C3-C7 would constitute lower cervical spine. Lower cervical spine fractures and dislocations are common injuries following major trauma.
Fractures of C6 and C7 account for nearly 40 percent of cervical spine injuries after blunt trauma.
Spinal cord damage is more frequently associated with lower cervical spine injuries than upper.
Age Distribution
Injuries most common in adolescents and young adults (15 – 24 years and middle-aged (>55 years)
Prehospital Care
The cervical spine injuries should be considered to be having cord injury untill ruled out. Moreover the cervical spine injury should be suspected in every major trauma.
Manual immobilization of the head and neck should be maintained until a hard cervical collar can be applied.
Airway security and hemodynamic resuscitation are crucial and should take prcedence. Tracheal intubation and central line placement are often performed in the emergency and due to danger of worsening of injury by manipulation, manual cervical stabilization should be maintained throughout the intubation process.
If intubation is not possible, a mask ventilation can be continued until fiberoptic or nasotracheal intubation can be safely performed in a hospital.
Cricothyroidotomy might be the safest alternative for airway control when spine is highly unstable.
Hospital Care
Initial assessment of the ABCs (airway, breathing, and circulation) should be performed and life-saving procedures initiated.
Before removing the collar, the cervical spine should be manually immobilized. Log-roll technique and spinal precautions should be observed at all times.
Maintaining a patent airway and hemodynamic stability are crucial and help in minimizing further ischemia to a compromised spinal cord.
Agressive manipulation of the neck in order to perform intubation should be avoided.
Neurogenic shock when present should be recognized and managed.
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