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Biomechanics of Cervical Spine
Biomechanics of
Cervical Spine
Presented By-Debanjan Mondal
MPT(Musculoskeletal), BPT, CMT,
Ergonomist.
 Made up of two anatomically and
functionally distinct segments.
1.Superior segment/suboccipital
segment-
-consist of c1 /atlas and c2/axis
-connected to eachother and
occiput with complex chain of joints.
-having 3 axes and 3 degrees of
freedom.
2.Inferior segment-
-streching from inferior surface
of axis to the superior surface of
T1.
-In total there are 7 cervical
vertebras-
 c1-c2 c3-c6
c7
Structure of a typical cervical
vertebra
 Vertebral body-superior plateau
is raised on either sides by 2
buttresses.
 which is called as unciform process.
 It is concave transversely and
convex anteroposteriorly-resembling
a saddle .
 Unciform processes guoides the AP
movements during flexion and
 Pedicals-connects the vertebral
body to the transverse process.
 Project posterolaterally.
 Lamina-part of the posterior arch
 Meets in the midline to form the
bifid spinous process
 Projects posteromedially and are
thin and slightly curved.
 Spinous process-short slender and
extend horizontally
 The tip is bifurcated
 Face superiorly and medially
 The length of spinous process
decreases from c2-c3
 C3-c5 remains constant
 And undergoes a significant increase
at c7.
 Vertebral foramen –is large and
triangular
Transverse process
They are peculiar in
orientation
They are hollowed in to
a gutter AP and they
point AL.
The posteromedial end
of the gutter lines the
intervertebral foramen.
The AL end is bifid
 Articular processes-they bear
superior and inferior articular facets.
 Superior facets face superiorly and
medially
 Inferior facets face anteriorly and
laterally
 Structure of a atypical cervical vertebra
 Atlas /c1-its ring shaped
 Transverse diameter greater than AP
diameter
 Has two lateral faces oval in shape
running obliquely anteriorly and
medially
 Which bear biconcave superior
articulate facet superiorly and medially
meant to articulate with occipital
condyles
 Inferior articular facet –facing
inferiorly and medially
 Convex AP
 Corresponds to superior facet of axis
 Anterior arch consist of small
cartilagenous oval shaped articular
facets for the odontoid process of axis
 Posterior arch is initially flattened but
becomes thicker posteriorly to form
posterior tubercle on the midline.
 Transeverse process
 No spinous process
 No intervertebral disc
The axis-is atypicsl
 Superior surface of the body carries
centrally the odomtoid process which
acts as a pivot for atlantoodontoid
joint .
 Laterally possess 2 articular facets
facing superior and laterally
 Facets are convex AP and flat
transversely
 Posterior arch consist of narrow
laminae
 The cartilage lined inferior articular
process corresponds to the superior
articular process of c3
 Transverse process
The atlanto-axial joint complex
 it is a plane synovial joint
 comprises of 3 mechanically linked
joints
 The central joint is the atlanto
odontoid joint
 Two lateral joints-atlanto axial joint
Atlantoodointoid joint
 it is synovial trochoid /pivot joint
 Jointsurfaces-anterior articular facet
of odontoid and posterior articular
facet of the anterior arch of the
atlas
Movements at atlantoaxial and
atlanto
odontoid joint
 Flexion-point of contact b/w two
convex surface moves forward
 interspace of atlanto odontoid joint
opens superiorly
Extention
 Interspace of atlanto odontoid
jointopens inferiorly
 Radiological findingas does not shoe
opening of interspaces
 This is due to transverse ligament and
keeps the anterior arch and odontoid
process in close contact
 During flxn and extn tha inferior
surface of atlas rols and sides over
superior articular surface of axis
rotation
 Left to right rotation-
The left lateral mass of
the atlas moves forward
 Right lateral mass
recedes in rotation from
left to right and vice
versa from right to left
Movement of atlanto occipital joint
 Formed b/w superior articular
facets of atlas and the occipital
condyles.
 It is an enarthodrial kind of joint
 Gives 3 degrees of freedom
 Axial rotation-about vertical axis
 Flexion/extension-about
transverse axis
 Lateral flexion-about AP axis.
flexion
 The occipital condyles
recede on the lateral
masses of the atlas.
 The occipital bone
moves away from the
posterior archof the
atlas
 Limited by tension
developed in the
articular capsules and
extension
 Occipital condyles
slides anteriorly on the
lateral masses of the
atlas.
 Occipital bone moves
neatrer to the posterior
arch of the atlas
 Posterior arch of the
atlas and axis are
approximated
Lateral flexion
 Movement only occurs b/w c0-c1
and c2-c3
 Left lateral flexion-slipping of
occipital condyles on right of atlas
 Right lateral flexion-vice versa
 Ther is asmall range of motion
 Total ROM-C0-C3=8 degrees
 C0-C1=3 degrees,C2-C3=5
degrees
rotation
 When occiput rotates on atlas its
rotation is secondary to rotation of
atlas on axis
 Around vertical axis passing
through the centre of odontoid
 Causes right anterior displacement
of oright occipital condyle on right
lateral mass of the atlas
 Lateral atlanto occipoital ligamenr is
 Thus rotation of occiput to left is
associated with –
 Linear displacement of 2-3 mm to the
left
 Lateral flexion to the right
Movements at the lower cervical
vertebral column
Extension-ovrlying
vertebral body tilts and
slides posteriorly
 IV space is compressed
posteriorly and opened
wide anteriorly
 Nucleus palposus is driven
slightly anteriorly
 Anterior fibers of annulus
fibrosus is streched
 Superiorly articulating facet slides
inferiorly posteriorly and tilts posteriorly
 Limited by anterior longitudinal ligament
and by the impact of the posterior
arches through ligaments
Flexion-upper vertebral body tilts and
slides anteriorly
 Intervertebral space is compressed
anteriorly and opened wide posteriorly
 Nucleus pulposus is driven posteriorly
 Posterior fibres of
annulus fiberosus is
streched
 Limited by the tension
developed in the
posterior longitudinal
ligament
 By the capsular
ligament,ligamentum
Combined lateral flexion and
rotation-
 Does not occur as pure motions
 Governed by orientation of articular
facets which are oblique inferiorly and
posteriorly
 Rotation is always coupeled with lateral
flexion
 Considering the whole cervical column
from C2-T1 extension component is
 Where as any movement b/w C6-C7
also adds up extension component
 Thus three composite movement occurs
in 3 planes-
 Lateral flexion –frontal plane
 Extension-sagittal plane
 Rotation-transverse plane
RANGE OF MOTION
JOINT COMBINED FLEXION ONE SIDE ONE SIDE
EXTENSION LAT BENDING AXIAL ROTATION
C2-C3 10 10 3
C3-C4 15 11 7
C4-C5 20 11 7
C5-C6 20 8 7
C6-C7 17 7 6
C7-T1 9 4 2
FROM- WHITE
stability
 Cervical region bears less weoight
and are more mobile
 Stability is provided by bony
configuration,muscles,ligamants
Muscles-flexion of head and
neck-
 Depends on anterior muscles of the
neck
 They are rectus capitis major, rectus
capitis minor
 Longus cervicis which plays an
important role in straightening the cervical
column and holding it rigid
 Scalene anterior posterior and medius
 Suprahyoid and infrahyoid muscles
helps in supporting the cervical column at
rest
 Thry are located at a distance from
cervical column
 Thus acts via long arm of lever and are
Extension of head and neck-
Brought about by posterior neck
muscles
They are0-splenius
cervicis,semispinalis
cervicis,leavator
scapulae,transverso
spinalis,longismus
capiis,spenius capitis,trapezius
These muscles helps in
 When contract unilaterally they
produce extension rotation and lateral
flexion on the same side
 Both flexors and extensor group of
muscles are responsible to maintain
cervical column rigid in neutral
position
 Essential in balancing the head and in
supporting weights carried on head
ligaments
 Anterior atlnatoaxial
ligament,posterior atlantoaxial
ligament,tectorial
membrane,ligamentum nuchae
 Transverse atlantal ligament-21.9
mm in length
 Also refered as atlantal cruciform
ligament
 Holds dense in closed
 Also serves as an articular surface for
dense
 Prevents anterior displacement of C1
on C2
Alar ligaments-arise from axis on
either side of dens
 Approx.1cm in legth
 Are taut in flexion
 Axial rotation of head and neck
tightens both alar ligaments
Apical ligaments-of the dens
connects the axis and occioital bone
of the skull
Biomechanics of cervical injury
WHIPLASH INJURY IS DUE TO HIT FROM
BEHIND CAUSING 1ST FORCED
EXTENSION OF THE NECK FOLLOWED BY
FOCED FLEXION OF THE NECK.
-2 PHAGES:
1)HYPEREXTENSION OF C5-C6 AND
MILD FLEXION AT C0-C4
2)HYPEREXTENSION OF THE
ENTIRE SPINE
-IF THE HEAD IS IN SLIGHT ROTATION THEN
BEFORE EXTENSION IS FORCED TO
FURTHER ROTATION CAUSING INJURY TO
 LOWER CERVICAL FACET RESPOND WITH
SHEAR AND DISTRACTION MECHANISM IN
FRONT AND SHEAR AND COMPRESSION IN
THE BACK.
 DUE TO THE INJURY CAUSE CHANGE IN
PIVOT POINT AT C5-C6 CAUSING JAMMING
OF THE INFERIOR FACET OF C5 AND
SUPERIOR FACET OF C6
 C2-C3 FACET IS THE COMMON SITE FOR
THE PATIENTS WITH HEADACHE(60%) AND
C5-C6 IS THE SITE FOR REFFERED ARM
PAIN
Facet joint syndrome
 FACET JOINT IS A SYNOVIAL JOINT AND
BETWEEN TWO FACET JOINT
CARTILAGENOUS DISC IS PRESENT,
DURING FACET LOCKING SYNOVIAL
MEMBRAME AND THE DISC GETS
ENTRAPPED BETWEEN TWO FACET
BONES.
 PAIN IN SIDE FLEXION AND ROTATION TO
THE SAME SIDE AND EXTENSION AS
WELL.
 COUPLING OF LATERAL FLEXION TO
ROTATION IS ALTERED DUE TO FACET
SYNDROME.
- CERVICAL SPONDYLOSIS BEGINS WITH
CAPSULAR --RESTRICTION OF THE FACET
JOINTS WITHOUT BONY -CHANGES AND
GRADUALLY PROGRESS TO
CHARACTERISTIC FLATTENING,LIPPING
AND SPURRING OF THE VERTEBRAL BODY.
- ACCELERATED BY INJURY
- BONY STENOSIS OF INTERVERTEBRAL
FORAMEN IS POSSIBLE.
- LOWER CERVICAL SPINE WILL BE
KYPHOTIC
- ACTIVE ROTATION, LATERAL FLEXION TO
PAINFUL SIDE WILL BE RESTRICTED WITH
EXTENSION AS WELL.
- CAPSULAR RESTRICTION IN LOWER
CERVICAL AREA
- MOBILITY IN UPPER CERVICAL AREA IS
GENERALLY QUITE GOOD.
- OSTEOPHYTES STABILIZES THE
VERTEBRAL BODY ADJACENT TO THE
DEGENERATIVE DISC AND INCREASE
THE WT. BEARING SURFACE OF
VERTEBRAL END PLATES.
- CERVICAL MYELOGRAM SHOWS
SPONDYLOTIC CHANGE WITH
OSTEOPHYTIC CHANGE
Acute cervical injuries
 The most common fracture mechanism in
cervical injuries is hyperflexion.
 Anterior subluxation occurs when the
posterior ligaments rupture.
Since the anterior and middle columns remain
intact, this fracture is stable.
 Simple wedge fracture is the result of a pure
flexion injury. The posterior ligaments remain
intact. Anterior wedging of 3mm or more
suggests fracture. Increased concavity along
with increased density due to bony impaction.
Usualy involves the upper endplate.
 Unstable wedge fracture is an unstable
flexion injury due to damage to both the
anterior column (anterior wedge fracture) as
the posterior column (interspinous ligament).
 Unilateral interfacet dislocation is due to
both flexion and rotation.
 Bilateral interfacet dislocation is the result
of extreme flexion. BID is unstable and is
associated with a high incidence of cord
damage.
 Flexion teardrop farcture is the result of
extreme flexion with axial loading. It is unstable
and is associated with a high incidence of cord
 Extension injuries
 Hangman's fracture
Traumatic spondylolisthesis of C2.
 Extension teardrop fracture
 Hyperextension in preexisting spondylosis
'Open mouth fracture'
 Axial compression injuries
 Jefferson fracture is a burst fracture of the ring of
C1 with lateral displacement of both articular masses
.
 Burst fracture at lower cervical level
Thank you.
Debanjan Mondal

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Cervical Spine Biomechanics Explained

  • 1. Biomechanics of Cervical Spine Biomechanics of Cervical Spine Presented By-Debanjan Mondal MPT(Musculoskeletal), BPT, CMT, Ergonomist.
  • 2.
  • 3.  Made up of two anatomically and functionally distinct segments. 1.Superior segment/suboccipital segment- -consist of c1 /atlas and c2/axis -connected to eachother and occiput with complex chain of joints. -having 3 axes and 3 degrees of freedom.
  • 4. 2.Inferior segment- -streching from inferior surface of axis to the superior surface of T1. -In total there are 7 cervical vertebras-  c1-c2 c3-c6 c7
  • 5.
  • 6. Structure of a typical cervical vertebra  Vertebral body-superior plateau is raised on either sides by 2 buttresses.  which is called as unciform process.  It is concave transversely and convex anteroposteriorly-resembling a saddle .  Unciform processes guoides the AP movements during flexion and
  • 7.
  • 8.  Pedicals-connects the vertebral body to the transverse process.  Project posterolaterally.  Lamina-part of the posterior arch  Meets in the midline to form the bifid spinous process  Projects posteromedially and are thin and slightly curved.
  • 9.
  • 10.  Spinous process-short slender and extend horizontally  The tip is bifurcated  Face superiorly and medially  The length of spinous process decreases from c2-c3  C3-c5 remains constant  And undergoes a significant increase at c7.  Vertebral foramen –is large and triangular
  • 11. Transverse process They are peculiar in orientation They are hollowed in to a gutter AP and they point AL. The posteromedial end of the gutter lines the intervertebral foramen. The AL end is bifid
  • 12.  Articular processes-they bear superior and inferior articular facets.  Superior facets face superiorly and medially  Inferior facets face anteriorly and laterally
  • 13.  Structure of a atypical cervical vertebra  Atlas /c1-its ring shaped  Transverse diameter greater than AP diameter  Has two lateral faces oval in shape running obliquely anteriorly and medially  Which bear biconcave superior articulate facet superiorly and medially meant to articulate with occipital condyles
  • 14.  Inferior articular facet –facing inferiorly and medially  Convex AP  Corresponds to superior facet of axis
  • 15.  Anterior arch consist of small cartilagenous oval shaped articular facets for the odontoid process of axis  Posterior arch is initially flattened but becomes thicker posteriorly to form posterior tubercle on the midline.  Transeverse process  No spinous process  No intervertebral disc
  • 16.
  • 17. The axis-is atypicsl  Superior surface of the body carries centrally the odomtoid process which acts as a pivot for atlantoodontoid joint .  Laterally possess 2 articular facets facing superior and laterally  Facets are convex AP and flat transversely  Posterior arch consist of narrow laminae
  • 18.  The cartilage lined inferior articular process corresponds to the superior articular process of c3  Transverse process
  • 19. The atlanto-axial joint complex  it is a plane synovial joint  comprises of 3 mechanically linked joints  The central joint is the atlanto odontoid joint  Two lateral joints-atlanto axial joint
  • 20. Atlantoodointoid joint  it is synovial trochoid /pivot joint  Jointsurfaces-anterior articular facet of odontoid and posterior articular facet of the anterior arch of the atlas
  • 21. Movements at atlantoaxial and atlanto odontoid joint  Flexion-point of contact b/w two convex surface moves forward  interspace of atlanto odontoid joint opens superiorly
  • 22.
  • 23. Extention  Interspace of atlanto odontoid jointopens inferiorly  Radiological findingas does not shoe opening of interspaces  This is due to transverse ligament and keeps the anterior arch and odontoid process in close contact  During flxn and extn tha inferior surface of atlas rols and sides over superior articular surface of axis
  • 24.
  • 25. rotation  Left to right rotation- The left lateral mass of the atlas moves forward  Right lateral mass recedes in rotation from left to right and vice versa from right to left
  • 26.
  • 27. Movement of atlanto occipital joint  Formed b/w superior articular facets of atlas and the occipital condyles.  It is an enarthodrial kind of joint  Gives 3 degrees of freedom  Axial rotation-about vertical axis  Flexion/extension-about transverse axis  Lateral flexion-about AP axis.
  • 28. flexion  The occipital condyles recede on the lateral masses of the atlas.  The occipital bone moves away from the posterior archof the atlas  Limited by tension developed in the articular capsules and
  • 29. extension  Occipital condyles slides anteriorly on the lateral masses of the atlas.  Occipital bone moves neatrer to the posterior arch of the atlas  Posterior arch of the atlas and axis are approximated
  • 30. Lateral flexion  Movement only occurs b/w c0-c1 and c2-c3  Left lateral flexion-slipping of occipital condyles on right of atlas  Right lateral flexion-vice versa  Ther is asmall range of motion  Total ROM-C0-C3=8 degrees  C0-C1=3 degrees,C2-C3=5 degrees
  • 31. rotation  When occiput rotates on atlas its rotation is secondary to rotation of atlas on axis  Around vertical axis passing through the centre of odontoid  Causes right anterior displacement of oright occipital condyle on right lateral mass of the atlas  Lateral atlanto occipoital ligamenr is
  • 32.  Thus rotation of occiput to left is associated with –  Linear displacement of 2-3 mm to the left  Lateral flexion to the right
  • 33. Movements at the lower cervical vertebral column Extension-ovrlying vertebral body tilts and slides posteriorly  IV space is compressed posteriorly and opened wide anteriorly  Nucleus palposus is driven slightly anteriorly  Anterior fibers of annulus fibrosus is streched
  • 34.  Superiorly articulating facet slides inferiorly posteriorly and tilts posteriorly  Limited by anterior longitudinal ligament and by the impact of the posterior arches through ligaments Flexion-upper vertebral body tilts and slides anteriorly  Intervertebral space is compressed anteriorly and opened wide posteriorly  Nucleus pulposus is driven posteriorly
  • 35.  Posterior fibres of annulus fiberosus is streched  Limited by the tension developed in the posterior longitudinal ligament  By the capsular ligament,ligamentum
  • 36. Combined lateral flexion and rotation-  Does not occur as pure motions  Governed by orientation of articular facets which are oblique inferiorly and posteriorly  Rotation is always coupeled with lateral flexion  Considering the whole cervical column from C2-T1 extension component is
  • 37.  Where as any movement b/w C6-C7 also adds up extension component  Thus three composite movement occurs in 3 planes-  Lateral flexion –frontal plane  Extension-sagittal plane  Rotation-transverse plane
  • 38. RANGE OF MOTION JOINT COMBINED FLEXION ONE SIDE ONE SIDE EXTENSION LAT BENDING AXIAL ROTATION C2-C3 10 10 3 C3-C4 15 11 7 C4-C5 20 11 7 C5-C6 20 8 7 C6-C7 17 7 6 C7-T1 9 4 2 FROM- WHITE
  • 39. stability  Cervical region bears less weoight and are more mobile  Stability is provided by bony configuration,muscles,ligamants Muscles-flexion of head and neck-  Depends on anterior muscles of the neck
  • 40.  They are rectus capitis major, rectus capitis minor  Longus cervicis which plays an important role in straightening the cervical column and holding it rigid  Scalene anterior posterior and medius  Suprahyoid and infrahyoid muscles helps in supporting the cervical column at rest  Thry are located at a distance from cervical column  Thus acts via long arm of lever and are
  • 41. Extension of head and neck- Brought about by posterior neck muscles They are0-splenius cervicis,semispinalis cervicis,leavator scapulae,transverso spinalis,longismus capiis,spenius capitis,trapezius These muscles helps in
  • 42.  When contract unilaterally they produce extension rotation and lateral flexion on the same side  Both flexors and extensor group of muscles are responsible to maintain cervical column rigid in neutral position  Essential in balancing the head and in supporting weights carried on head
  • 43.
  • 44.
  • 45. ligaments  Anterior atlnatoaxial ligament,posterior atlantoaxial ligament,tectorial membrane,ligamentum nuchae  Transverse atlantal ligament-21.9 mm in length  Also refered as atlantal cruciform ligament  Holds dense in closed
  • 46.
  • 47.  Also serves as an articular surface for dense  Prevents anterior displacement of C1 on C2 Alar ligaments-arise from axis on either side of dens  Approx.1cm in legth  Are taut in flexion  Axial rotation of head and neck tightens both alar ligaments
  • 48.
  • 49. Apical ligaments-of the dens connects the axis and occioital bone of the skull
  • 50. Biomechanics of cervical injury WHIPLASH INJURY IS DUE TO HIT FROM BEHIND CAUSING 1ST FORCED EXTENSION OF THE NECK FOLLOWED BY FOCED FLEXION OF THE NECK. -2 PHAGES: 1)HYPEREXTENSION OF C5-C6 AND MILD FLEXION AT C0-C4 2)HYPEREXTENSION OF THE ENTIRE SPINE -IF THE HEAD IS IN SLIGHT ROTATION THEN BEFORE EXTENSION IS FORCED TO FURTHER ROTATION CAUSING INJURY TO
  • 51.  LOWER CERVICAL FACET RESPOND WITH SHEAR AND DISTRACTION MECHANISM IN FRONT AND SHEAR AND COMPRESSION IN THE BACK.  DUE TO THE INJURY CAUSE CHANGE IN PIVOT POINT AT C5-C6 CAUSING JAMMING OF THE INFERIOR FACET OF C5 AND SUPERIOR FACET OF C6  C2-C3 FACET IS THE COMMON SITE FOR THE PATIENTS WITH HEADACHE(60%) AND C5-C6 IS THE SITE FOR REFFERED ARM PAIN
  • 52. Facet joint syndrome  FACET JOINT IS A SYNOVIAL JOINT AND BETWEEN TWO FACET JOINT CARTILAGENOUS DISC IS PRESENT, DURING FACET LOCKING SYNOVIAL MEMBRAME AND THE DISC GETS ENTRAPPED BETWEEN TWO FACET BONES.  PAIN IN SIDE FLEXION AND ROTATION TO THE SAME SIDE AND EXTENSION AS WELL.  COUPLING OF LATERAL FLEXION TO ROTATION IS ALTERED DUE TO FACET SYNDROME.
  • 53.
  • 54. - CERVICAL SPONDYLOSIS BEGINS WITH CAPSULAR --RESTRICTION OF THE FACET JOINTS WITHOUT BONY -CHANGES AND GRADUALLY PROGRESS TO CHARACTERISTIC FLATTENING,LIPPING AND SPURRING OF THE VERTEBRAL BODY. - ACCELERATED BY INJURY - BONY STENOSIS OF INTERVERTEBRAL FORAMEN IS POSSIBLE. - LOWER CERVICAL SPINE WILL BE KYPHOTIC - ACTIVE ROTATION, LATERAL FLEXION TO PAINFUL SIDE WILL BE RESTRICTED WITH EXTENSION AS WELL. - CAPSULAR RESTRICTION IN LOWER CERVICAL AREA
  • 55. - MOBILITY IN UPPER CERVICAL AREA IS GENERALLY QUITE GOOD. - OSTEOPHYTES STABILIZES THE VERTEBRAL BODY ADJACENT TO THE DEGENERATIVE DISC AND INCREASE THE WT. BEARING SURFACE OF VERTEBRAL END PLATES. - CERVICAL MYELOGRAM SHOWS SPONDYLOTIC CHANGE WITH OSTEOPHYTIC CHANGE
  • 56. Acute cervical injuries  The most common fracture mechanism in cervical injuries is hyperflexion.  Anterior subluxation occurs when the posterior ligaments rupture. Since the anterior and middle columns remain intact, this fracture is stable.  Simple wedge fracture is the result of a pure flexion injury. The posterior ligaments remain intact. Anterior wedging of 3mm or more suggests fracture. Increased concavity along with increased density due to bony impaction. Usualy involves the upper endplate.
  • 57.  Unstable wedge fracture is an unstable flexion injury due to damage to both the anterior column (anterior wedge fracture) as the posterior column (interspinous ligament).  Unilateral interfacet dislocation is due to both flexion and rotation.  Bilateral interfacet dislocation is the result of extreme flexion. BID is unstable and is associated with a high incidence of cord damage.  Flexion teardrop farcture is the result of extreme flexion with axial loading. It is unstable and is associated with a high incidence of cord
  • 58.
  • 59.  Extension injuries  Hangman's fracture Traumatic spondylolisthesis of C2.  Extension teardrop fracture  Hyperextension in preexisting spondylosis 'Open mouth fracture'
  • 60.
  • 61.  Axial compression injuries  Jefferson fracture is a burst fracture of the ring of C1 with lateral displacement of both articular masses .  Burst fracture at lower cervical level