weakness and loss of coordination.
Critical First Response Steps
If a broken neck is suspected, the immediate priority is to prevent further movement of the head and neck, as displacement of an unstable fracture can worsen the spinal cord injury. The instruction is to not move the injured person unless they are in immediate danger, such as from fire or drowning. Moving the person risks causing new or greater paralysis by shifting a fractured vertebra into the spinal cord.
The first action should be to call emergency medical services (911 or the local equivalent) and state that a neck or spinal injury is suspected. While waiting for professional help, a bystander should manually stabilize the injured person’s head and neck in the position it was found. This stabilization must be maintained steadily to prevent twisting or bending movements of the spine.
If the person is unconscious, checking for breathing and circulation is necessary, but this must be done without tilting the head back to open the airway. Instead of the standard head-tilt/chin-lift maneuver, a jaw-thrust maneuver is used to open the airway while keeping the head and neck aligned. If the person is wearing a helmet, it should not be removed, as removal could destabilize the neck further, unless necessary to access the airway for cardiopulmonary resuscitation (CPR).
Hospital Treatment and Long-Term Prognosis
Upon arrival at the hospital, medical professionals focus on immediate stabilization to prevent secondary injury to the spinal cord. This often begins with the application of a rigid cervical collar or traction to gently realign the spine and hold the neck still. Diagnostic imaging, such as CT scans and MRI, is used to determine the location and severity of the fracture and the extent of any spinal cord damage.
Definitive treatment options depend on the stability of the fracture and whether neurological function is compromised. Stable fractures without spinal cord involvement may be managed non-surgically with external immobilization, such as a rigid neck brace or a halo vest. A halo vest is a device pinned to the skull and attached to a body vest for maximum stability. Unstable fractures or those causing spinal cord compression typically require surgical intervention. Surgery aims to decompress the spinal cord by removing bone fragments and stabilizing the spine through fusion, often using metal rods, screws, and plates.
The long-term prognosis is individualized and directly related to the severity and location of the initial spinal cord injury. Patients with incomplete injuries generally have a higher chance of recovering some motor and sensory function compared to those with complete injuries. A significant portion of neurological recovery occurs within the first six to nine months following the injury. Long-term rehabilitation, including physical and occupational therapy, is necessary to maximize functional independence and manage chronic conditions resulting from paralysis, such as muscle spasticity, pain, and loss of bladder control.