TBL 5 vertebral column

Question 1

Spondylolysis
also known as a ______ fracture

where does it normally occur?

Answer 1

• Spondylolysis is a unilateral or bilateral defect (fracture or separation) in the
  posterior arch of the spine, specifically the pars interarticularis between the
  zygapophyseal (facet) joints.
• Although usually an overuse injury, spondylolysis may present following an acute
  overload.
• Spondylolysis is primarily a fatigue fracture.
• It occurs most frequently in athletes whose sport involves repetitive increased
  spinal loads.
• Spondylolysis occurs at the fifth lumbar vertebra (L5) approximately 85% to 95%
  of the time.
• When bilateral defects develop, the vertebral body may slip anteriorly relative to
  the adjacent vertebra and this is termed, spondylolisthesis.

Question 2

Spondylolisthesis

Answer 2

• In spondylolisthesis, the body of a lower vertebra (usually L5) slips
  forward on the body of the vertebra below (or upon the sacrum) and
  carries with it the whole of the upper portion of the vertebral column.

Question 3

Congenital Spondylolisthesis

Answer 3

Congenital Spondylolisthesis
* In this condition, the pedicles are abnormally formed, and centers of
ossification fail to unite.
* The spine, laminae, and inferior articular processes remain in position,
whereas the remainder of the vertebra slips forward.
* The vertebral canal is not narrowed but the nerve roots may be
compressed.

Question 4

Degenerative Spondylolisthesis

Answer 4

• This condition is common in the elderly and involves degeneration of
  the intervertebral discs in the lumbar region and osteoarthritis of the
  intervertebral joints.
• Anterior slippage of the L5 vertebra often occurs, and the lumbar
  nerves roots may be pressed on, causing low back pain and pain down
  the leg in the distribution of the involved nerve.

Question 5

Hangman’s Fracture

what happens and what vertebra is involved

Answer 5

• Bilateral fracture in the pars interarticularis of the axis (C2).
• Sudden hyperextension of the neck, such as in an automobile accident, is the usual cause of hangman’s fracture.
• The vertebral canal is enlarged by the forward displacement of the vertebral body of the axis. Because of this, the spinal cord is rarely
  compressed and patients are usually neurologically intact.
• However, it is considered an unstable fracture which may cause bones to move and cause damage to the spinal cord, which can lead to
  paralysis of respiratory muscles and most often death.

Question 6

C1 Vertebra (Atlas) Fracture

Answer 6

• Caused by axial loading on the back of the head, such as in “spearing” in football or diving into a shallow pool.
• C1 fractures are traumatic injuries usually caused by high-energy trauma with axial loading in young patients (Jefferson Fracture) or
  low-energy falls in elderly.

Question 7

Jefferson Fracture

also called ______ when anterior and posterior arch fractures

Answer 7

• Jefferson fracture is a burst fracture that is a type of a C1 fracture.
• When there are both anterior and posterior arch fractures, this is called a “burst” fracture.
• With the neck straight, an excessive vertical force applied from above will cause the ring of the atlas to be disrupted and the lateral masses
  to be displaced laterally.
• Often caused by trauma. The contact makes the neck violently snap back or forward, cracking the ring-shaped C1.
• Divers are at high risk of getting this fracture. Anyone who plays contact sports is also at a higher risk.
• A Jefferson fracture doesn’t always result in a spinal cord injury, because the dimensions of the bony ring increase.

Question 8

Extension “Teardrop” Fractures

Answer 8

Extension teardrop - An extension teardrop fracture occurs when abrupt neck extension causes the anterior longitudinal
ligament to avulse a corner from the remainder of the vertebral body, producing a triangular-shaped fragment (tear drop).
* Usually occur at C2 and are a stable avulsion fractures.
* In older patients, the C2 vertebral body is commonly affected due to degenerative ankylosis of lower levels.

Question 9

Flexion “Teardrop” Fractures

Answer 9

• The most severe, unstable fracture of the cervical spine which typically occurs from flexion and compression.
• Typically occur at C5-C6 and may occur, for example, from diving head first into shallow water.
• Flexion tear drop fractures are usually associated with spinal cord injuries.
• There will be displacement of the posterior part of the vertebral body into the spinal canal.
• Separation of the spinous processes will be seen due to a disruption of the posterior ligaments; often a tear of the
  interspinous ligament is seen.
• The fracture is unstable and will require surgery.