What are the different types of neck fracture and what are the symptoms?
We have 7 cervical vertebrae, numbered from 1 to 7.
That’s why if you’ve had an X-ray, CT scan or other imaging test, you may have seen things like:
- C6-C7 fracture: this means that the 6th and 7th cervical vertebrae from the back are broken;
- C2 fracture : the 2nd cervical vertebra from the top is broken.
You may fracture one vertebra at a time, or several.
Cervical vertebrae can break in different places and in different ways, which is why they are given different names. For example, fracture of the anterior arch of the cervical vertebra (Jefferson), fracture of the cervical spinous process, fracture of the atlas, etc.
This is of little importance (apart from curiosity!), as it does not change the main lines of treatment and rehabilitation, nor the prognosis for recovery time.
What can have the greatest impact on rehabilitation, treatment and healing is if your spinal cord has also been affected by the fracture.
The spinal cord passes through the spinal column, and is connected to the brain.
If the spinal cord is injured during the fracture (for example, compressed or even ruptured), this can lead to more serious problems.
In 15% to 56% of cases , there is a problem with the spinal cord in addition to a cervical fracture or cervical dislocation (Waseem Beeharry 2021; McMordie 2023).
When the spinal cord has been affected, we speak of a “medullary injury”. This is also a neurological problem, not just a bone one as in the case of a fracture.
What are the symptoms of a neck fracture?
Diagnosis is guided by the symptoms experienced, in addition, of course, to X-rays, CT scans or MRIs. And numerous clinical tests (asia score, testing, etc.).
Here are the symptoms of a cervical fracture without spinal cord injury:
- you have had a direct trauma to the neck, or an indirect one, such as a car accident or a fall, which has resulted in a sudden and large amplitude torsion of the neck;
- you have severe neck pain, even without doing anything;
- you have trouble moving your neck or turning your head
- You have swelling or bruising of the cervical spine, neck, back, shoulders;
- you have a headache.
And signs indicating a possible problem with the spinal cord.
- Loss of sensation: you have less feeling in your arms, legs or other parts of the body.
- Muscular weakness: you have less strength in your arms, legs, abs and back muscles: this is known as tetraparesis. And tetraplegia if you can no longer move certain parts of your body at all.
- Coordination problems
- Numbness: sensation of numbness or tingling in the limbs.
- Breathing or swallowing problems
- Loss or reduction of bladder or bowel control and sexual function: you find it hard to stop yourself from peeing or pooping (or you no longer feel the need), you also have sexual concerns
Spinal cord injuries are relatively rare.
And even with a spinal cord problem, it is sometimes possible to make a 100% recovery. Often after several months or even years.
Can a fractured neck be missed?
Some people who have had whiplash or other major neck trauma sometimes wonder if they could have missed a vertebral fracture.
Usually, doctors are rather cautious when it comes to avoiding missing a vertebral fracture diagnosis.
Imaging tests are relatively reliable for this type of fracture.
So, even if we can never be 100% sure, as is always the case in medicine, the probability is low that we’ve missed a cervical vertebra fracture.
And this is true even in the case of severe, long-lasting pain : there’s not necessarily a link between pain and the presence of a fracture.
What are the consequences of a neck fracture?
The consequences are different if you have or have not had a spinal cord injury.
And if so, whether it has simply been compressed, or whether it is severed.
Case 1: the cervical spinal cord has not been affected at all: 45% to 85% of people with a cervical fracture are in this situation.
You have pain and stiffness. It will take several weeks (sometimes months) to recover. But most of the time, you won’t suffer any after-effects.
Case 2: the spinal cord has been compressed due to contusion, hematoma or compression, and the injury is to the nerve root.
You may experience sensory loss and have some difficulty moving certain parts of your body. But this usually returns within a few weeks to a few months.
Case 3: the spinal cord has been partially ruptured: incomplete injury.
You have certain parts of your body (arms, legs, trunk) that are partially or totally paralyzed, or without sensitivity, or with altered sensitivity. You can recover motor skills and sensibility over months and years.
Case 4: the spinal cord has been completely severed: complete lesion.
You have certain parts of the body (arms, legs, trunk) that are totally paralyzed or without sensitivity, or with altered sensitivity. Recovery is more difficult, and the focus will be on compensating for lost motor skills and sensitivity.
You’ll probably spend several months in a rehabilitation center, and you’ll probably need help in your daily life in the future.
Although it’s unimaginable to think about it when it happens to us (or to someone close to us), many people regain a taste for life and a certain autonomy even after such a major injury.
In the latter 3 cases, the more an upper vertebra has been affected, the greater the paralysis, affecting almost the whole body.
In rare cases (5-10% of people with cervical fractures; McMordie 2023), death may also occur as a result of the fracture. In most cases, death occurs immediately or in the days that follow, during a stay in intensive care.
After examining you and having you undergo tests and imaging examinations, the multidisciplinary team in charge of you (doctors, surgeons, neurologists, physiotherapists, etc.) will determine the most suitable treatment for you:
- conservative, orthopedic treatment: no need for surgery. You may be immobilized with a neck brace, usually for 4 weeks to 3 months, until a follow-up x-ray. More rarely, a simple cervical collar may be used. In all likelihood, you will need rehabilitation and physiotherapy;
- surgical treatment : an operation is required.
When is there an operation?
Depending on the location and type of fracture, your fracture may be unstable. This means that if nothing is done, the bone fragments may move, causing further damage.
In this case, surgery is required to stabilize the fracture.
Your surgeon will first reduce the fracture = realign everything properly. Then he or she will stabilize it (partly to replace the role of the ruptured ligaments), by fitting hardware (plates, necks, screws, arthrodesis) which will be kept for life, or removed in a few months or years.
This is particularly the case if you’ve had a spinal cord injury. Your surgeon will also decompress the spinal cord.
After an operation, orthopedic treatment and physiotherapy are often required.
Do I need physiotherapy or rehabilitation?
It’s very common to need physiotherapy after a cervical trauma.
If you’re hospitalized, a physiotherapist will probably visit you every day to check what you can and can’t do, and suggest suitable exercises, especially for your neck.
If you have a major fracture, you will probably spend several weeks or months in a rehabilitation center. You’ll have physiotherapy, but probably also occupational therapy and adapted physical activities.
If you’re at home, you’ll probably have physiotherapy sessions at home, or go to a private practice. Sometimes just after the diagnosis, sometimes after the consolidation period and the follow-up x-ray (around 1? months/2 months after the accident).
Physiotherapy sessions at home, in a rehabilitation center, in hospital or in private practice are covered by French health insurance and mutual insurance companies. For private practice, you’ll need a prescription for physiotherapy from a doctor or surgeon.
What is the purpose of physiotherapy sessions?
This will of course depend on the precise problems you are experiencing (rather than the type of fracture).
Your physiotherapist will carry out an assessment and then determine with you what help he or she can give you, depending on what is most important to you.
Here is a non-exhaustive list of what physiotherapy can help you with:
- regain better neck mobility, without apprehension. To lift the head, turn it, tilt it to one side;
- Maintain or regain motor skills and flexibility in other joints and muscles that may have been affected by the accident: shoulders, arms, abs, back muscles, legs;
- gradually resume carrying heavy loads, physical activity and high-impact sports such as running;
- keep in shape as best you can until you are allowed to do certain things again or regain motor skills in one or more parts of your body;
- avoid stiffening of your limbs in the event of paralysis, or the appearance of complications linked to immobility (bedsores, phlebitis, constipation, etc.);
- identify compensations (material, physical, etc.) to enable you to continue doing things despite your current limitations;
- relieve your pain;
- answer your questions and those of your loved ones, to the best of our ability;
- put you in touch with other people in your situation, if that’s what you want.
Is it possible to walk with a fractured neck?
Walking does not generally aggravate a cervical vertebra fracture once you are sure that the fracture is stable (= not likely to move).
Walking is therefore usually permitted, once the diagnosis has been made and all the tests have been carried out.
However, you will normally receive personalized instructions from your medical and surgical team, who know exactly what’s going on in your case!
In cases where the spinal cord has been affected, walking is sometimes impossible due to paralysis. Physiotherapists will be among the professionals on hand to help you regain walking ability or compensate for it, as the case may be.
How long does it take to heal and recover?
Neck fractures are among the fractures for which people recover in extremely different ways.
According to :
- pre-accident health ;
- the extent of the trauma;
- whether or not there is a spinal cord lesion, and to what extent.
So it’s really tricky to give you a precise idea of how you’re going to recover, because there really are people at both ends of the spectrum. I know it’s frustrating, and I’m sorry!
Here are a few points to consider.
| Usual lead times | |
|---|---|
| Your vertebra is starting to consolidate: consolidation time | 6-8 weeks |
| You have far less pain | A few days to a few weeks Some people have very severe pain and are only comfortable in certain positions (often lying on their back), but this is not necessarily a sign of severity or longer recovery. A foam cervical collar worn appropriately can help relieve pain. |
| You’re back on the move | Immediately if you have no spinal cord problems. If not, timescales vary enormously, from a few days to several months or even years (and sometimes, in the case of major spinal cord injury, walking can never be resumed). |
| You’ve got it all back: neck and shoulder flexibility, muscle strength, physical activity and sports, work… | Without spinal cord problems: 2/3 months at best – sometimes up to 1 year or more With spinal cord injuries: recovery times are generally longer: 4/6 months in the best case, often over a year (it is possible to recover slowly but for a long time after a spinal cord injury). And sometimes, significant after-effects are retained, making it impossible to return to one’s former life. |
Neck fracture in the elderly: what are the particularities?
In the elderly, there is a greater risk of loss of autonomy and complications associated with bed rest (bedsores, constipation, phlebitis, etc.) after a cervical vertebra fracture.
That’s why treatment is generally adapted to encourage early resumption of physical activity: armchair or bed exercise, walking, etc.
The elderly can also be very apprehensive about resuming walking, and afraid of falling. Physiotherapists are among the professionals who can help reduce the risk of falling and support the gradual return to activity.
See also my article on post-fall syndrome in the elderly.
Cervical fractures also occur as a result of less severe trauma in the elderly, due to osteoporosis: bone density is lower and bones break more easily.
Are there any after-effects from a fractured neck?
It is indeed possible to retain the after-effects of a broken neck. Just as it is possible not to have any!
The less rare after-effect is occasional or frequent neck pain. Accompanied or not by stiffness.
The rarer after-effects mainly concern people who have had a spinal cord injury.
Here are the sequel-free recovery rates from a Chinese study 🇨🇳 that followed the progress of people after an operated cervical vertebra fracture with spinal cord injury (Bin-Hao 2019). So, the most severely affected people.
They are determined according to the initial ASIA score. This is a score that we calculate for you to determine the severity of your neurological lesions. You can find it in your medical file, or ask the teams who treated you.
| Pre-op ASIA score | Number of people | Sequelae-free recovery rate | Score A at end of follow-up | B score at end of follow-up | C score at end of follow-up | D score at end of follow-up | E score at end of follow-up |
|---|---|---|---|---|---|---|---|
| A= no sensitivity or motricity | 25 | 20 % | 20 | 3 | 1 | 1 | 0 |
| B = sensitivity present but no motor skills | 17 | 76,5 % | 4 | 9 | 3 | 1 | |
| C = Presence of sensation and muscle contraction, but insufficient muscle strength to overcome gravity | 8 | 87,5 % | 1 | 5 | 2 | ||
| D = Presence of sensation and muscle contraction, with insufficient muscle strength against resistance | 5 | 100 % | 5 | ||||
| E = Normal sensitivity and motor skills | 0 |
Please note: the recovery rate without sequelae is calculated for some immediately after the operation, for others after 2 to 3 years.
***
