The Natural History of Unstable Traumatic Injuries of the Cervical Spine

Abstract

Survival and rehabilitation of patients after injury of the cervical spine have improved significantly since World War II due to increased interest in these lesions and to improved surgical management. Traumatic lesions of the cervical spine may be classified according to radiological or clinical criteria. The mechanism leading to the injury can also be taken into account [2]. A luxation is defined as loss of contact of articular facets, in the case of the cervical spine (C2–7) leading to uni- or bilateral interlocking of articular facets. Displacement of vertebral bodies is defined as retrolisthesis (backward slipping) or anterolisthesis (forward slipping). Another effect of injury may be local kyphotic angulation of the cervical spine. Instability implies an abnormal mobility in one or more positions [3], also defined as the inability of the cervical spine to prevent neurological damage under physiological conditions [6,7]. Instability is found to occur in 6%–12% of all conservatively treated cervical spine injuries. It is usually the result of a fracture and/or luxation, frequently of a rupture of posterior ligaments [4]. Unstable lesions become stable after a period of 10–12 weeks as a result of scar formation and bony fusion [1]. It is estimated that in 36%–66% of the patients a spontaneous fusion will occur.