Chapter 22- Spinal Column Injury

Question 1

How is stability of the spine determined

Answer 1

1. Bony configuration
   2 ligaments and intervertebral discs connecting them
2. Muscles

Question 2

When is a spinal injury considered stable

Answer 2

If either the anterior or posterior elements have been injured individually

Question 3

What does an interspinous gap indicate

Answer 3

Highly significant and pathognomonic of unstable spinal injury

Question 4

Describe the pattern of injury with an extension force to the spine

Answer 4

• cervical spine
• tear drop fracture
• firmly attached anterior longitudinal ligament causes avulsion fracture of inferior border or vertebra
• posterior elements intact
• stable if held in Flexion

Question 5

Describe the pattern of injury of a compression force on the spinal column

Answer 5

• cervical or lumbar spine
• Spine is straight at time of impact
• burst fracture: bursting of body, encroachment into spinal canal
• posterior elements intact
• classified stable but high incidence of cord damage

Question 6

What is the pattern of injury with a flexion force applied to the spinal column

Answer 6

• in cervical spine it is similar to the tear drop but fragment is large starting in superior end plate
• common in dorsal and lumbar spine
• often associated with osteoporosis
• ‘wedge compression fracture’: wedge fracture body anteriorly
• posterior elements intact
• normal interspinous distance
• classified stable

Question 7

Describe the pattern of injury when a flexion rotation force is applied to the spinal column

Answer 7

• cervical and lumbar spine at junctions
• slice fracture: the rotational component disrupts the posterior ligaments with or without fracture; flexion produces a fracture of the body anteriorly
• anterior and posterior elements disrupted

Question 8

Pattern on injury when distraction force applied to the spine? What is the pattern when flexion distraction force applied

Answer 8

Distraction: axis of rotation is well anterior to vertebral column at anterior abdominal wall
Flexion distraction: axis is more posterior resulting in fracture of the body.
Anterior and posterior elements injured
Classified as unstable

In cervical spine: may cause unilateral or bilateral dislocated facets

Question 9

Features of shear injury to the spinal column

Answer 9

• Thoracic or lumbar area
• shear fracture
• usually complete paraplegia
• anterior and posterior elements disrupted
• classified unstable

Question 10

Treatment of stable extension injury of the spine

Answer 10

Bed rest on halter traction until acute pain settles. Then allow up in cervical collar, keeping cervical spine in slight flexion. Collar is worn for 6 weeks