Cervical spine fracture, dislocation or fracture-dislocation combined with cervical spinal cord injury is a common injury and the causal relationship between spinal cord injury and fracture-dislocation has become a theorem in people’s minds. However, the non-fracture-dislocation cervical spinal cord injury refers to a different type of cervical spinal cord injury. It indicates the presence of a cervical spinal cord injury without a break in bone structure or joint dislocation, as opposed to those injuries that have fractures or dislocations that are not detected by imaging. This is a not uncommon cervical spine condition among middle-aged and older people. I. Why would the cervical spinal cord be injured while the bone structure remains intact? Cervical spine fractures or dislocations resulting in spinal cord injury are easy to understand. The causal relationship between spinal cord injury and fracture dislocation has become a theorem in people’s minds. Therefore, it is assumed that when a spinal cord injury occurs, there must be a fracture dislocation and the imaging must be altered accordingly. The traditional view is that non-fracture-dislocation cervical spinal cord injury is a transient dislocation of the cervical spine and therefore does not show up on the imaging. In 1951, Dr. Taylor demonstrated experimentally and clinically that cervical ligamentous folds cause spinal cord injury when the cervical spine is hyperextended. When the cervical spine is hyperextended, the ligamentum flavum folds into the spinal canal and can damage the spinal cord. Some clinicians have since called this injury “cervical hyperextension injury” or “whiplash injury”. Some scholars have described this phenomenon as “spinal cord injury in which no fracture or dislocation is found on x-ray” for the purpose of objective observation. Second, what are the causes of non-fracture dislocation type cervical spinal cord injury? Most scholars believe that it is the result of the synergistic effect of multiple factors. Non-fracture-dislocation cervical spinal cord injury is mostly seen in middle-aged and elderly people over 50 years old. The pathological basis of non-fracture-dislocation cervical spinal cord injury in adults mainly includes congenital or developmental or degenerative cervical spinal stenosis, hypertrophy or ossification of the ligamentum flavum, hypertrophy or ossification of the posterior longitudinal ligament, degenerative changes of the cervical spine, formation of bone redundancy at the posterior edge of the vertebral body, cervical instability, abnormal development of the cervical spine, acute cervical disc herniation or prolapse, etc. Post-traumatic spinal edema and hematoma are also important factors of spinal cord injury. Among them, cervical spinal stenosis and acute cervical disc herniation or prolapse are the most important pathological basis. When these factors are present, spinal cord injury can be caused by the action of external forces. Injuries caused by external forces are mostly minor injuries, mainly car accidents, smashes, falls, sprains, bruises, etc. Minor traumatic injuries such as falls on flat surfaces, head bumps, and neck manipulation are more common in daily life, and the strength of the force is not sufficient to cause fracture or dislocation. However, they can cause cervical spinal cord injury. This means that when certain pathological factors are latent in the cervical spine, minor external forces can lead to spinal cord injury. Third, why are middle-aged and elderly people suffering from cervical degenerative diseases prone to non-fracture dislocation type cervical spinal cord injury? Cervical spinal stenosis caused by various reasons is a susceptible factor for cervical spinal cord injury and compression. Some scholars believe that the effective space of the cervical spinal canal is narrowed when the cervical spine is hyperextended, so that non-fracture dislocation cervical spinal cord injury often occurs during cervical hyperextension injury. In China, Dai Li Yang and other scholars believe that there are at least two compression mechanisms of the spinal cord during cervical extension, one of which is the buckling mechanism of the ligamentum flavum during cervical extension, and the other is the clamping mechanism between the vertebral plate and the posterior edge of the vertebral body, and believe that these two mechanisms are important causes of nonfracture-dislocation cervical spinal cord injury during cervical extension injury. In addition, in flexion injury, the vertebral body is displaced forward causing spinal cord injury, and the instantaneous muscle contraction causes the upper cervical segment at the level of injury to jump posteriorly and return to its original position, so the X-ray can show normal signs, and some scholars call this mechanism the “Flexion-Recoil” theory of flexion. What is the effect of the injury on the spinal cord? This type of injury often leads to incomplete spinal cord injury, such as central spinal cord injury and anterior spinal cord injury. However, severe spinal cord injury is not uncommon. In addition, any compression of the spinal cord, including trauma, can lead to infarction of the spinal cord blood vessels, altering their hemodynamics and aggravating the spinal cord injury. These injuries are usually mild, and many patients with cervical spondylosis are not even aware that they have had a cervical spine trauma, but MRI often reveals high signal changes in the spinal cord. Some patients are more symptomatic, but motor function of the extremities often begins to recover gradually after the spinal shock has passed. Due to the presence of certain pathological factors in the cervical spine, non-surgical treatment of their spinal cord disease tends to be mild and severe repeatedly, with some patients becoming more and more symptomatic over time. Usually, such spinal cord injuries occur mostly at the C4 to C6 level. It is related to the following reasons: C4 is the most obvious place of cervical physiological pronation, and the flexion and extension activities of the cervical spine are mostly centered on C4 to C6. At the same time, the activity frequency of this segment of the cervical spine is high, and the activity amplitude is large, so degenerative changes are prone to occur, leading to spinal stenosis. This segment of the cervical spine is highly mobile and relatively unstable, and the cervical spine and spinal cord are prone to injury in the event of cervical trauma. V. Since there is no fracture and dislocation, is there any significance in imaging examination? How to diagnose? Although there is no fracture or dislocation in cervical spinal cord injury. However, this does not mean that the imaging examination is meaningless. On the contrary, the necessary tests are important to detect hidden injuries, evaluate the severity of spinal cord injury and determine the prognosis. 1.X-ray examination X-ray examination is important in this disease: excluding fracture and dislocation; finding the original structural abnormalities of the cervical spine: physiological anterior convexity change, bone redundancy formation, posterior longitudinal ligament ligament ossification, spinal canal stenosis, segmental cervical intervertebral instability, etc., which are all helpful for diagnosis. 2.CT CT examination has greater significance for the diagnosis of this disease, and is highly reliable for determining the bony structural changes of vertebral stenosis. In particular, the diagnostic value of ossification of the posterior longitudinal ligament is higher than that of MRI. However, conventional CT is a cross-sectional scan with a large scan spacing, so it is easy to miss the observation of the intervertebral space level and cannot show the structure of the spinal cord. MRI not only reduces the misdiagnosis rate of non-fracture dislocation type cervical marrow injury, but also plays a key role in determining its pathological basis, which is conducive to the development of treatment plans and is an essential basis for diagnosis and treatment. It is an essential basis for both diagnosis and treatment. VI. What should I pay attention to when I consider spinal cord injury? After the injury occurs, the patient’s family and medical personnel should follow the spinal cord injury treatment process. Such as: 1, the suspected spinal and spinal cord injury, should be taken to the correct braking and lifting measures. 2, high cervical spinal cord injury, respiratory distress, timely cricothyrotomy or tracheotomy. 3, all first aid and diagnostic tests should be performed while maintaining spinal stability. 4. Maintain existing spinal cord function to prevent further injury. Seven, how to treat non-fracture dislocation type cervical spinal cord injury? 1, non-surgical treatment: dehydration agents, gangliosides, high-dose methylprednisolone can be treated to block the process of secondary spinal cord injury. Although non-surgical treatment can make the spinal cord function partially restored, but the effect is limited; at the same time, because the underlying pathological factors of spinal cord injury (cervical stenosis, degenerative segmental instability, etc.) have not been lifted or corrected, from the long-term results, spinal cord injury will be repeated, most of them will be aggravated. In recent years, with further clarification of the pathological basis of the disease and further improvement of the means of examination, the vast majority of doctors advocate surgical treatment. The significance of surgical treatment is: ① Eliminate the pathological basis for the occurrence of the disease. ② Early decompression can reduce spinal edema and intramedullary pressure, thus improving the blood circulation of the spinal cord and avoiding or reducing secondary damage to the spinal cord. ③ The technique of internal fixation of the cervical spine has been greatly improved, and internal fixation allows the cervical spine to obtain immediate stiffness and stability, which facilitates the recovery of spinal cord function. ④ Early activity, fewer complications, and better long-term results are possible. VIII. Prognosis and regression There are many influencing factors. In addition to the degree of spinal cord injury, age, underlying disease, general physical condition, and the timing of surgical treatment, the surgical approach is closely related. Therefore, once such an injury occurs, it should be treated actively.