Cervical Spine Fractures Flashcards
What is the most common spine fracture?
Lumbar
Why is the lumbar spine the most common part to have back pain? (2 things)
- Upper body loads lumbar spine region
- Higher mechanical stresses + strains
What are the possible causes of neck and back pain? (9 things)
- Degenerative Disc Disease
- Disc herniation
- Spinal stenosis
- Congenital anomalies
- Spondylolisthesis
- Trauma
- Facet-joint pain
- Sacro-iliac joint pain
- Cancer
What is the gold standard investigation for back pain?
MRI
When are XR and CT useful for back pain?
In trauma setting (e.g #s)
What are the treatment options for back pain? (4 things)
- Analgesia
- Physio
- Psychological pain management
- Spinal fusion surgery
In spinal fusion surgery, what is given to the patient at the expense of what?
Pain relief at the expense of movement
What is sciatica?
Pain in leg @ distribution of sciatic nerve
Is sciatica back pain or nerve root pain?
Nerve root pain
What are the causes of sciatica? (4 things)
Nerve root compression / irritation from:
- Herniated (slipped) disc
- Spinal stenosis
- Trauma – bone fragment retropulsed aka gone backwards into spinal canal)
- Tumour
What is the gold standard investigation for sciatica?
MRI lumbar spine
What is the treatment for sciatica? (2 things)
- Analgesia
- Remain active
Most sciatica resolves with X?
Time
What should be considered if there is persistent pain in sciatica, and the MRI shows dermatomal distribution of symptoms?
Discectomy
What is whiplash?
A flexion-extension injury to neck
What is whiplash caused by?
Sudden deceleration
What are the symptoms of whiplash? (3 things)
- Neck pain + stiffness
- Neck muscle tenderness
- Headaches
How long after an accident does it take for whiplash symptoms to develop?
6-12 hours
How is a diagnosis of whiplash made? (3 things)
- History
- @ exam: muscle spasm, neck tenderness, ROM
- Imaging not usually req
What is the treatment for whiplash? (3 things)
- Self limiting
- Analgesia
- Encourage normal neck movements
What is the purpose of the Cervical spine? (2 things)
- Supports head
- Provides motility
How are C spine fractures classified in terms of region? (3 regions)
Type 1 = Occipital condyle + Craniocervical junction
Type 2 = C1 ring + C1/2 joint
Type 3 = C2 + C2/3 joint
(pic shows Occipital condyle)
How are C spine fractures classified in terms of fracture type? (3 things)
Type A = Bony injury only
Type B = Tension band injuries
Type C = Translation injuries (dislocation)
What is the Tension Band in the spine?
Group of muscles / ligaments / processes / pedicles
that maintain integrity of vertebral column
What are the possible clinical features of a C spine fracture?
- Neck pain (doesn’t present if there are other concurrent injuries)
- Neuro involvement:
- Sensory / motor deficit
- Defected innervation to diaphragm
- Poor vasomotor tone (determine artery pressure)
- Post circulation stroke (if vertebral artery injured)
What are some different diagnosis of C spine fractures? (3 things)
- Cervical spondylosis
- Cervical dislocation
- Whiplash
What are some named types of C spine fractures? (2 things)
- Hangman’s Fracture
- Odontoid Peg Fractures
What is a Hangmans Fracture also known as?
Traumatic spondylolisthesis of axis
What is a Hangmans Fracture? (2 things)
- # thru pars interarticularis of C2 bilat.
- Subluxation (partial dislocation) of C2 onto C3
What is a Hangmans Fracture caused by?
Cervical hyperextension (getting hung by a noose innit)
What is required if a Hangmans Fracture is unstable?
Surgical fixation
What is a common cause of Odontoid peg fractures?
Low impact injury in elderly
Can Odontoid peg fractures be fatal?
Yeah, esp w significant displacement of odontoid
Those who survive Odontoid peg fractures have no X?
Neurology
What rules determine if a pt needs imaging for C spine fracture?
Canadian C spine rules
Who qualifies to even be considered by the Canadian C spine rules? (2 things)
- Glasgow Coma scale 15/15
- Stable condition
Who does the Canadian C spine rules say needs imaging? (3 things)
- 65+ yrs
- Dangerous mechanism
- Paraesthesia in extremities
Who does the Canadian C spine rules say does NOT need imaging? (5 things)
- Simple-rear end motor vehicle collision
- Waiting in sitting position
- Ambulatory at any time
- Delayed onset neck pain
- Absence of midline C spine tenderness
If Canadian C spine rules say someone does not need imaging, what should be done instead?
ROM assessment
What scans does Canadian C spine rules say should be done for adults vs children?
CT = adults MRI = children
How should a patient w sus C spine fracture be managed?
Per ATLS guidelines, including: 3-point C-spine immobilisation
Why should movement of the spine be restricted in a sus C spine fracture?
To prevent spinal cord damage cah movement at level of unstable # can cause neurological defect
What are the indications for NON-operative management of C spine fractures? (2 things)
- Stable #s
- Pt in which surgiacal intervention is risky
What are the non-operative management options of C spine fractures? (3 things)
- Rigid collars
- Halo vests
- Traction devices
What are Rigid collars used for in non-operative management of C spine fractures?
Immobilisation of C spine # extrication + initial assessment
What are Halo vests used for in non-operative management of C spine fractures?
When more rigid support is needed
Non-operative Unstable C spine #s
What is a Halo vest (non-operative management of C spine fractures)? (3 steps)
- Pins placed in outer table of skull under local
- Pins connected to Halo device
- Device mounted on thoracic brace
When are Traction devices used as definitive treatments for in non-operative management of C spine fractures? (2 things)
- When surgical treatment risky
- When # reduction required (e.g facet joint dislocation)
What is the indication for Operative management of C spine fractures?
Unstable #
What are the Operative management options for C spine fractures? (2 things)
- Fusion
- Stabilisation
What is the Fusion operation for C spine fractures? (2 things)
- Fusing injured segment of spine to uninjured segments above + below
- +/- decompression of vertebral canal
What is the Stabilisation operation for C spine fractures?
Fragments fixated using pedicle screws and rods
(Patient lying prone)
