A cervical sprain is an acute painful neck resulting from an injury or disruption of the supportive soft tissue of the cervical spine
The degree of injury varies from the slight separation of a few fibers to complete disruption of the ligaments of the cervical spine
The cervical Spine is completely encircled by layers of muscles that enables neck movements while maintaining the stability of the cervical spine. So, any disruption of the muscles and ligaments will cause an imbalance in the cervical spine
Relaxation position of Cervical spine is lordotic
Ligament Injury:
The two common mechanisms for ligamentous injuries are:
- Antagonist’s muscles are stretched beyond this anatomical length and their fiber are torn
- The range of movement permitted by bony anatomy is exceeded and tension stress brought to bear on ligamentous structures
In hyperflexion injury, ligamentum nuchae are torn
In flexion-distraction injury, the tear may extend deeply to involve the capsular structure of the posterior facet and the annulus and permit the cephalad to displace forward
Most common injury is acceleration-decceleration injury
Classifications of cervical sprain
| Mild Sprain | Moderate sprain | Severe sprain |
| Involves muscles, Symptoms last (a few days to weeks) Muscles are affected and tender | Muscle + supporting ligaments, Symptoms last within hrs The pain becomes more severe and intense muscle spasms | Complete interruption of ligaments Injury to ligaments can also displace bony part Pain and weakness of neck/head to hold |
Investigations for cervical sprain
Lateral X-rays show straightening of the cervical spine
- Once no bony elements are intact
- Bending lateral radiographs will show slippage of one vertebra over another
- Ligamentous injury is seen in MRI
Treatment options for cervical sprain
Mild
- Usually, no treatment is necessary
- Bed rest with firm support ( rolled-up towel behind the neck)
- Hot pack
Moderate to severe
After the acute phase subsides (within a few days), the patient is allowed to ambulatory with a cervical collar and applied till all movements can be performed painlessly
In very severe cases which is due to extensive ligamentous disruption, extreme caution should be done to prevent displacement
(Neck should be supported initially with the brace)
If MRI/ Bending views if ligamentous disruption is seen then standard surgical stabilization is performed
‘Anterior cervical discectomy with plates at affected segment’ via Smith-Robinson approach
