Have you been involved in an accident, and you have been told you have fractured your neck and you have been placed in a neck collar.I believe you have started wondering how long you will need to wear your neck collar. And what the healing and recovery time frame is.
With my background as a diagnostic radiographer and based on in-depth medical scientific studies, I’m here to provide you with the most useful information on this topic.
Happy reading!😃
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: June 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
Summary: A neck fracture can be one of the most serious and debilitating injuries. The healing time of the c-spine usually takes at least 2 months. It may take several months to fully recover, but a full recovery is also possible.
▶️What are the different types of (neck) cervical spine fracture?
Basic:
The cervical spine is a dynamic structure tasked with protecting the nervous system to the entire body while also maintaining a range of motion for the head and neck.
Our neck is composed of a spinal bone known as cervical vertebrae or c-spine which are 7 in number from C1, C2, C3, C4, C5, C6 and C7 indicated by the letter C.
For example, when we say a C2 fracture, it means the 2nd vertebra from the top is broken. The image below clearly outlines the different 7 Cervical vertebrae bodies.
Image: radiology masterclass.co.uk/gallery/trauma/
During my years of practice, I have seen few c-spine fractures, but this does not mean they do not happen.
Fractures of the cervical spine can be described based on the level involved and typically divided into three groups:
Group 1:
C1 fractures typically result from axial loading.
Group 2:
C2 fractures typically occur due to a combination of compression, hyperflexion, and hyperextension.
Fractures through the C2 dens can be classified as type I, II, or III.
⚫Type I is an avulsion of the tip of the dens.
⚫Type II is a fracture through the base of the dens,
⚫Type III is a fracture extending into the C2 vertebral body.
Group 3:
⚫C3 to C7 Sub axial cervical spine fracture is commonly seen with high impact accidents such as motor vehicle accidents.
All these vertebra bodies can break simultaneously or multiple and when they do, we call them vertebral fractures.
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.
▶️What are the symptoms of a broken neck fracture without spinal cord injury?
⚫You will have localised neck pain and pain radiating to nearby parts of the body even without any activity.
⚫Deformity or twist of your neck.
⚫Edema (swelling) the broke will damage soft tissues which will trigger an inflammatory response which may be accompanied by internal bleeding and bone bruising.
⚫Feeling a headache.
And signs of possible problems in the spinal cord.
🟤Tingling: you might feel pins and needles which might occur in almost any part of the body
🟤 Altered mental status, trouble breathing and swelling, head injury, or neurological deficit.
🟤 Numbness, you may loss sensation particularly with the injury.
🟤Muscle weakness in your legs, arms back and abdominal muscles
🟤Reduction of bladder and bowel control, you may find it difficult to hold back urine or stool.
What to take from this: Spinal cord injuries remain relatively rare and even when you are told you have injured your spinal cord, it is sometimes possible to recover 100% yes it may take longer than normal.
▶️What is the diagnosis for a cervical spine injury?
X-ray will be the first line of imaging to check for any fractures especially if it’s not traumatic.
Computed tomography (CT) is then preferred in acute spine trauma as it is more sensitive for detection of bony cervical spine injury when compared to x-ray imaging.
CT scan showing A fracture at the den (B) fracture of the C3 vertebral body.
MRI will be used to assess further evaluation of ligamentous structures of the spinal cord and to determine spinal stability and in planning surgical treatment if needed.
▶️Can a fracture of the cervical spine be overlooked?
I often hear this question from people who have suffered whiplash or other neck injuries who sometimes wonder if a c-spine fracture can be overlooked.
Cervical spine fractures are high-risk injuries with the potential for devastating nervous systems.
That’s why the diagnosis and management of c-spine requires a trained interprofessional team which includes a spine specialist, physician, radiologist, orthopaedic surgeon and nurses who carry out subsequent evaluation and treatment.
The answer is NO, although it is never 100% certain in medicine, it is very rare to say that a cervical spinal fracture was overlooked because usually a thorough clinical and radiological evaluation in any patient is done by doctors.
Even when in doubt, further imaging studies such as computed tomography or magnetic resonance imaging are often required to rule out a fracture.
▶️What are the treatment and management options of cervical fractures?
Treatment approaches for vertebral fractures will vary depending on the fracture location, fracture pattern, and associated neurologic deficits.
We should understand that the neck fractures do not always mean spinal cord damage and with effective immediate treatment you can recover from your injury quicker than you think.
Conservative options based on your case:
Case 1:
The most common fractures of the c-spine are injuries on C1 and C2. These fractures usually occur through the lateral arch in a single or multiple places and are said to compose approximately 30% of neck fractures.
Statpearls 2023:
If no spinal cord region is involved, these kinds of fractures are managed in a rigid cervical collar or halo if no ligaments are involved.
You may be immobilised for 4 weeks to 3 months with a follow up x-ray to assess the healing process.
Your neck will feel pain and stiffness, which may take several weeks or months to recover. There is usually not permanent damage.
These types of stable c-spine vertebral injury will have a very high likelihood for full recovery with the right treatment.
Also, unstable fracture to the vertebrae that has not affected the spinal cord can also be expected to mend well in a healthy person, with careful management.
Case 2:
Immediately after an injury that affects the spinal cord, there is likely to be some shock and inflammation affecting the function of the nerves. or your spinal cord may be compressed by a hematoma affecting the nerve root.
You may have sensory loss and may find it difficult to move certain body parts. This usually returns to normal within weeks to months. This can improve with time.
So, the immediate effect of an injury to the spinal cord is not always a good predictor of the lasting impact.
Case 3:
Your spinal code was partially injured causing you partially numb or paralysed areas of your body.
Here your motor skills and sensation may improve over months and years.
Case 4:
The spinal code is completely injured, some body parts like legs and arms are completely paralysed or numb.
This kind of injury usually takes longer rehabilitation and recovery. You may need specialised home care assistance with daily living needs for some time.
However, serious damage to the spinal cord, especially where the nerves are partially or totally severed or crushed, will not be expected to resolve.
▶️Why use a hard neck cervical collar:
🟧It will help you to limit movement of your neck. The collar does not prevent all movement within your neck, it just limits it.
so, it is important you are aware of your posture and ensure the collar is fitted tight enough to give your neck the support it needs.
🟧The collar will maintain your neck in the proper position while it is healing.
The collar should always be kept on unless you have received different instructions from your nurse, physiotherapist, or consultant.
The only time you are allowed to remove your collar is when you are cleaning it and checking your skin. Because If the collar is not tight enough or not cleaned, it can rub and cause pressure sores or skin irritation.
🟧Wearing a collar may cause some weakness to your muscles around your neck because of the slight movement.
However, when you no longer require your collar, you will need a physio-therapist to help with your muscle strength.
🟧Bathing and showering are not permitted unless you are given special instruction from your health care team.
▶️When is surgery necessary?
Sometimes you may need surgery if your doctor thinks your fracture is unstable and it will not heal well with a neck collar immobilisation.
When your fracture has bone fragments which are unstable, they can move if not treated. If that happens, it can damage the spinal cord, which can cause pain, paralysis, or even death.
A lot of damage to your neck, spine, and the vertebrae may need surgery. Your fracture will be reduced and stabilised by putting plates, pins, and screws.
A common surgical technique used is open reduction and internal fixation (ORIF) with pedicle screws and concurrent fixation.
Which will help to:
🟡Reconnect pieces of bone and hold them in place.
🟡Repair vertebrae on your spine
🟡Relieve pressure on your spinal cord!
🟡Remove damaged vertebrae discs!
🟡Some surgeries may include using plates, screws, or wires.
Sometimes these plates can stay in the body for life or be removed after a few months or years.
Images of a c-spine operation
You will also require additional orthopaedic treatment and physiotherapy rehabilitation after treatment.
▶️Is it safe to walk with a neck brace?
Walking does not usually aggravate a broken neck if it has been identified that the fracture is stable.
In such a situation you can walk once the diagnosis has been made and all examinations have been carried out.
However, you will receive individual instructions from your medical team before you start walking.
In cases where the spinal cord is affected, walking sometimes will be impossible due to paralysis.
Caution! Not being able to turn or shake your head may seem unusual, but limiting the motion of your neck is an important part of your treatment and will help prevent further damage.
so it’s important you avoid walking in the beginning of your treatment until you feel you are fit enough to go back to your normal activities.
▶️Possible complications of neck fractures after treatment.
You may experience frequent neck pain accompanied or not by stiffness.
Also, some scientific studies do identify other chronic obstructive pulmonary medical conditions such as osteoporosis, diabetes mellitus and muscle weakness to be risk factors for 30-day mortality after ORIF of vertebral fractures.
Recognizing these risk factors is important in pre-operative risk stratification, peri-operative care, and patient counselling.
▶️When to stop wearing your collar
The collar is usually worn for a period of 12 weeks to support your neck and prevent movement around the injury site, but this can alter depending on your healing rate and your consultant’s opinion.
After your final X-ray you will be advised if your bones have healed sufficiently for you to be able to remove the collar.
The specialist nurse or physiotherapist will discuss this with you and give you further instruction to help with your recovery.
You will be advised to wean yourself from the collar gradually to prevent sudden strain on your neck and to help to strengthen your neck muscles slowly to minimise discomfort.
You may feel stiffness initially in the affected part of the neck when you start to wean the use of your collar. This is normal and will improve as your activity levels increase.
Many patients regain the movement in their neck through natural recovery and gentle movement throughout the day.
Some people require further input and will be referred to physiotherapy to help improve the mobility of the neck. This will be decided after your review by your doctor.
Once out of the collar, you should try to maintain a good upright posture. The collar will have supported you up until this point and slumping will cause additional strain on your muscles.
Heavy lifting should be avoided and return to activity should be controlled. If you have any specific activities, you wish to return to please ask your physiotherapist for advice.
▶️ What is the healing or recovery time for a broken cervical spine?
A neck fracture can sometimes result in spinal cord and nerve injury and paralysis. This may require major life changes, involving work, family, and social life. And the healing time will differ from everyone.
What do we mean by healing and recovering?
Healing time is the period during which the fractured bone repairs and heals. The bone will bond to form a strong union.
Recovery time is both bone consolidation and restoration of normal function and elimination of any symptoms you might have.
It means restoration of your mobility, strength and complete soft tissues recovery surrounding the fractured vertebra.
Note: Healing time is usually longer than consolidation time and can take several months.
Everyone’s healing times are a little different depending on underlying general health and medical conditions.
If your fracture is stable and supported by a neck brace you can expect to take the brace off safely after around 8 weeks.
If your fracture is unstable, fracture will need treatment which keeps the neck bones fully stabilised while they heal.
A more rigid type of brace known as a halo vest will be used to stabilise the head and neck relative to the shoulders and chest, providing very good stability while bones knit together.
The halo vests are usually in place for around 12 weeks, with regular follow-up visits to ensure correct positioning.
Useful timeline
| Useful timeline | Duration. |
| Your vertebrae begin to consolidate well | 6-8 weeks |
| Your experience less painSome people complain of pain when they lay on their back which is not a sign of prolonged recovery. | A few days to a few weeks |
| You neck collar is removed | After 8 weeks |
| You resume walking. For Severe spinal cord injuries | Immediately if you have no spinal cord problems.Timelines may vary from a few days so several months or even years if you have spinal code issues. Sometimes walking may never be resumed. |
| You have fully recovered no more pain in the neck, shoulder mobility and muscle strength | Without spinal cord issues 2 to 3 months or several months.For some people up to a year or more with spinal cord problems. |
Conclusion: Spinal cord injury management continues to be at the forefront of medical research, and the treatment and prognosis are improving all the time.
So, be rest assured that your road to recovery is looking positive. Wishing a quick recovery.🙋
Hope I have answered some of your common questions. Below are the scientific publications I have relied on to write this article.
Questions and comments are welcome.
📚Sources :
Joseph H. McMordie; Vibhu Krishnan Viswanathan; Christopher C. Gillis. Cervical Spine Fractures Overview
Fehlings MG, Tetreault L, NaterA, Choma T, Harrop J, Mroz T, Santaguida C, Smith JS. The Aging of the Global Population: The Changing Epidemiology of Disease and Spinal Disorders. Neurosurgery. 2015 Oct;77 Suppl 4:S1-5. doi: 10.1227/NEU.0000000000000953. PMID: 26378347.
Hussain M, Javed G. Diagnostic accuracy of clinical examination in cervical spine injuries in awake and alert blunt trauma patients. Asian Spine J. 2011 Mar;5(1):10-4. [PMC free article] [PubMed] [Reference list]
Ye IB, Girdler SJ, Cheung ZB, White SJ, Ranson WA, Cho SK. Risk Factors Associated with 30-Day Mortality After Open Reduction and Internal Fixation of Vertebral Fractures. World Neurosurg. 2019 May;125:e1069-e1073. doi: 10.1016/j.wneu.2019.01.247. Epub 2019 Feb 18. PMID: 30790742.
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.
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
Harris MB, Reichmann WM, Bono CM, Bouchard K, Corbett KL, Warholic N, Simon JB, Schoenfeld AJ, Maciolek L, Corsello P, Losina E, Katz JN. Mortality in elderly patients after cervical spine fractures. J Bone Joint Surg Am. 2010 Mar;92(3):567-74. doi: 10.2106/JBJS.I.00003. PMID: 20194314; PMCID: PMC2827825.