Spinal Trauma Flashcards
What is a spinal fracture?
A soft tissue injury in which there is also a broken bone.
How efficient is Computed Tomography (CT)?
- The most efficient technique for detecting or formally eliminating an injury
- Indications should be extended but also limited to a selected population
What is a Spinal Cord Injury (SCI)?
An insult to the spinal cord resulting in a change, either temporary or permanent, in the cord’s normal motor, sensory, or autonomic function.
How does a traumatic spinal cord injury manifest?
- Manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures.
- Can result from minor injury if the spine is weakened from disease such as ankylosing spondylitis or if there is pre-existing spinal stenosis.
What is a dermatone?
An area of skin innervated by sensory axons within a particular segmental nerve root - essential to determine the level of injury.
What potential pathology might a SCI have?
- spinal cord swelling
- spinal cord contusion/oedema
- –cord oedema only: most favourable prognosis
- –cord oedema and contusion: intermediate prognosis
- –cord contusion only: worse prognosis
- Intramedullary haemorrhage
- extrinsic compression, e.g. from fracture fragment or disc herniation
- Spinal cord transection
Where is the spine most commonly injured?
40 % Cervical spine (C5-C7) (C1-C2) 10% Thoracic spine 3% Lumbar spine 35% Dorso-lumbar (T12-L2)
What are the most common mechanisms of cervical spine injury?
Hyperflexion, hyperextension and (axial) compression.
(Excessive flexion/extension of neck in sagittal plane; force directly over vertex in caudal direction).
What are the limitations of lateral C-spine radiographs?
- Horizontal beam ‘cross table’ lateral alone will not reveal 15% of injuries
- 30% of lateral projections are technically inadequate
- Standard three projections (AP, lateral & open mouth AP) will miss between 1% and 10% of significant injuries
What are the three columns of the spinal instability theory, used in the Denis classification system?
Anterior column: consists of the anterior two-thirds of the annulus and vertebral body, along with the anterior longitudinal ligament.
Middle column: consists of the posterior one third of the annulus and vertebral body, along with the posterior longitudinal ligament.
Posterior column: consists of all bony and tissue elements posterior to the anterior and middle column.
Radiographic evaluation is used to assess the number of columns involved and likely stability or instability of the fracture
How should an open mouth AP projection look?
- Lateral margins of C1 and C2 should align
- Distance between odontoid process (“peg”) and lateral masses should be equal distance
**Beware of positional rotation
What is a hyperextension teardrop injury?
The longitudinal ligament ruptures, avulsing a small bone fragment from the vertebral body. It is an unstable fracture, associated with ligamentous tears and possible spinal cord compression.
What is a hyperflexion teardrop?
A severe hyperflexion injury resulting from posterior ligament disruption and anterior compression fracture of the vertebral body. May also result in spinal cord compression and spinous process fracture.
What is anterior subluxation?
Disruption of the posterior ligamentous complex resulting from hyperflexion.
When stable, causes:
- loss of normal cervical lordosis
- anterior displacement of the vertebral body
- fanning of the interspinous distance
What is the Hangman’s Fracture?
Fractures through the pars interarticularis (part of bone between inferior and superior facets) of the axis (C2) resulting from hyperextension and distraction. C2 is displaced anteriorly and there is (anterior) prevertebral soft tissue swelling.
