Approximately 5-10% of unconscious patients who present to the ED as the result of a motor vehicle accident or fall have a major injury to the cervical spine. Most cervical spine fractures occur predominantly at 2 levels. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7. Most fatal cervical spine injuries occur in upper cervical levels, either at craniocervical junction C1 or C2.
Cervical spine injuries are best classified according to several mechanisms of injury. These include flexion, flexion-rotation, extension, extension-rotation, vertical compression, lateral flexion, and imprecisely understood mechanisms that may result in odontoid fractures and atlanto-occipital dislocation.
When a cervical spine injury is suspected, minimize neck movement during transport to the treating facility. Ideally, transport the patient on a backboard with a semirigid collar, with the neck stabilized on the sides of the head with sand bags or foam blocks taped from side to side (of the board), across the forehead.
If spinal malalignment is identified, place the patient in skeletal traction with tongs as soon as possible , even if no evidence of neurologic deficit exists.


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