Spine 2 Flashcards
Pars Defect
Spondylolysis/ Spondylolisthesis
Fracture in the pars intraarticularis (spondylolysis)
When there is separation at the fracture and slipping of the vertebra it is spondylolisthesis
Spondylolysis/ Spondylolisthesis
Sx
Pain exacerbated by
Pain is usually unilateral, localized, and exacerbated by hyperextension
The pain may spread across the back and feel like a muscle strain
Spondylolysis/lithesis
PE
Special examination includes pain with extension
Single-leg hyperextension test when standing on one foot and bringing the back into extension
pain with deep palpation of the spine
a step-off is sometimes palpable with spondylolisthesis
Spondylolysis/ Spondylolisthesis
imaging
X-rays…SCOTTY DOGS for spondylolysis and will see visible step off with spondylolisthesis
Confirm the extent of damage with MRI
Spondylolysis/ Spondylolisthesis
Tx
Depends on severity
If no slip: activity restriction or bracing if noncompliant
If minimal spondylolisthesis: brace, PT, Tylenol
The rest will have arthrodesis/ fusion surgery
SI Joint Disorders
general and Sx
Inflammation of one or both sacroiliac joints
Very low back pain
Painful with sitting
Sometimes will complain it is hard to find a comfortable sleeping position
SI Joint Disorders
PE and imaging
Physical Exam:
TTP (tenderness to palpation) over SI joints
Does not typically have nerve involvement
Tests:
Nothing is really needed; usually diagnosed with HPI and PE
X-rays might show arthritic changes
MRI will show inflammation
SI Joint Disorders
Tx
Treatment:
NSAIDs
Bracing/ SI belt
Steroid injection
Surgical fusion
Misc: common in several diseases like ankylosing spondylitis, ulcerative colitis, psoriasis, very common in pregnancy
Compression Fracture
general and Sx
Describe pain
Fracture of vertebral body because of weakened bone (osteoporosis, tumor, etc)
Common complaints/ symptoms:
Sometimes will have no symptoms
Usually will have deep, aching pain in the area of the fracture
Do not typically have nerve involvement
Compression Fracture
PE and imaging
Physical Exam:
clinical based on Sx
Might also notice hyperkyphosis because of multiple thoracic fxs (new and old)
Tests:
X-rays
DEXA
Compression Fracture
Tx
Treatment:
Manage pain with medication
Brace will sometimes help
Kyphoplasty
Treat underlying cause
Misc:
Burst Fracture
general and clin man
Compression fracture related to high-energy axial loading
Disruption of vertebral body endplate and posterior vertebral body cortex.
May be retropulsion of posterior cortex fragments into spinal canal.
Clinical presentation
Back pain and/or LE neurologic deficits in clinical scenario of trauma.
Pathology
Most commonly occur at L1
~90% occur from T9-L5.
burst fracture
patho
Mechanism
High-energy compressive injury.
Fall from height (often landing on feet)
MVA
Intervertebral disc is driven into vertebral body below.
burst fracture
Radiographic features
Loss of vertebral height on lateral views: anterior portion often compressed more than posterior portion of vertebral body
Always involves posterior vertebral body cortex
Bone fragment retropulsion into spinal canal may occur
Spinal cord contusion may occur – assess with MRI
Jefferson Fracture
general
Burst fracture of the atlas. C1
Bilateral fracture of anterior and posterior arch
Epi
50% associated with other C-spine injuries
33% associated with C2 fracture
25-50% of young children have concurrent head injury
May be vertebral artery injury
Mechanism
Axial/vertical compression injury
Typical is diving headfirst into shallow water.
Not normally associated with neurological deficit, though spinal cord injurymay occur if retropulsed fragment.
Jefferson Fx
Dx
X-ray findings
Diagnosis:Xrays–
Lateral radiographs: increased space in the predental space between C1 and odontoid
Open mouth view: stepoff of the lateral masses of the atlas
always get CTA
jefferson
Tx
Treatment
Operative: posterior C1-2 fusion vs occipitocervical fusion
Nonoperative: hard C collar vs halo immobilization
Hangman’s (C2/ axis pedicle) Fracture
general. MOI
Bilateral fracture traversing pars interarticularis of c2 with associated traumatic subluxation of C2 on cervical vertebra 3.
Epidemiology
Second most common fracture of C2 vertebra (odontoid fracture is most common).
Mechanism
extreme hyperextension with secondary flexion with subluxation
associated tearin of posterior longitudinal ligament
Hangman’s Fracture
Sx and imaging
Clinical manifestation
Pain
neuro exam typically spared
Diagnosis
Xray (C2 subluxation)
CT scan: exam of choice
hangman’s Fx
Tx
When to operate
Nonoperative: Immobilization +/- closed reduction (rigid C collar vs halo)
Operative: if > 5 mm displacement, severe angulation or face dislocations
Odontoid Fracture
general and MOI
Fracture of dens
Mechanism of Injury:
forced flexion or extension
Diagnosis:
Xray–seen best on AP odontoid (open mouth) view
Type 1: cervical orthosis
Type 2: Halo immobilization vs surgery
Type 3: cervical orthosis
Clay Shoveler Fractures
general
Fracture of spinous process avulsion of a lower cervical vertebra.
Mechanism of Injury
Forced neck flexion with simultaneous muscle contraction
sudden deceleration injury
clay shoveler’s
clin man
Clinical presentation
Often unrecognised at the time and found incidentally years later when cervical spine imaged for other reasons.
Acutely they tend to be associated with1:
motor vehicle accidents
sudden muscle contraction
direct blows to the spine
clay shovelers
Radiographic features
seen on lateral radiographs as an oblique lucency through the spinous process, usually of C7
typically displaced
Clay Shoveler’s Fracture
Tx
Nonoperative: symptomatic management, C collar for comfort
Surgical excision for nonunion/chronic pain
Chance Fractures (seatbelt fractures)
general
Mechanism
Flexion injury of vertebral body and distraction injury of posterior elements.
Flexion fulcrum occurs anterior to the abdomen. The anterior and middle columns fail in compression, and the posterior column fails in distraction.
Location
Most commonly upper lumbar spine/thoracolumbar junction.
Associations
High incidence of associated intra-abdominal injuries (especially pancreas and duodenum).
Chance Fractures (seatbelt fractures)
Tx
Treatment
Nonoperative: immobilization in TLSO brace
Operative: in setting of neurological injury
decompression and surgical fixation (typically fusion)
Atlanto-occipital dislocation
general and Tx
caused by extreme flexion of the neck involving C1/C2
May be associated with odontoid fractures
“internal decapitation”
nonsurvivable injury in 70% of cases, high risk of neurological injury
Tx: occipitalcervical fusion
Atlantoaxial Instability
general
Instablility C1-C2 not dislocation
Traumatic (extreme flexion/rotational injury) vs chronic degeneration
Downs, RA, Os odontoideum
Clinical Presentation: neck pain, muscle weakness, hyperreflexia, wide gait
Dx: odontoid view, Flex/Ex XRays
