Cervical spine fractures are potentially deadly conditions that arise after trauma, exaggerated extension or flexion. Gravity depends on the location, stability, and pattern of the injury.
Patients present with symptoms like pain located on the posterior side of the neck, spontaneous or induced by palpation, leading to a decrease of the motion range and paresthesias in the territories of the affected nerves. Neck muscles may be spastic  and tender and an ecchymosis may be present at the fracture site. Muscular spasticity may be persistent if the condition remains undiagnosed . Vertebral malalignment may be visible or palpable.
Clinical examination may find one or more of the following: spinal or neurogenic shock, hypotension with paradoxical bradycardia, fecal incontinence, urinary retention, ileus, priapism, poikilothermia, areflexia, flaccidity, weakness or paresthesias of the arms or legs. Pain may also radiate to the arms and legs and be associated with proprioceptive deficiency and deep tendon reflex loss if spinal cord injury exists. In this case, patients also have difficulty breathing. Distal pulses remain uncompromised.
Unstable fractures are characterized by involvement of more than one vertebral column and increased intervertebral disc space height or interspinous distance. The intervertebral disc space height may also be increased, with having the same significance.
Clinical examination can observe specific cord syndromes. Central cord syndrome is characterized by greater upper extremity deficit compared to lower limb impairment. In anterior cord syndrome, patients present with paralysis that sets in immediately after the injury, while posterior cord syndrome causes disruption of the dorsal nervous columns. Complete spinal cord injury has the worse prognosis and consists of a complete absence of motor and sensorial function.
A frequent type of injury after automobile accidents is whiplash, that may become symptomatic immediately or 6-12 hours afterward. Accuses consist of neck, jaw, interscapular, shoulder or arm pain, reduced motion range of the neck, headache, vertigo, nausea, vision abnormalities and paresthesia in the arms and legs, as well as dysphagia caused by a retropharyngeal hematoma. In this case, neurologic examination reveals reflex hyperactivity and abnormal plantar response .
While evaluating a suspected cervical spine fracture patient, the clinician should not forget to evaluate cranial nerves . The patient should be alert during the examination, and even if so, neurological examination sensitivity may be inadequate , therefore clinical protocols should be followed  and injury severity score should be calculated .
Entire Body System
Although the patient certainly sustained a cervical strain/sprain, there was no explanation or diagnosis for the arm pain/numbness/tingling. [circleofdocs.com]
Accuses consist of neck, jaw, interscapular, shoulder or arm pain, reduced motion range of the neck, headache, vertigo, nausea, vision abnormalities and paresthesia in the arms and legs, as well as dysphagia caused by a retropharyngeal hematoma. [symptoma.com]
This condition can cause neck pain/stiffness, arm pain, weakness in the hands, muscle spasms, loss of coordination and sometimes loss of bowel or bladder control. [centerforneuroandspine.com]
Unfortunately not all patients underwent objective evaluation of dysphagia as measured by the speech and language pathologists. [tsaco.bmj.com]
A 40-year-old woman sought chiropractic care for neck pain and weakness in both arms after a motor vehicle accident. Neck flexion worsened the weakness in her upper extremities, her radiating neck pain, and upper extremity pain. [ncbi.nlm.nih.gov]
According to the USC Center for Spinal Surgery, most people report a great deal of neck pain after a cervical spine fracture. The neck may also be tender to the touch. [livestrong.com]
What Cervical Spine Pain Could Mean Neck pain can be debilitating and there is a wide range of possible causes. [centerforneuroandspine.com]
Emergency medical personal arrived at the scene and found the patient alert and oriented, with complaints of right shoulder weakness and cervical spine pain. [ispub.com]
Cervical spine fractures occasionally cause severe kyphotic deformities, such as chin-on-chest deformities. In such cases, the patients typically exhibit a chronic progression of hyperkyphosis after the traumatic event. [ncbi.nlm.nih.gov]
Autonomic hyperreflexia The chronic phase in which spinal reflexes reappear is characterized by autonomic hyperreflexia in a high proportion of patients. [trauma.org]
Hyperreflexia, clonus, Babinski signs, and Hoffmann signs indicate spinal cord compression, although areflexia is common initially in an emergency injury. [orthopaedicsone.com]
If the nerve is affected, neurological symptoms such as pain and weakness can radiate down the path of the nerve into the arm and/or hand ( cervical radiculopathy ). [spine-health.com]
[…] of a 36-year-old man diagnosed with an isolated cervical spine fracture, where an associated carotid artery lesion was initially overlooked and diagnosis was made after development of a neurological deterioration secondary to a posterior reversible encephalopathy [ncbi.nlm.nih.gov]
CONCLUSION: Despite a high percentage of patients with traumatic intracranial hemorrhage, our study failed to demonstrate that intracranial hemorrhage is predictor of occult cervical-spine fracture. [ncbi.nlm.nih.gov]
Although patients may have no complaints related to neck tenderness, they need to have a radiological evaluation if they have a neurologic deficit, altered sensorial function or other significant injuries, according to Canadian C-Spine Rules and National Emergency X-Radiography Utilization Group  . These rules also apply to children. If sitting and walking are possible and the patient can rotate the head by 45 degrees both ways, the level of suspicion of cervical fracture is diminished.
On the other hand, computer tomography examination is urgent if the patient has a Glasgow coma scale below 13, has been intubated or a rapid diagnosis is needed.
When the radiological evaluation is considered necessary, all classical five views should be ordered: anteroposterior, oblique, odontoid, swimmer's and cross-table lateral. If available, a computer tomography  or magnetic resonance imaging  examination is useful, being more sensitive. Magnetic resonance is superior in describing ligament and disc lesions. Even if symptoms are limited to the cervical spine, motor vehicle accident victims should have the whole spine examined if a cervical spine fracture is demonstrated . Furthermore, the clinician should keep in mind that C1-C3 spine fractures may be associated with vertebral artery injury .
- Schliack H, Schaefer P. Hypoglossal and accessory nerve paralysis in a fracture of the occipital condyle. Nervenarzt. 1965;36(8):362–364.
- Bolender N, Cromwell LD, Wendling L. Fracture of the occipital condyle. AJR Am J Roentgenol. 1978;131(4):729–731.
- Carroll LJ, Holm LW, Hogg-Johnson S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4):S83-S92.
- McCleary AJ. A fracture of the odontoid process complicated by tenth and twelfth cranial nerve palsies: A case report. Spine. 1993;18:932–935.
- Duane TM, Dechert T, Wolfe LG, et al. Clinical Examination and its reliability in identifying cervical spine fractures. J Trauma. 2007;62:1405–1410.
- Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk Criteria in patients with trauma. N Engl J Med. 2003;349:2510–2518.
- Albrecht RM, Malik S, Kingsley DD, et al. Severity of cervical spine ligamentous injury correlates with mechanism of injury, not with severity of blunt head trauma. Am Surg. 2003;69:261–265.
- Kanwar R, Delasobera BE, Hudson K, et al. Emergency department evaluation and treatment of cervical spine injuries. Emerg Med Clin North Am. 2015;33(2):241-282.
- Leonard JC, Kuppermann N, Olsen C et al. Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med. 2011;58(2):145-155.
- Mulkens TH, Marchal P, Daineffe S, et al. Comparison of low-dose with standard-dose multidetector CT in cervical spine trauma. AJNR Am J Neuroradiol. 2007;28(8):1444-1450.
- Kumar Y, Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord. 2016;17:310.
- Winslow JE 3rd, Hensberry R, Bozeman WP, et al. Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. J Trauma. 2006;61(3):686-687.
- Hagedorn JC 2nd, Emery SE, France JC, et al. Does CT Angiography Matter for Patients with Cervical Spine Injuries?. J Bone Joint Surg Am. 2014;96(11):951-955.