VERTEBRAE FRACTUREMAULANA SAPUTRAWIRASASMITA PARIPIHMAULIDA ANGRAINI

INTRODUCTIONIncidence 30-40/ 1,000,000 personThe mortality rate 40-50%Most common in the thoracolumbal region 64%The peak incidence in the young age group (15-25 year-old)Motor vehicle accidents acounts for 50% followed by falls (25%), athletic accidents (15%), and penetraing injuries (10%)

The Vertebral Column> central bony pillar of the body> provides a base of support for the head and internal organs; a stable base for the attachments of ligaments, bones, and muscles of the UE, rib cage, pelvis, > a link between the UE and LE> protects the spinal cord

Structure33 short bones called vertebrae and 23 IV disks5 regions> cervical (7)> thoracic ( 12)> lumbar ( 5)> sacral ( 5)> coccygeal ( 4)

Primary and Seconday CurvesPrimary curves ( thoracic and sacral) posterior convexity, anterior concavity( kyphotic curves)Secondary curves (cervical and lumbar) posterior concavity, anterior convexity( lordotic curves)

General characteristics of vertebra

7 processes4 articular and 3 nonarticularNONARTICULARA. (1) spinous process or spine (directed posteriorly )B. (2) transverse processes ( directed laterally)> arise from the junction of pedicles and laminae> serves as levers> receives attachments of muscles and ligaments

7 processesARTICULAR ( vertically arranged)A. (2) superior articular B. (2) inferior articular 2 superior articular processes of one arch articulate with the 2 inferior articular processes of the arch above forming two synovial joints IV foramen formed by superior notch of one vertebra and inferior notch of an adjacent vertebra; transmits the spinal nerves and blood vessels

Characteristics of a typical cervical vertebraTransverse processes has a foramen transversarium for passage of vertebral artery and veinsSpines are small and bifidBody is small and broad from side to sideVertebral foramen is large and triangularSuperior articular processes have facets that face backward and upward; inferior have facets that face downward and forward

Typical cervical vertebra

Characteristics of the atypical cervical vertebrae( C1, C2, and C7)C1 atlas ( supports the globe of the head)> s body and spinous process> has anterior and posterior arch> has a lateral mass on each side with articular surfaces on its upper surface for articulation with the occipital condyles(atlanto-occipital joints)

Characteristics of the atypical cervical vertebrae( C1, C2, and C7).C2 axis ( epistropheus)> has peglike odontoid process

C7 (vertebra prominens)> has the longest spinous process and not bifid> transverse process is large> foramen transversarium is small and transmits the vertebral vein or veins.

Atypical vertebrae

Characteristics of a Typical Thoracic VertebraBody is medium size and heart shapedVertebral foramen is small and circularSpines are long and inclined downwardCostal facets are present on the sides of the bodies for articulation with the head of the ribsCostal facets are present on the transverse processes for articulation with the tubercles of the ribs( T11 and 12 have no facets on the transverse processes)Superior articular processes facets backward and laterallyInferior articular processes facets forward and medially

Typical thoracic vertebra

Characteristics of a Typical Lumbar VertebraBody is large and kidney shapedPedicles are strong and directed backwardLaminae are thickVertebral foramina are triangularTransverse processes are long and slenderSpinous processes are short, flat, and quadrangular and project backwardArticular surfaces of the superior articular process face mediallyInferior articular processes face laterally

comparison

Sacrum5 vertebrae fused together to form wedge-shaped boneConcave anteriorlyUpper border articulates with L5Inferior border articulates with coccyxLateral border articulates with 2 iliac bones ( sacroiliac joints)

Structure and Function of the IV DiskThe Annulus Fibrosus fibrocartilage and collagen provides tensile strength restrain various spinal motion fibers of the inner layer blend with the nucleus pulposus firmly attached to the adjacent vertebra and to one anotherSupported by ligaments

Structure and Function of the IV DiskThe Nucleus Pulposusgelatinous mass with loosely aligned fibers. high concentration of proteoglycans Fluid Mechanics In the Spine evenly distribute pressure transport for nutrients normally: NP does not move in a healthy disk

The Cartilaginous End-Plates encircled by the apophyseal ring of the respective vertebral body nutrition diffuses from marros of the vertebral bodies to the disk via the endplates

Ligaments

Intervertebral disk

OTHER FACTORS THAT INFLUENCE MOVEMENT

Slant and Shape of Spinous Process

Relative size of IV and Body

Ribs in the thoracic Region

Muscles

Spinal Column InjuryAtlanto-occipital dislocationAtlanto-occipital dislocation (AOD) is a devastating condition that frequently results in prehospital cardiorespiratory arrestaccounts for 1% of spinal trauma.AOD occurs 3 times more commonly in children than adults,hyperextension. UnstablePowers ratio=BC/OA

Spinal Column InjuryAtlanto-Axial dislocationLower mortality than Atlanto-occipital dislocation1/3 of patients have deficitTransverse ligament injuryAAD occurs more commonly in children than adultsNon-traumatic in downs syndrome and Rheumatoid arthritisUnstableADI> 5mm

Spinal Column InjuryAtlas (C1) fracturesDescribed as Jefferson #Axial load Usually no neurological deficit1/3 have C2 #Usually stable

Spinal Column InjuryAxis (C2) #Includes Hangmans # and Odontoid process #

HANGMANS #Bilateral # of the isthmus of the pedicles of C2 with anterior sublaxation of C2-C3Hyperextention and axial loadingUsually stable

Spinal Column InjuryAxis (C2) #Includes Hangmans # and Odontoid process #

Odontoid #Flexion injury15% of all cervical injuriesII unstable,I & III stableIIIIII

Spinal Column InjurySubaxial (C3-C7) #Whiplash injury:Traumatic injury to the soft tissue in the cervical regionHyperflexion, hyperextentionNo fractures or dislocationsMost common automobile injuryRecover 3-6 months

Spinal Column InjurySubaxial (C3-C7) #Vertical compression injury:Loss of normal cervical lordosisBurst #Compression of spinal cordUnstableRequires decompression and fusion

Spinal Column InjurySubaxial (C3-C7) #Compression flexion injury (teardrop #)Classical diving injuryPosterior elements involved in >50%Displacement of inferior margin of the bodyUnstableRequires stabilization

Spinal Column InjurySubaxial (C3-C7) #flexion distraction injury (locked facet)>50% displacementUnstableRequires reduction and stabilization

Spinal Column InjurySubaxial (C3-C7) #extention injury (# posterior elements)# lamina, pedicles or spinous processWith or without ligamentous injuryUsually stable

Spinal Column InjuryThoracic and lumbar #Stability (three column model of Denis)Injury affecting two or more column is unstable

Spinal Column InjuryThoracic and lumbar #Compression #Burst #Chance # (seat belt)Flexion distractionFracture dislocation

General Management GuidelinesStrict spine precautions (immobilization)Emergency resuscitation (ABC..)Comprehensive approachNeurological and Radiological assesment.Always expect multiple trauma (neuroexam, chest, abdomin,muskuloskeletal)Differentiate hggic from neurogenic shock

General Management GuidelinesExternal vs Internal stabilization