Spinal fractures and surgeries

Question 1

Minor fx to posterior column

Answer 1

secondary to trauma
localized pain and tenderness aggravated with movement when acute
may be source of local residual pain after healing

Question 2

Minimal wedge (anterior) compression fractures

Answer 2

usually secondary to osteoporosis
T10-L1 most common
Hyperextension (Jewett or CASH) brace for severe pain
heals within 3 months

Question 3

Wedge compression (spinal/transverse process)

Answer 3

usually no neurological involvement and responds to a conservative approach of rest, may require bracing for pain reduction; no loss of stability of the spine

Question 4

Burst fracture

Answer 4

from a vertical fall from a height

Posterior stuctures are intact so fracture is usually stable

Question 5

With burst fx, what is the major concern?

Answer 5

comminuted fracture of vertebral body
may drive disc into cancellous bone and fragments into spinal cord so potential for neuro deficits –> decompression (usually fusion) required if SC is injured

Question 6

How is uncomplicated burst fx managed?

Answer 6

if no complications- bedrest for a couple of weeks than 8 weeks with a body cast/jacket

Question 7

What is a chance fx?

Answer 7

transverse non-comminuted fracture of the vertebral body and the posterior elements

Question 8

What causes chance fx?

Answer 8

caused by a distraction force - (e.g seat belt holds down spine during a sudden deceleration in a car)
T12-L4, L2 has highest incidence

Question 9

What are chance fx outcomes?

Answer 9

Usually no neural defects
High incidence intra-abdominal injuries
causes hinge effect of ALL

Question 10

How are chance fx’s managed?

Answer 10

If bone only – may need bedrest for 2 weeks , hyperextension brace

If also ligamentous, more unstable - may be operative