Spinal fractures profoma

Question 1

Epidemiology of spinal fractures

Answer 1

Two types:
- acute traumatic
- pathological.

Most common= fragility crush fracture in osteoporotic bone (usually lumbar spine).

More common in men.

Commonly aged between 19-64

Most fractures occurred in the thoracic spine

Most common cause of injury= fall from height, then traffic accidents

Spinal cord injuries reported in 73% of patients.

Question 2

Presentation of spinal fractures

Answer 2

Thoracic spine fractures:
- Pain
- Shrinking & becoming round shouldered
- Kyphotic deformity- exaggerated, forward rounding of the back.
- Scoliosis
- Injuries to T6-T12 can result in paraplegia (paralysis of the legs & lower body).
- Spinal shock - a period of altered distal function which may result from inadequate tissue perfusion due to the spinal injury. Leads to bradycardia & hypotension.

Question 3

Investigations for spinal fractures: blood tests

Answer 3

FBC & CRP - to exclude malignancy or infection.

Bone profile- excludes metabolic causes of fracture.
- Serum Ca
- Albumin
- PTH
- Phosphate
- Alkaline phosphatase
- Mg
- Serum 25(OH)D.
- Thyroid screen
- LFTs & U&Es e.g. creatinine
- Myeloma screen

Question 4

Investigations for spinal fractures: imaging

Answer 4

CT scan - shows bones & soft tissues e.g. nerves. It allows doctor’s to look at cross-sections of the spine.

MRI scan - shows soft tissues like discs & nerves. Helps to distinguish btw osteoporotic causes & tumour or infection causes.

X-ray - shows bones & fractures.

+ neurological assessment- to test reflexes etc to see if there is any nerve damage.

Question 5

Management for spinal fractures: conservative

Answer 5

• Can be treated w/ bracing for 6 to 12 weeks
• By gradually increasing physical activity & doing rehabilitation exercises, most patients avoid post-injury problems.

Question 6

Management for spinal fractures: pharmacological

Answer 6

Analgesia e.g. morphine

Bisphosphonates or denosumab - for fragility fractures.

Question 7

Management for spinal fractures: surgical

Answer 7

Balloon kyphoplasty - use a balloon to inflate a space around the fracture. Then fill the space with cement. Used only for pathological fractures.

Laminectomy - is the procedure used to decompress the spine by removing the bony arch called the lamina.

Spinal fusion - involves pedicle screws - can hold a fracture together & provide stability.

Minimally invasive surgery

Smaller stab incisions - good for younger patients w/ trauma or tumour.

Question 8

Prognosis for spinal fractures

Answer 8

Majority of spinal fractures are treated effectively w/ full function & mobility restored.

Complications associated w/ spinal fractures:
- DVT- these may develop during long periods of bed rest or immobility
- PE - a blood clot that breaks free &d
travels to the lungs.
- Pneumonia
- Pressure sores

Complications associated w/ spinal surgery:
- Bleeding
- Infection
- Spinal fluid leaks
- Non-union
- Wound complications