Spine trauma: Subaxial cervical spine (c3–c7)

The subaxial cervical spine (C3–C7) provides the majority of forward and lateral neck flexion and almost 50 % of cervical rotation. Over 75 % of all cervical spine injuries in adults occur in the subaxial region, and C5–C6 is the most frequently injured level. Injuries include fractures, subluxations, dislocations, and ligamentous tears, each of which can be isolated or can occur in conjunction with one another. Suspected cervical spine trauma should be screened with thin-cut axial CT from the occiput to T1 with sagittal and coronal reconstructions. General management involves early cervical immobilization and closed reduction of the injury whenever possible, then operative or nonoperative stabilization. Treatment is based on the mechanism of injury, neurologic deficit, spinal column alignment, type of bony injury, and expected long-term stability. Missing a cervical injury on initial evaluation can result in delayed treatment, instability, and permanent neurologic deficit.