Subaxial (C3 through C7) Injuries/Fractures Flashcards
Subaxial cervical spine injury classification (SLIC) is used to assess injuries to the diskoligamentous complex, in addition to neurologic and bony injuries. Which of the following is correct regarding SLIC?
● A. According to the morphology, scores of 0, 1, 2, 3, and 4 are given to no abnormality, simple compression, burst fracture, distraction and rotation, and translation, respectively
● B. According to diskoligamentous complex, scores of 0, 1, and 2 are given to intact, intermediate, and disrupted
● C. According to the neurologic status, scores of 0, 1, 2, 3, and + 1 are given to intact, complete spinal cord injury, incomplete spinal cord injury, and continuous cord compression with neuro deficit
● D. Only patients with score of 5 or more are treated with surgical management
● E. All of the above
E. All of the above
Flexion injury acting alone will produce unilateral or bilateral facet dislocation. Flexion injury with compression will produce which type of injury?
● A. Anterior VB fracture with kyphosis, disruption of interspinous ligament, and teardrop fracture
● B. Torn posterior ligaments and dislocated and locked facets
● C. Fractured spinous process and possible lamina
● D. Burst fracture
● E. Fracture through lateral mass or facet including horizontalization of facet
A. Anterior VB fracture with kyphosis, disruption of interspinous ligament, and teardrop fracture
In general, compromise of anterior elements produces more instability in extension, while compromise of posterior elements produces more instability in flexion. Which of the following is correct regarding White and Panjabi model of subaxial cervical spine stability?
● A. Anterior elements destroyed or unable to function, posterior elements destroyed or unable to function, positive stretch test or spinal cord damage are given the score of 2
● B. Nerve root damage, abnormal disk narrowing, developmentally narrow canal with either sagittal diameter less than 13 mm or Pavlov ratio less than 0.8 and dangerous loading anticipated are given a score of 1
● C. In neutral position cervical spine, sagittal displacement of more than 3.5 mm or 20% while in flexion–extension cervical X-rays sagittal plane translation of more than 3.5 mm or 20%
are given point 2
● D. Relative sagittal plane angulation more than 11 degrees in neutral position cervical spine X-rays and sagittal plane angulation more than 20 degrees in flexion–extension cervical spine X-rays are given point 2
● E. Cervical spine is considered unstable if total score is more than or equal to 5
● F. All of the above
F. All of the above
Clay shoveler’s fracture is avulsion of spinous process of
which vertebra?
● A. C6
● B. C7
● C. C8
● D. T1
● E. T2
B. C7
Teardrop fracture is a type of flexion injury which results from axial loading at the vertex of the skull with neck flexed or from hyperflexion. Following are findings in this type of fracture except?
● A. A small chip of bone just beyond the anterior inferior edge of the involved vertebral body on the lateral cervical spine film
● B. Often associated with a fracture through the sagittal plane of the VB which can almost always be seen on AP view
● C. A large triangular fragment of the anterior inferior VB
● D. Fractured vertebra is usually displaced posteriorly
● E. Other fractures through the vertebral body never occur
E. Other fractures through the vertebral body never occur
Which of the following patients with subluxation are treated with conservative approach only?
● A. Subluxation on plain radiograph is less than or equal to 3.5 mm with no neurological deficit
● B. A + No abnormal movement on flexion–extension views
● C. Angulation more than 11 degrees with neurological deficit
● D. Subluxation of less than 3.5 mm with neurological deficit
● E. All of the above
E. All of the above
Unilateral locked facet is produced with flexion plus rotation while hyperflexion injury produces bilateral locked facet. Which of the following are the signs that are visible in case of locked facet?
● A. Naked facet sign on axial CT in which the articulating surface of the facet will be seen with appropriate articulating mate either absent or on the wrong side
● B. Bow tie sign on lateral X-ray which would be seen as left and right facets at the level of injury side by side instead of the normal superimposed position
● C. Oblique X-ray may depict blocking of the neural foramen
● D. All of the above
D. All of the above
Traction is applied in pounds 3 times the cervical vertebral level and increased by 5 to 10 pounds increments at 10 to 15 minutes interval until desired alignment is achieved (under SSEP or MEP monitoring or using lateral c spine X-ray or fluo-
roscopy). Following are the end points of traction application except?
● A. 10 pounds per vertebral level is not increased or some say up to 5 pounds
● B. If distraction of perched/locked facet or desired reduction is achieved
● C. If occipital cervical instability develops
● D. If any disk space height exceeds 5 mm
● E. If any neurologic deterioration occurs
D. If any disk space height exceeds 5 mm
Classification of cervical lateral mass and facet fracture includes following except?
● A. Separation fracture is fracture through lamina and ipsilateral pedicle which permits horizontalization of facet
● B. Comminuted fracture is multiple fracture often associated with lateral angulation deformity
● C. Split fracture is coronally oriented vertical fracture in one lateral mass with invagination of one articular facet of level below
● D. Traumatic spondylosis is bilateral horizontal fracture through pars interarticularis
● E. Pars fracture with isthmic subtype is also included in this
E. Pars fracture with isthmic subtype is also included in this
Indications of anterior approach in cervical spine are fractured vertebral body with bone retropulsed into the spinal canal, most extensive injuries, severe fracture of posterior elements that preclude posterior stabilization and fusion, most
extension injuries, and in traumatic subluxation of cervical spine. Following are the complications of anterior approach except?
● A. Anterior cage problems like cage displacement or extrusion, cage subsidence/telescoping into the end plate and vertebral body fracture
● B. Problems with plating like screw pull out, loosening or breakage, fatigue fracture of plate, screw injury of nerve root spinal cord or vertebral artery
● C. Nonunion of graft
● D. Improper surgical approach or failure to incorporate all unstable levels
● E. Injury to subclavian vessels
E. Injury to subclavian vessels
A patient presented with subaxial C spine injury. He
sustained a compression fracture with indeterminate diskoligamentous complex status and root injury. What is the total score according to the SLIC?
● A. 1
● B. 2
● C. 3
● D. 4
● E. 5
C. 3
Surgical management for subaxial C spine injury is indicated with an SLIC score of how much?
● A. 1
● B. 2
● C. 3
● D. 4
● E. 5
E. 5
Burst fracture of subaxial cervical spine is associated with which of the following?
● A. Compression in neutral position
● B. Flexion with compression
● C. Extension with compression
● D. Flexion with distraction
● E. Extension with distraction
A. Compression in neutral position
Teardrop fracture of subaxial cervical spine is associated with which of the following?
● A. Compression in neutral position
● B. Flexion with compression
● C. Extension with compression
● D. Flexion with distraction
● E. Extension with distraction
B. Flexion with compression
A score of 1 point in White and Panjabi scheme for stability of subaxial spine is given to which of the following?
● A. Anterior elements destroyed or unable to function
● B. Posterior elements destroyed or unable to function
● C. Positive stretch test
● D. Spinal cord damage
● E. Pavlov ratio < 0.8
E. Pavlov ratio < 0.8
