May 30, 2024

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

Cervical sprain

Ligament Injury:

The two common mechanisms for ligamentous injuries are:

  1. Antagonist’s muscles are stretched beyond this anatomical length and their fiber are torn
  2. 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 SprainModerate sprainSevere 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