Traumatology >>>> Dislocation of the cervical vertebra

Dislocation of the cervical vertebra.

The prolapse of the capsule of the cervical vertebra (or dislocation of the cervical vertebra) is not a frequent phenomenon among the total number of skeletal injuries, but sometimes it puzzles many doctors of non-core specialties who first encounter a problem of this nature (especially if the injury is received in a domestic environment), and leads to incorrect setting diagnosis, and therefore the wrong treatment. A person who has received this kind of trauma has many questions and concerns about what happened. Therefore, it makes sense to explain the causes, consequences and methods of treatment for this injury.

How does the dislocation of the cervical vertebra occur?

The structure of the spine in the cervical spine is such that it provides its mobility through a special articulation of the joint formed by the vertebra itself, the intervertebral disc and the intervertebral ligaments: each superior vertebra is articulated with the inferior vertebra in the form of a capsule of the intervertebral joint. All seven vertebrae of the cervical spine are strung alternately on top of each other. The entire structure is held by the tendons and muscles of the neck in such a position that the vertebrae can move within certain boundaries, indicated by their intervertebral joints, but not go beyond these boundaries. The fairly flexible structure of the vertebral joint allows them to mix in such a way that a person can tilt his head forward, slightly backward, and sideways. The tension of the tendons and ligaments does not allow the vertebrae to move up, but in situations where when there is an overstretching of the ligaments (forced or involuntary pulling) that hold the vertebrae within their joints, at the time of an unsuccessful turn or tilt of the head (neck), a gap forms between the vertebrae, which allows the capsule of the joint of the superior vertebra to leave its location. Dislocation occurs, and the superior vertebra is considered dislocated.

In this case, the head is no longer held by the spine, but by the tendons and muscles. The head begins to tilt to one side or forward, and the more time has passed since the moment of injury, the stronger this tilt becomes. It is not possible to raise the head from the "lying" position of the body without the participation of the hands supporting it. This position of the head is called in medicine a symptom of "guillotination", since in fact the head begins to "dangle" on the neck, not attached to it by anything other than tendons and muscles. This is the danger of a prolapse of the cervical vertebra, which, in the worst case, can lead to severe neurological complications or damage to the spinal cord.

Dislocations of the cervical vertebrae are of varying degrees of complexity (from partial to complete displacement of the vertebra or weighed down by the interlocking of the vertebrae between themselves by the processes) and possible localizations of injury (more often 3-7 vertebrae are displaced).

Causes of dislocation of the cervical vertebrae.

The most common causes of dislocation of the cervical vertebra are associated with road traffic accidents, when sudden braking occurs and a person involuntarily jerks his head in the anterior-posterior or lateral direction, which allows the inter-articular ligaments to stretch and simultaneously displace the vertebra.

An unsuccessful fall upside down with neck bending also causes the vertebral capsule to fall out.

Diving with the head hitting the bottom and bending the neck can provoke a dislocation of the cervical vertebra.

Failed somersaults can lead to this kind of injury.

Flexion of the neck during sleep, followed by a sharp rise of the head can lead to dislocation of the cervical vertebra.

Excessive flexion of the neck when tilting the head can cause the cervical vertebra to prolapse.

Dislocation of the cervical vertebra – signs.

The most obvious signs of dislocation of the cervical vertebra for an injured person are arbitrary positions of the head relative to the body with its various inclinations that do not depend on the person's desire, determined by the type of injury. With unilateral incomplete dislocation, the head tilts to the side opposite to the displacement of the vertebra. With a complete unilateral dislocation of the vertebra, the head tilts towards the displacement of the vertebra. With bilateral dislocation of the vertebra (in cases of excessive bending of the neck), the head tilts forward and, as it were, moves in the anterior direction.

Any dislocation of the cervical vertebra is accompanied by pain due to the fact that the ligaments of the cervical spine are certainly stretched. And the more time passes, the more painful sensations become. A person cannot lie with his head on a horizontal surface, since this position of the head begins to be accompanied by severe aching pains. It is also impossible to control turning and raising the head (only with support from the hands). If you need to turn your head, you have to turn around with your whole body.

Other unpleasant sensations can be added to the pain symptom: a crunch when moving the head, headache, dizziness, darkening in the eyes. Sometimes the pain radiates to the shoulder, arm. Very often, pain and the impossibility of turning the head without an attack of pain misleads doctors of non-core specialties and patients who are in a hurry to see a doctor of the wrong profile (for example, they assume myositis and go to a neurologist for treatment, or when visiting a general practitioner, they receive a referral to a neuropathologist who puts diagnosis "myositis"). The correct solution would be to contact either a traumatologist or a chiropractor (vertebrologist), since the dislocation of the vertebra will require its reduction, which only these doctors can do. On the roentgenogram, the dislocation of the cervical vertebra may be clearly invisible, but the roentgenogram shows a displacement of the head relative to the cervical spine, which should suggest a dislocation.

Untimely access to a doctor can lead to contractures of tendons and muscles, their traumatic overstretching and further loss of the ability to return the ligamentous apparatus to its previous position. This will give the neck a stable curved position and a constant position for the head in a tilted state.

Dislocation of the cervical vertebra – treatment.

Depending on the severity of the dislocation, the reduction of the vertebra is carried out under anesthesia, with local anesthesia or without anesthesia at all. In the case when the doctor does not offer anesthesia, he will be guided by the results of the reduction and for this he needs to know the patient's feelings. The doctor sets the uncomplicated dislocation of the cervical vertebra as follows:

Puts the patient on a chair,
Warns of necessary manipulations and short-term pain sensations,
It makes you relax and, as it were, load your whole body on the chair, then, holding the patient by the head from the sides, begins to raise him above the chair, but so that the patient's body creates a natural counterweight, and the patient himself does not rise. This creates conditions for forced stretching of the ligamentous apparatus of the cervical spine, and a gap appears that allows the vertebra to be put in place.

The manipulation is carried out until the vertebra returns to its previous position (usually one to three times), and the doctor is convinced that the patient can control the turns and tilts of the head. The procedure is carried out in one session.

Further treatment of stretching of the ligamentous apparatus of the cervical spine involves physiotherapy to relieve the inflammatory process in the tissues. You can warm up the muscles of the cervical spine at home using hot salt sealed in a bag, or a heating pad. Since the patient may feel painful symptoms for three months when turning and tilting the head, it is recommended to wear a special collar that fixes the head and neck, or to wrap the neck with a suitable cloth in several layers to restrict movement in the area of the cervical muscles.