Chapter 16 - Spinal Trauma

Question 1

Brown-sequard syndrome

Answer 1

Ipsilteral loss of motor and posterior column function (Proprioception/vibration)worst prognosis of
Contralateral loss of pain and temperature (spinothalamic function)

Best prognosis for recovery

Question 2

Central cord syndrome

Answer 2

Motor weakness/paralysis in the upper extremities > lower extremities and distal > proximal

Question 3

Anterior cord syndrome

Answer 3

Motor and sensory loss below the level of the injury - worst prognosis of any SCI

Question 4

Mechanism of action for methylprednisolone in SCI

Answer 4

inhibition of lipid peroxidation and inhibition of inflammatory cytokines. Modulation of inflammatory cells and improved vascular perfusion. Prevention of calcium channel influx and accumulation

Question 5

Define the Powers Ratio

Answer 5

Distance from the basion to the posterior arch divided by the distance from the anterior arch to the opisthion

Ratio >1 -> consider anterior dislocation

Question 6

Harris Basion-Axial interval and Basion-dental interval method

Answer 6

TWO Parameters
- Basion-axion interval - the distance from the basion to a line drawn tangentially to the posterior border of C2. >12mm or <4mm is abnormal
- Basion-dental interval - distance from the basion to the odontoid. >12mm abnormal

Question 7

what defines a C1 burst (Jefferson) fracture?

Answer 7

Bilateral fractures of the anterior and posterior arches from an axial load

Question 8

What suggests transverse ligament disruption in a C1 fracture on XR?

Answer 8

Lateral mass displacement >7mm (8.1 wih XR magnification)

Question 9

Describe the following C1 fracture paterns

Answer 9

A. Posterior arch fracture - stable, treat in hard collar
B. Lateral mass fracture - stable - treat in hard collar
C. Burst/Jefferson fracture - if displacement of bl lateral masses >7mm, treat with surgery, otherwise hard collar
D. Anterior arch fracture - stable
E. TP fracture - stable
F. Anterior arch avulsion fracture

Question 10

Define a “Hangman’s fracture”

Answer 10

Traumatic spondylolisthesis of C2 bilateral pars interarticularis

Question 11

Describe the Levine and Edward classification of traumatic spondylolisthesis of C2

Answer 11

type I: axial compression and hyperextension - <3mm of displacement NO angulation
Type II: Hyperextension and axial load followed by rebound flexion - translation >3mm plus angulation
Type IIA: flexion-distraction - angulation without significant translation
Type III: Flexion-distraction followed by hyperextension - Type 1 injury plus an injury to C2-3 facets (most commonly bilateral facet dislocation)

Question 12

Indication for fusion in Sub-axial cervical spine compression fractures

Answer 12

Angulation that exceeds 11deg or more than 25% loss of vertebral height - goal: prevent cervical kyphosis

Question 13

INITIAL Treatment of facet fracture-dislocations

Answer 13

Awake person - attempt closed reduction without MRI
Obtunded person or failed reduction - get an MRI
Following reduction - get an MRI to look for disc herniation

Question 14

Following closed reduction of facet dislocation - how to treat if MRI shows disc herniation

Answer 14

anterior decompression followed by definitive posterior stabilization

Question 15

Following closed reduction of facet dislocation - how to treat if UNILATERAL facet disloction

Answer 15

these re often stable and will autofuse - treat non-op with with close radiographic monitoring

Question 16

Following closed reduction of facet dislocation - how to treat if Bilateral facet dislocation

Answer 16

Posterior surgical stabilization

Question 17

What is the rate of non-contiguous spine injuries when a thoracolumbar fracture is diagnosed?

Answer 17

12%

Question 18

AO classification of thoracolumbar injuries

Answer 18

Type A: Compression injuries
Type B: Distraction injuries
Type C: Torsional injury
each type then broken down further into
fracture morphology
bony versus ligamentous failure
direction of displacement

Neurologic injury:
0- intact, 1 - transient deficit, 2 - radiuclar symptoms, 3 - cauda sx, 4 - complete sci, X - undertermined

M - modifiers. 1 - tension band injury, 2 - patient specific co-morbidities

Question 19

TLICS classification

Answer 19

Morphology:
- Compression (+1)
- Burst (+2)
- Translational/rotational (+3)
- Distraction (+4)

Integrity of Posterior Ligamentous Complex
- Intact (0)
- Indeterminate or suspected (+2)
- Disrupted (+3)

Neuro Status
- Intact (0)
- Nerve root (+2)
- Complete cord/conus (+2)
- Incomplete cord/conus (+3)
- Cauda (+3)

• score < 4 points
  nonsurgical management
• score = 4 points
  nonsurgical or surgical managment
• score > 4 points
  surgical management indicated

Question 20

TLICS treatment implications

Answer 20

• score < 4 points
  nonsurgical management
• score = 4 points
  nonsurgical or surgical managment
• score > 4 points
  surgical management indicated

Question 21

Treatment for thoracolumbar trauma - indications for surgery

Answer 21

> 25deg focal kyphosis, >50% loss of vertebral height, >50% canal compromise, non-intact posterior ligamentous complex

Question 22

Treatment for thoracolumbar trauma - incomplete deficits from retropulsed fragments

Answer 22

Anterior decompression and stabilization. May require adjunctive posterior stabilization if posterior elements are disrupted as well

Question 23

Treatment for thoracolumbar trauma with unstable burst fractures that include failure of the posterior ligamentous complex, fracture dislocations, or significant rotational displacement

Answer 23

Posterior stabilization

If canal decompression needed - may need to do staged anterior decompression as well

Question 24

Denis classification of sacral fractures

Answer 24

Zone 1: from sacral ala to the lateral foramen
Zone 2: sacral foramen
Zone 3: medial sacral foramen to the canal