Conservative treatment of injuries to the cervical spine. Mobilization or immobilization

Many injuries to the cervical spine can be treated conservatively. Treatment options include early functional, mobilizing and immobilizing procedures. If a structural injury can be ruled out by morphological imaging, early functional mobilization should be performed in combination with adequate analgesia according to the World Health Organization (WHO) step by step scheme to avoid chronification. If a structural injury to the cervical spine is present, a stability test is crucial for the decision on treatment. Stable fractures include, for example, types I, II and V fractures of the atlas according to Gehweiler, types I and III fractures of the dens axis according to Anderson and D'Alonzo and type A fractures of the subaxial cervical spine according to the AO. If the results of the imaging examination are inconclusive, functional imaging should be performed. If the injury is stable, external immobilization can be used for conservative treatment. Semirigid and rigid cervical orthotic devices as well as Minerva corsets and the halo fixator are available for this purpose. The degree of immobilization increases with the invasiveness of the procedure. Immobilization should be carried out under clinical and radiological monitoring until the injury has healed. An increase or persistence of symptoms during conservative treatment indicates treatment failure and should result in follow-up imaging. Immobilizing treatment should also be accompanied by isometric physiotherapeutic exercise and adequate analgesic treatment. In adult patients the external stabilization should be gradually reduced through physiotherapeutic exercise after completion of the immobilization treatment.