A C6 fracture involves the sixth bone of the cervical spine, the seven vertebrae that make up the neck. This area houses the cervical spinal cord, the bundle of nerves that transmits signals between the brain and the rest of the body. A fracture at this level is serious because displacement of broken bone fragments can compress or sever the spinal cord, potentially leading to immediate neurological damage.
Understanding the C6 Vertebra and Typical Injuries
The C6 vertebra is part of the lower cervical spine, situated near the base of the neck, and is a major attachment point for several muscles responsible for neck movement and stability. It features a vertebral body that supports weight and a bony arch that surrounds the spinal cord. Injuries often result from high-energy, traumatic events that force the neck beyond its normal range of motion.
Common mechanisms of injury include high-speed motor vehicle accidents, falls from significant heights, and sports-related trauma like diving into shallow water. These forces cause various types of fractures, classified by their stability. Stable fractures, such as simple compression fractures, may not threaten the spinal cord. Unstable fractures, including those involving displacement or rotation, pose a significant risk of secondary spinal cord injury. The seriousness of a C6 fracture is determined by the stability of the spinal column and the degree of associated neural compromise.
Defining Severity: Neurological Function After a C6 Injury
The severity of a C6 fracture is defined by the extent of spinal cord damage and the resulting loss of neurological function. An injury at this level typically results in tetraplegia, involving impaired function or paralysis in all four limbs and the torso. The specific functional outcome depends on whether the spinal cord injury (SCI) is complete or incomplete.
A complete SCI results in a total loss of motor and sensory function below the injury level. An incomplete SCI means some neural pathways remain intact, allowing for movement or sensation below the injury site and offering a better prognosis. Clinicians use frameworks like the ASIA Impairment Scale (A to E) to grade severity, with Grade A signifying complete loss and Grade E representing normal function.
A person with a complete C6 injury often retains significant upper body function. The nerves controlling the shoulders and upper arms, specifically the biceps and wrist extensors, originate at or above the C6 level. This retained function, particularly the ability to extend the wrist, allows for a tenodesis grip, where wrist extension passively closes the fingers. This action maximizes independence, enabling individuals to perform tasks like pushing a manual wheelchair or engaging in self-care with adaptive equipment. Loss of fine motor control in the hands and fingers is common.
Acute Treatment and Stabilization Protocols
Immediate management of a suspected C6 fracture focuses on rapid stabilization to prevent further spinal cord damage. First responders apply rigid spinal immobilization using a cervical collar and a backboard to restrict neck movement. A comprehensive neurological assessment, including CT and MRI scans, determines the fracture pattern, stability, and presence of spinal cord compression.
If the fracture is unstable or involves significant compression, the acute protocol may involve skeletal traction to gently realign the spinal column. This is often achieved using a halo vest or specialized tongs attached to the skull to apply controlled force. The decision for surgical intervention is based on fracture stability and the patient’s neurological status.
Unstable C6 fractures, or those causing neurological deficits, typically require surgery to decompress and stabilize the spine. Procedures involve removing bone fragments and fusing the damaged vertebrae using instrumentation like metal rods, screws, and plates. For stable fractures without neurological impairment, treatment involves non-operative management with prolonged external bracing or a cervical collar for up to 12 weeks.
Long-Term Recovery and Rehabilitation
Recovery from a C6 fracture with an associated spinal cord injury begins immediately after medical stabilization. Rehabilitation focuses on maximizing the function of innervated muscles, such as the biceps and wrist extensors. Physical therapy strengthens these preserved muscle groups and maintains range of motion in joints below the injury level to prevent contractures.
Occupational therapy focuses on practical independence, teaching individuals to perform daily activities using adaptive techniques and specialized equipment. This includes using retained wrist extension for self-feeding, grooming, and dressing, often with the aid of universal cuffs or modified utensils. The most significant functional gains occur within the first year post-injury, corresponding to the period of greatest neurological recovery.
Long-term care addresses secondary health concerns common after SCI, such as managing chronic pain, preventing pressure sores, and addressing cardiovascular and bowel function. The retained function associated with a C6 injury allows for a high degree of functional independence, including the potential to live independently and manage a manual or power wheelchair.