21. Spine and spinal cord - Traumatic injury

Question 1

General:

Answer 1

Cervical spine: most common site
Spinal cord injury = myelopathy

Imaging:
X-ray: minor injuries (fracture, dislocation)
CT: polytrauma
MRI: SC injury, ligament injury
MRA: carotid/vertebral arteries (fractures can lead to occlusion/dissection)

Question 2

Denis 3 column classification:

Answer 2

Description: stability of SC injury

Anterior column: anterior longitudinal ligament + 2/3 of anterior body

Middle column:
posterior longitudinal ligament + 1/3 posterior body
(injury never happens isolated, always with anterior/posterior)

Posterior column:
pedicles, facet joints, ligamentum flavum

Question 3

Spinal injury (fracture, luxation):

Answer 3

General complication: most serious spine fracture is compression of medulla oblongata and SC

Jefferson fracture (C1-Atlas):
Burst fracture (diving head) - 4 fractures (2 anterior arches, 2 posterior arches)

Hangman fracture (C2-Axis):
Intraarticularis on both sides
Hyperextension and distraction (hanging or motor accident)
Lethal

Compression fracture (below C2):
Most common fractures of vertebral body
Hyperflexion

Question 4

Whiplash injury:

Answer 4

Epidemiology: rear-end car accident, women>men

Pathophysiology: hyperextension by hyperflexion of cervical spine –> damage muscles/ligaments/joints

Complications: chronic pain, decreased movement, anxiety/PTSD

Imaging: X-ray, CT, MRI

Treatment:
Conservative: physiotherapy, NSAIDs
Surgery: NOT indicated

Question 5

Luxation:

Answer 5

Description: displacement of vertebral body out of position

Common site: thoracolumbar junction