Axial loading injuries to the middle cervical spine segment

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Abstract
Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamen tous structures are rare. We present 25 cases of trau matic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level differ from those involving the upper (C1-C2) and lower (C4-C5- C6-C7) cervical segments. Specifically, the C3-C4 le sions appear to be unique with regard to the infre quency of bony fracture, difficulty in effecting and main taining reduction, and a more favorable recovery follow ing early, aggressive treatment. In the majority of instances, injury at this level results from axial loading of the cervical spine. Lesions were distributed into specific categories: 1) acute intervertebral disc hernia tion (N = 4), 2) anterior subluxation of C3 on C4 (N = 4), 3) unilateral facet dislocation (N = 6), 4) bilateral facet dislocation (N = 7), and 5) fracture of vertebral body C4 (N = 4).