Thoracolumbar spine injuries

Question 1

What are common associated injuries with high energy injuries?

Answer 1

Chest wall and lung injuries, extremity injuries (e.g., femur fractures)

High energy injuries often lead to multiple system injuries.

Question 2

What percentage of injuries are considered non-contiguous?

Answer 2

10%

Non-contiguous injuries involve parts of the spine that are not adjacent.

Question 3

Define a fracture.

Answer 3

Break in the continuity of bone.

Question 4

Define a dislocation.

Answer 4

Loss of continuity/congruity of articulation of articular surfaces of a joint.

Question 5

What is a contiguous injury?

Answer 5

Injury to adjacent parts of the spine (e.g., L3 and L4 vertebral body fracture).

Question 6

What is a non-contiguous injury?

Answer 6

Injury to parts of the spine which are not adjacent (e.g., L2 and L5 vertebral body fracture).

Question 7

List the objectives for managing thoracolumbar (TL) spine fractures.

Answer 7

• Identify common presentations of TL spine fractures
• Demonstrate initial management
• Clinical process including history and examination
• Tests and imaging investigations
• Treatment for various fractures and dislocations.

Question 8

What are the three columns of the spine?

Answer 8

• Anterior column
• Middle column
• Posterior column.

Question 9

What does the anterior column of the spine consist of?

Answer 9

Anterior half of vertebral column, vertebral body, anterior longitudinal ligament, and intervertebral disc.

Question 10

What does the middle column of the spine consist of?

Answer 10

Posterior half of vertebral column, vertebral body, posterior longitudinal ligament, and intervertebral disc.

Question 11

What does the posterior column of the spine consist of?

Answer 11

Pedicles, lamina, and all processes (facets, transverse and spinous processes).

Question 12

What are the mechanisms of injury for spinal trauma?

Answer 12

• Axial load
• Distraction
• Rotational
• Burst
• Flexion and Extension.

Question 13

What are modes of injury classified as low energy?

Answer 13

Ordinary fall, abnormal twists.

Question 14

What are modes of injury classified as high energy?

Answer 14

MVA (motor vehicle accidents), PVA (pedestrian vehicle accidents), fall from height.

Question 15

What do ATLS principles include in the clinical process?

Answer 15

• Primary survey – ABC
• Secondary survey – examination of the whole spine.

Question 16

What is the logroll technique used for?

Answer 16

Examination of the spine for contusions, swellings, deformity, and checking for tenderness and gaps.

Question 17

What is the purpose of immobilisation for TL spine injuries?

Answer 17

To prevent further injury and support the spine.

Question 18

What is used for transfer and transportation of patients with TL spine injuries?

Answer 18

• Spine scoop
• Rigid spine board.
• Soft/ripple mattress (to avoid pressure sores).

Question 19

What does widened interpedicular distance indicate?

Answer 19

Burst type fracture.

Question 20

What are indications for further investigations for TL spine injuries?

Answer 20

• All patients with C-spine fractures
• Positive logroll findings
• Suspicious LODOX™ findings
• Mechanism of injury.

Question 21

When is a CT scan indicated for spine injuries?

Answer 21

When subtle injuries are suspected or fractures identified on x-rays.

Question 22

When is an MRI indicated for spine injuries?

Answer 22

For neurological injuries.

Question 23

What immediate care should be provided for spinal injuries?

Answer 23

• Immobilisation
• Supportive care (analgesia, oxygen, ulcer prophylaxis, pressure point care, psychological support, bladder and bowel management).

Question 24

What does short-term care for spinal injuries involve?

Answer 24

Stabilisation (operative/non-operative).

Question 25

What is included in long-term care for spinal injuries?

Answer 25

Rehabilitative care and surveillance for sequelae.