Chapter 16 - Spinal Trauma Flashcards
Brown-sequard syndrome
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
Central cord syndrome
Motor weakness/paralysis in the upper extremities > lower extremities and distal > proximal
Anterior cord syndrome
Motor and sensory loss below the level of the injury - worst prognosis of any SCI
Mechanism of action for methylprednisolone in SCI
inhibition of lipid peroxidation and inhibition of inflammatory cytokines. Modulation of inflammatory cells and improved vascular perfusion. Prevention of calcium channel influx and accumulation
Define the Powers Ratio
Distance from the basion to the posterior arch divided by the distance from the anterior arch to the opisthion
Ratio >1 -> consider anterior dislocation
Harris Basion-Axial interval and Basion-dental interval method
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
what defines a C1 burst (Jefferson) fracture?
Bilateral fractures of the anterior and posterior arches from an axial load
What suggests transverse ligament disruption in a C1 fracture on XR?
Lateral mass displacement >7mm (8.1 wih XR magnification)
Describe the following C1 fracture paterns
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
Define a “Hangman’s fracture”
Traumatic spondylolisthesis of C2 bilateral pars interarticularis
Describe the Levine and Edward classification of traumatic spondylolisthesis of C2
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)
Indication for fusion in Sub-axial cervical spine compression fractures
Angulation that exceeds 11deg or more than 25% loss of vertebral height - goal: prevent cervical kyphosis
INITIAL Treatment of facet fracture-dislocations
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
Following closed reduction of facet dislocation - how to treat if MRI shows disc herniation
anterior decompression followed by definitive posterior stabilization
Following closed reduction of facet dislocation - how to treat if UNILATERAL facet disloction
these re often stable and will autofuse - treat non-op with with close radiographic monitoring
Following closed reduction of facet dislocation - how to treat if Bilateral facet dislocation
Posterior surgical stabilization
What is the rate of non-contiguous spine injuries when a thoracolumbar fracture is diagnosed?
12%
AO classification of thoracolumbar injuries
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
TLICS classification
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
TLICS treatment implications
- score < 4 points
nonsurgical management - score = 4 points
nonsurgical or surgical managment - score > 4 points
surgical management indicated
Treatment for thoracolumbar trauma - indications for surgery
> 25deg focal kyphosis, >50% loss of vertebral height, >50% canal compromise, non-intact posterior ligamentous complex
Treatment for thoracolumbar trauma - incomplete deficits from retropulsed fragments
Anterior decompression and stabilization. May require adjunctive posterior stabilization if posterior elements are disrupted as well
Treatment for thoracolumbar trauma with unstable burst fractures that include failure of the posterior ligamentous complex, fracture dislocations, or significant rotational displacement
Posterior stabilization
If canal decompression needed - may need to do staged anterior decompression as well
Denis classification of sacral fractures
Zone 1: from sacral ala to the lateral foramen
Zone 2: sacral foramen
Zone 3: medial sacral foramen to the canal
