Can you help me understand a neck injury my husband got from a horseback riding accident? The surgeon says it's a moderately severe fracture of C34 and surgery is needed. They won't be able to tell until they do surgery how unstable it is. What makes a fracture moderately severe and/or unstable? I didn't really want to ask too many questions in front of my husband in case it's worse than we thought.

Posted September 24th, 2009 by Matt

Spine Cervical

Your desire to protect your husband, the patient is very admirable. Given the stress of the accident and preparation for the upcoming surgery, a low key approach is often needed for the involved individual. But questions like this are appropriate and the information important to family members trying to plan ahead.

Cervical spine injuries from trauma are not uncommon but their management isn't standard. In other words, one treatment doesn't work for everyone with this type of injury. The severity of the injury dictates the treatment.

An unstable cervical fracture suggests that the bones have separated at the fracture site. We call this a displaced fracture. There may or may not be torn or ruptured ligaments, which adds to the instability. It's difficult to tell how much soft tissue damage there is until the surgeon gets inside the surgical site and takes a closer look.

The goal of treatment is to put the bones back together as close to normal as possible and keep them there during the healing process. The hope is to avoid further displacement and minimize any neurologic damage (to the spinal cord and spinal nerve roots). Fractures can occur in any of four major anatomical locations of each cervical vertebra. Sometimes there's more than one fracture.

All of these variables determine the severity of the injury and the need for surgery to stabilize (hold the spine together) the neck until healing can take place. Don't hesitate to contact the surgeon at a time when you can speak with him or her privately to find out the extent of the injury and anticipated surgery.

Scott W. Zehnder, MD, et al. Teachability and Reliability of a New Classification System for Lower Cervical Spinal Injuries. In Spine. September 1, 2009. Vol. 34. No. 19. Pp. 2039-2043.

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