Cervical Hyperextension Injuries
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- Class of neck injuries typically seen in rapid, forceful extension of the cervical spine
- Usually from motor vehicle accidents (MVA—whiplash), falls, violence, or sports-related injuries (1)
- May involve:
- Injury to vertebral and paravertebral structures: fractures, dislocations, ligamentous tears, and disc disruption/subluxation
- Spinal cord injury (SCI): traumatic central cord syndrome (CCS) secondary to cord compression or vascular insult, SCI without radiologic abnormality (SCIWORA) (see “SCIWORA”)
- Blunt cerebrovascular injury (BCVI): vertebral artery or carotid artery dissection
- Soft tissue injury: cervical strain/sprain (i.e., whiplash), cervical stingers (see “Brachial Plexopathy”)
- Predominant age: CCS mostly seen in older population (average age is 53 years). Trauma and sports injuries are more common in young adults (average age 29 years).
- Predominant sex: male > female (1)
In the United States
- Cervical fractures: 2 to 5/100 blunt trauma patients
- CCS: 4/100,000 people/year
- BCVI: estimated 1/1,000 of hospitalized trauma patients; incidence increased with cervical spine or thoracic injury
- Cervical strain: 3 to 4/1,000 people/year
- Whiplash is the most common injury in MVAs and accounts for 28% of all ED visits for MVAs.
- Incidence of whiplash is 70 to 328/100,000 with rates highest in 20- to 24-year-old females.
- 5% of trauma patients have spinal fractures, and 20% of those have SCI.
- The incidence of traumatic SCI ranges from 2.3 to 83 cases per million population per year.
Etiology and Pathophysiology
Blunt trauma due to MVAs, sports injuries, falls, and assaults
- Whiplash, initial injury: no seat belt use, female gender
- Chronic pain and/or disability: litigation, previous neck pain or injury, female gender, report of headache/low back pain at inception, low education level (2)[C]
- Fractures: osteoporosis, conditions predisposing to spinal rigidity, such as ankylosing spondylitis or other spondyloarthropathies
- CCS: preexisting spinal stenosis present in >50%
- Acquired: prior trauma, spondylosis
- Congenital: Klippel-Feil syndrome (congenital fusion of any two cervical vertebrae)
Seat belts, use of proper safety equipment, rule changes for sports activities, and proper technique in sports activities can prevent or minimize injury.
Commonly Associated Conditions
Closed head injuries, whiplash-associated disorders (WAD), SCI, soft tissue trauma