A neck fracture can be one of the most serious and debilitating injuries a person can suffer, but what does it mean to fracture or break your neck, and what are the symptoms, treatment, and prognosis?
All about the neck
To understand how a neck fracture can affect somebody, it’s helpful to understand a little about the form and function (anatomy and physiology) of the neck.[i]
There are seven spinal bones (vertebrae) in the neck; these are known as the cervical vertebrae, and are numbered c1 down to c7, beginning at the base of the skull. The spinal vertebrae play two main roles in the body – they provide structure and allow the body to move appropriately, and they protect the spinal cord. Each vertebra has a hole through it meaning that the spinal column has a channel running through the length of it which houses and protects the spinal cord.
The spinal cord is a long bundle of nerves which takes messages to and from the brain, and is responsible for physical impulses, bodily control, movement and sensation. A pair of nerves extends from the spinal cord at each vertebra, controlling specific areas of the body. If the spinal cord is injured, some or all of the signal pathways going between the brain and the body below the point of injury are broken, resulting in loss of function, movement and sensation. Read more about complete vs incomplete spinal cord injuries here…
What does it mean to fracture your neck?
A ‘neck fracture’ usually refers to a fracture in one of the cervical bones; it does not necessarily mean that there is injury to the spinal cord. A fracture to the c-spine vertebrae is nearly always the result of trauma, such as a car accident or serious sports injury.[ii] Non-traumatic or low-impact c-spine injuries are rarer, and where they do occur they tend to affect people who are frail and elderly, and those with underlying conditions affecting the bones, such as severe osteoporosis.[iii]
Having one or more fractured cervical vertebrae can be referred to as a neck fracture, but that isn’t a very useful term as there is such a wide range of extent and impact of a ‘neck fracture’. A fracture may be stable, where appropriate treatment can help keep the bones in place thus avoiding damage to the spinal cord. It may be unstable, where the bones are likely to move and cause further damage without effective treatment. Damage to the bony structures of the neck does not always affect the spinal cord, but where the spinal cord is damaged there can be an extreme range in the impact and treatment of the injury, so it’s important to be clear about the exact position and extent of the injury. Those facing severe spinal cord damage will most likely require a tailored package of complex care at home to support them in their day to day life.
Symptoms of a neck fracture
As a neck fracture is usually the result of a traumatic injury, there are immediate symptoms that can vary depending on the nature of the event leading to the injury. There may be loss of consciousness, but people who remain conscious throughout can experience a number of symptoms immediately after the event:
- Pain – Breaking a bone can be very painful, and a spinal bone in particular can cause pain both at the site and radiating to nearby parts of the body.
- Numbness – loss of sensation occurs particularly with injury or swelling impacting the spinal cord or nearby nerves.
- Tingling – an injury which affects nerves can cause different sensations such as tingling or a feeling of pins and needles. These can occur in almost any part of the body depending on the position and severity of the injury, and don’t necessarily occur in a predictable pattern.
- Swelling – broken bones and damaged soft tissue trigger an inflammatory response and may be accompanied by internal bleeding and bone bruising. An injury to the spine can have a significant amount of swelling, both deep internal swelling and shallower palpable or visible swelling. Some of the symptoms of neck injury can resolve somewhat as swelling settles.
- Trouble breathing – a suspected neck injury should always be treated as a medical emergency, and when accompanied by breathing problems can become critical very quickly.
There are a few different reasons why someone might feel short of breath after a serious injury, some more serious than others. A high spinal cord injury can affect the way we use the muscles that are responsible for breathing and diaphragm control, and people with high spinal cord injuries often need to have long-term respiratory support.[iv]
- Difficulty moving – someone with a high spinal injury should be immobilised immediately after the event, so shouldn’t try to move around at all. An injury which affects the spinal cord can have a profound impact on movement, and a total spinal cord injury means no control over movement in any part of the body below the level of injury. Partial spinal cord injuries, or short-term injury caused by swelling can impact movement in different ways, positions, and to different degrees.
Can a neck fracture heal?
Broken bones can heal, but there is currently no reliable way of mending severed nerves.
A stable c-spine vertebral injury that hasn’t affected the spinal cord will have a very high likelihood for full recovery with the right treatment. An unstable fracture to the vertebrae that has not affected the spinal cord can also be expected to mend well in a healthy person, with some very careful management.
Immediately after an injury that affects the spinal cord, there is likely to be some shock and inflammation affecting the function of the nerves. This can improve with time and treatment so the immediate effect of an injury to the spinal cord is not always a good predictor of the lasting impact. However, serious damage to the spinal cord, especially where the nerves are partially or totally severed or crushed, will not be expected to resolve.
Spinal cord injury management continues to be at the forefront of medical research, and the treatment and prognosis are improving all the time.
Treatment for a neck fracture
The kind of treatment offered for a neck fracture depends on the extent and nature of the injury, and may also be guided by the underlying health of the affected person.[v]
The immediate management of a suspected neck fracture is crucial; a fracture does not necessarily injure the spinal cord, but moving somebody with an unstable break can cause broken bones to shift which can cause damage, or further damage, to the spinal cord. Anyone with a suspected spinal injury needs emergency medical treatment. Paramedics and Accident and Emergency departments have special equipment for immobilising people with spinal damage to prevent movement of fractures; a suspected spinal injury should be presumed to be unstable and immobilised until proven otherwise.
Bony fractures can be identified by x-ray in hospital, but more detailed information about damage to nerves and soft tissues requires a CT or MRI scan.
After the immediate stage of stabilising and managing the injury, medical and surgical teams will use a combination of patient input, physical examination, and medical imaging to inform the course of treatment. When teams have more information about the placement and extent of the damage and the underlying health and ability of the patient, they can tailor treatment to meet individual needs and wishes.
Neck fractures fall into one of several categories depending on the position and character of the fracture within the neck, and different types of injury require different types of treatment.[vi] Broadly, management for cervical vertebral injuries varies depending on whether the fracture is stable or unstable, and may be conservative (non-surgical) or surgical.
A neck fracture which has caused damage to the spinal cord requires complex treatment. The bony injury needs to be stabilised and managed alongside special care to manage the impact of a damaged spinal cord. Someone with a new spinal cord injury will usually be managed initially in an intensive care unit, either in an acute hospital setting or in a specialist spinal unit. A high spinal cord injury can cause permanent total or partial loss of nerve function, with accompanying loss of motor and sensory ability to the body below the level of injury. The impact, treatment and prognosis for someone with a spinal cord injury is complex and requires a carefully tailored approach from a specialist team.
Some cervical spine injuries can be surgically managed, which involves surgically realigning the spine and stabilising it with surgical fixing devices like pins and plates. Surgery for a c-spine injury where the spinal cord has been affected also aims to decompress the nerve tissue. Where surgical interventions are medically indicated for spinal fractures, they can have excellent results.[vii]
How long does it take for a neck fracture to heal?
Everyone’s healing times are a little different, depending on underlying general health and medical conditions, but all being well, a person with a stable fracture supported by a neck brace can expect to take the brace off safely after around 8 weeks. Treatment for a vertebral fracture can be led by a combination of medics and orthopaedic surgeons, with specialist nurses and physiotherapists. Follow-up for a simple fracture may be in-person or increasingly at a ‘virtual’ clinic – this is where further medical imaging is reviewed by specialists and if there are no concerns, following consultations may be by telephone or video.
Someone with an unstable fracture – one that might cause more severe damage if not carefully immobilised – will need treatment which keeps the neck bones fully stabilised while they heal. This can involve a more rigid type of brace known as a halo vest which stabilises the head and neck relative to the shoulders and chest, providing very good stability while bones knit together. Halo vests are usually in place for around 12 weeks, with regular follow-up visits to ensure correct positioning and avoid complications.
Some underlying conditions can affect the amount of time it takes for fractures to heal; osteoporosis in particular tends to increase the healing time for bony injuries, and other medical conditions including vascular disease, diabetes, or malnutrition.
Damaged vertebrae; damaged spinal cord?
The phrase ‘neck fracture’ is highly emotive and people are likely to associate the phrase with an injury that is always profoundly debilitating or fatal. In reality, the impact that a fractured cervical vertebra or vertebrae can take many forms. The impact of a c-spine injury is on a spectrum of effect, variable and individual. A neck fracture – fractured c-spine vertebra – does not always mean spinal cord damage, and with effective immediate care further damage from a simple bony injury can be prevented.
Recovering from a neck injury
An injury to the bones of the neck will require a period of stabilisation with a high degree of caution over physical activity. Follow-up appointments with further imaging can confirm healing and guide people resuming normal activities. A period of time in a neck brace can affect muscle tone so specialist physiotherapists can recommend exercises to increase muscle strength and range of movement after time in a neck brace or after spinal surgery.
A neck injury that affects the spinal cord may have a profound and permanent effect on movement, sensation, and function. The rehabilitation: physiotherapy, physical and emotional support, lifestyle modifications and sometimes very complex care, can last a lifetime. On the other hand, a stable injury affecting only the bones of the neck can be expected to heal well.
The immediate management of a neck injury can make a huge difference to the overall outcome, and getting the right help is key. After the emergency care and stabilisation period of a neck fracture, some people need a short period of extra care to support them while their movement and ability is temporarily restricted. People with high spinal cord injuries resulting in problems with mobility, sensation, and breathing function will need extra support, specialist care and equipment, often for the rest of their lives. Complex care needs can increasingly be met with support and appropriate equipment at home, and people with even the most profound injuries can expect adjustments to help them live full and fulfilled lives.
[i] Bogduk, N. (2016). Functional anatomy of the spine. Handbook of clinical neurology, 136, 675-688.
[ii] Passias, P. G., Poorman, G. W., Segreto, F. A., Jalai, C. M., Horn, S. R., Bortz, C. A., … & Lafage, V. (2018). Traumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013. World neurosurgery, 110, e427-e437.
[iii] Torlincasi AM, Waseem M. Cervical Injury. (Updated 2021 Nov 7). StatPearls, Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK448146/
[iv] Berlowitz, D. J., Wadsworth, B., & Ross, J. (2016). Respiratory problems and management in people with spinal cord injury. Breathe (Sheffield, England), 12(4), 328–340. https://doi.org/10.1183/20734735.012616
[v] Yelamarthy, Chhabra, H. S., Vaccaro, A., Vishwakarma, G., Kluger, P., Nanda, A., Abel, R., Tan, W. F., Gardner, B., Chandra, P. S., Chatterjee, S., Kahraman, S., Naderi, S., Basu, S., & Theron, F. (2019). Management and prognosis of acute traumatic cervical central cord syndrome: systematic review and Spinal Cord Society—Spine Trauma Study Group position statement. European Spine Journal, 28(10), 2390–2407. https://doi.org/10.1007/s00586-019-06085-z
[vi] Nemani, V. M., & Kim, H. J. (2014). The Management of Unstable Cervical Spine Injuries. Clinical Medicine Insights: Trauma and Intensive Medicine. https://doi.org/10.4137/CMTIM.S12263
[vii] Dobran, M., Iacoangeli, M., Nocchi, N., Di Rienzo, A., di Somma, L. G., Nasi, D., Colasanti, R., Al-Fay, M., & Scerrati, M. (2015). Surgical treatment of cervical spine trauma: Our experience and results. Asian journal of neurosurgery, 10(3), 207–211. https://doi.org/10.4103/1793-5482.161192
