Thoracic, Lumbar, and Sacral Spine Fracture Flashcards
Denis three-column model of spine attempts to identify CT criteria of instability of thoracolumbar spine fractures. Which of the following statements is incorrect regarding this model?
● A. Anterior column consist of anterior half of vertebral body, anterior half of disk, and the anterior longitudinal ligament
● B. Middle column consist of posterior half of disk and vertebral body including posterior longitudinal ligament
● C. Posterior column consist of posterior bony complex (posterior arch) with interposed posterior ligamentous complex (supraspinous and interspinous ligament, facet joints and capsule, and ligamentum flavum)
● D. Injury to posterior column alone does cause instability in flexion
D. Injury to posterior column alone does
cause instability in flexion
Minor spinal injuries involve only a part of column and do not lead to acute instability (when not accompanied by major injuries). These injuries include which of the following?
● A. Fracture of transverse process except in two areas (L4–L5 which can cause lumbosacral plexus injury and T1–T2 which can cause brachial plexus injury)
● B. Fracture of articular process or pars interarticularis
● C. Isolated fracture of spinous process
● D. Isolated laminar fracture
● E. All of the above
E. All of the above
McAfee classification describes six main types of fractures. A simplified system with four categories includes the following except?
● A. Compression fracture which includes anterior column compression and posterior distraction if severe
● B. Burst fracture which includes compression of both anterior and middle columns
● C. Seat belt fracture in which there is middle and posterior column distraction with intact or mild compression of anterior column
● D. Fracture dislocation which includes compression, rotation, and shear of anterior column along with distraction, rotation, and shear of middle and posterior columns
● E. All of the above
E. All of the above
Pure axial load can cause compression of vertebral body and compression failure of anterior and middle columns. Five subtypes of L5 burst fracture are fracture of both end plates, fracture of superior end plate, fracture of inferior end plate, burst rotation, and burst lateral flexion. Which the following is a radiographic picture of this type of fracture?
● A. On lateral X-ray, there can be cortical fracture of posterior vertebral body wall, loss of VB height and retropulsion of bone fragment from end plate into the canal
● B. AP X-ray can show increase in interpediculate distance, vertical fracture of lamina, and splaying of facet joints
● C. CT can demonstrate break in the posterior body wall with retropulsion of bone into the spinal canal
● D. MRI may show possible cord compression anteriorly with possible cord compression usually with fragments occupying more than 50% of the canal diameter
● E. All of the above
E. All of the above
Denis categorized spine injuries as 1st degree, 2nd degree, and 3rd degree causing mechanical instability, neurologic instability, and both mechanical and neurological instability, respectively. Following are included in the unstable compression
fracture except?
● A. Single compression fracture with loss of more than 50% height with angulation or excessive kyphotic angulation at one segment
● B. Three or more contiguous compression fracture
● C. Neurologically intact patient
● D. Disrupted posterior column or more than the minimal middle column fracture
● E. Progressive kyphosis (risk of kyphosis increases when loss of height of anterior vertebral body is more than 75%)
C. Neurologically intact patient
Which of the following is incorrect regarding thoracolumbar injury classification and severity score (TLICS)?
● A. Compression fracture, burst component or lateral angulation more than 15 degrees, translational/rotational injuries, and distraction injuries are given numbers 1, 2, 3, and 4, respectively
● B. Intact neurologic status, root injury, complete spinal cord injury, incomplete spinal cord injury, and cauda equina syndrome are given numbers 0, 2, 2, 3, and 3, respectively
● C. Intact posterior ligamentous complex, undetermined status, and definite injury to posterior ligamentous complex are given numbers 0, 2, and 3, respectively
● D. Patients with a score of more than or equal to 4 are surgical candidates
D. Patients with a score of more than or equal to 4 are surgical candidates
Postoperative wound infection with spinal instability is due to which organism?
● A. Staphylococcus aureus
● B. Staphylococcus epidermidis
● C. E. coli
● D. Pseudomonas aeruginosa
● E. Pneumococcal organisms
A. Staphylococcus aureus
Risk factors for osteoporosis include cigarette smoking, drugs (like heavy alcohol consumption, phenytoin, warfarin, chronic heparin use, steroids use), postmenopausal female, physical inactivity, low calcium intake, and low serum levels of vitamin D. Diagnosis of osteoporosis can be made using DEXA
scan which measures bone mineral density at proximal femur, lumbosacral spine, and forearm. Which of the following are the treatment options for osteoporosis?
● A. Drugs that increase bone formation, for example, parathyroid hormone analogues and sodium fluoride
● B. Drugs that reduce bone resorption like estrogen, calcium and vitamin D analogues, calcitonin, bisphosphonates, estrogen analogues, and RANK ligand
● C. Percutaneous vertebroplasty
● D. Kyphoplasty
● E. All of the above
E. All of the above
Indications for kyphoplasty include painful osteoporotic compression fractures, for affected levels from T5 to L5, some symptomatic vertebral hemangiomas, osteolytic metastasis and multiple myeloma, and pathologic compression fracture.
Following are the contraindications of kyphoplasty except?
● A. Coagulopathy
● B. No focal neurologic deficit
● C. Spinal instability
● D. Completely healed fractures
● E. Active infections
C. Spinal instability
Which of the following is correct regarding sacral fractures?
● A. Zone I is fracture of region of ala sparing the central canal and neural foramina
● B. Zone II is fracture through the region of sacral foramina
● C. Zone III is vertical fracture through the region of central canal
● D. Zone IV is transverse fracture through the region of central canal
● E. All of the above
E. All of the above
According to three-column model of spine by Denis, which of the following is not included in the middle column?
● A. Posterior half of disk
● B. Posterior wall of vertebral body
● C. Posterior annulus fibrosus
● D. Posterior longitudinal ligament (PLL)
● E. Posterior arch
E. Posterior arch
Burst fracture has five subtypes. Which of the following is the most common?
● A. Fracture of both end plates
● B. Fracture of superior end plate
● C. Fracture of inferior end plate
● D. Burst rotation
● E. Burst lateral flexion
B. Fracture of superior end plate
Chance fracture is a subtype of which of the following?
● A. Compression
● B. Burst
● C. Seat belt
● D. Three-column failure
● E. Fracture-dislocation
C. Seat belt
Surgery is indicated in burst fracture when kyphotic angle is greater than what?
● A. 5
● B. 7
● C. 10
● D. 15
● E. 20
E. 20
Cushing’s disease is a risk factor for osteoporosis if the disease persists for how long?
● A. 1 month
● B. 3 months
● C. 6 months
● D. 1 year
● E. 2 years
E. 2 years
