Spine Flashcards
The most common causative bacteria in adults, pyogenic vertebral osteomyelitis
Staphylococcus aureus
Anderson and Montesano classification of occipital condyle fractures and management
Type I: comminuted fracture from impact.
Type II: extension of linear basilar skull fracture.
Type III: Avulsion of bone fragment
Management
Simple unilateral type I or II: collar
Bilateral or type III: halo
Fracture with ligament injury: OC fusion
Condyle-C1 interval (for AOD)
Adult < 1.4 mm
Pedia < 2.5 mm
Basion-axial interval (BAI)
Adult <=12 mm
Pedia 0-12 mm ( never negative)
Basion-Dental interval (BDI)
Adult <= 12 mm
Pedia : variable because of Odontoid ossification stages
Management of atlanto-occiptal dislocation
Always surgical
Occipito cervical fusion
❌DO NOT USE RETRACTION
Landell’s classification of C1 fracture and management
Type 1: single posterior arch fracture
Type 2: anterior and posterior ring fracture
Type 3: lateral mass fracture
Management
Type I: collar
Type II:
intact transverse ligament: halo
Disrupted ligament: C1/C2 fusion or OC fusion
Type III: halo
Illustration and Jafferson classification of C1 fracture
Type 1: posterior arch fracture
Type 2: anterior arch fracture
Type 3: anterior and posterior arch fracture
Type 4: lateral mass fracture
Normal atlanodental interval (ADI)
Male <=3 mm
Female <= 2.5 mm
Pedia <= 4 mm
Feilding and Hawkins classification of atlantoaxial rotatory deformity
Type 1: POTENTIALLY STABLE
-anterior subluxation of C1 on C2
-Both joints affected
-Symmetric literal mass subluxation
-pivot point is dens
-fixed rotation
-Transverse ligament intact
-Normal ADI
Type 2: POTENTIALLY UNSTABLE
-Anterior subluxation of C1 on C2
-only one joint affected
-pivot point is intact joint
-Transverse ligament disrupted
-ADI < 5mm
Type 3: POTENTIALLY UNSTABLE
-Anterior sublaxation of C1 on C2
-both joints affected
-Asymmetrical lateral mass subluxation
-asymmetric pivot around dens
-transverse ligament disrupted
-ADI > 5 mm
Type 4: POTENTIALLY UNSTABLE
-posterior displacement of C1 on C2
Dickman classification of TAL disruption
Dickman type I: anatomic disruption. Tear of TAL itself without osseos component
Type Ia: midsubstance TAL disruption
Type Ib: osteoperiosteal TAL disruption.
Dickman type II: physiologic disruption. Detachment of the C1 tubercle.
Management
Type I: require surgical stabilization.
Type II: 74% chance of healing with immobilization (halo recommended)
NASCIS III trial outcome
Methylprednisolone 30mg/kg then 5.4 mg/kg/h for 48 administered 3-8 h post injury was associated with better outcome.
Three column model (DENIS)
Anterior column
-Anterior longitudinal ligament
-Interior 50% of vertebral, body and disc
Middle column
-Posterior 50% of vertebral body and disc
-Posterior longitudinal ligament
Posterior column
-Pedicles
-Posterior bones (laminae, facet joint, spinous process)
-Ligaments (ligamentum flavum, interspinous, supraspinous)
-Facet joint capsule
According to DENIS model of spine when injury considered potentially unstable
Potentially stable if
->= columns are involved
-below T8 and middle column involved
-Any of the following
* lots of height > 50%
* canal compromise > 50
* kyphosis > 20°
Type of spine fracture according to DENIS model
Compression fracture : anterior column only
Burst fracture: anterior and middle column + endplates (most commonly superior)
Chance fracture: distraction of middle and posterior column + compression of anterior column
Fracture dislocation: failure of all 3 columns
