SPINAL FRACTURES

Sheweidin Aziz – ST3 to Mr Basu CT teaching – Thursday 01/10/2015

AIM1. Anatomy

2. Risk factors and causes

3. Assessment

4. Interpretation of C-spine X-Ray

5. Classification

6. Management

Anatomy

Risk factors• EVERYONE IS AT RISK

• Age

• Osteopososis

• Ankylosing spondylitis

• Malignancies

ASSESSMENT• AcBCDE

• History

• Physical Examination• Other injuries • Neurological assessment (ASIA chart)

• Investigation (XR/CT/MRI)

INTERPRETATION OF C-SPINE X-RAY

What is next?• Are the images adequate?

• Are there other conditions making it difficult to read plain radiographs?

• What is ikely injury? Bony? Ligamentous?

• Is further imaging required? CT? MRI?

CLASSFICATIONS

FRACTURES OF THE ATLASLevine and EdwardsA. Transverse process fracture: Avulsion injury

B. Posterior arch fractures: Hyperextension injury associated with axis fractures

C. Anterior arch fractures: Hyperextension injury

D. Comminuted fractures/Lateral mass fractures: Axial Load and lateral bending injury

E. Burst Fracture (Jefferson Fracture): Axial load injury

FRACTURES OF THE ODONTOID PROCESS (Dens)Anderson and D’AlonzoType I: Oblique avulsion fracture of the apex (5%)

Type II: Fracture at the junction of the body and the neck; high non-union rate (60%)

Type III: Fracture extends into the body of C2 and may involve the lateral facets (30%)

TRAUMATIC SPONDYLOLISTHESIS OF AXIS

Levine and Edwards

Type I: Minimally displaced with no angulation; translation <3mm; stable.

Type II: Significant angulation; translation >3mm; unstable C2–C3 disc disrupted. Subdivided into Flexion/extension/listhetic types.

TRAUMATIC SPONDYLOLISTHESIS OF AXIS

Type IIA: Avulsion of entire intervertebral disc in flexion, ALL intact. Severe angulation. No translation; unstable due to flexion-distraction injury.

Type III: Rare. Initial anterior facet dislocation of followed by extension injury fracturing the neural arch. Severe angulation and translation with unilateral or bilateral facet dislocation. Unstable.

OTA ClassificationType A: Compression injuries of the body (compressive forces)

• Type A1: Impaction

• Type A2: Split

• Type A3: Burst

Type B: Distraction injuries of the anterior and posterior elements (tensile forces)

• Type B1: Posterior. Predominantly ligamentous

• Type B2: Posterior: Predominantly osseous (flexion-distraction injury)

• Type B3: Anterior disruption through the disc (hyperextension-shear injury)

Type C: Multidirectional injuries with translation affecting the anterior and posterior elements

• Type C1: Rotational wedge, split, and burst fractures

• Type C2: Flexion subluxation with rotation

• Type C3: Rotational shear injuries (Holdsworth slice rotation fracture)

FRACTURES THORACOLUMBAR SPINE• McAfee: based on the failure mode of the middle osteo-

ligamentous complex (PLL, posterior ½ vertebral body and posterior annulus fibrosus)

1. Wedge-compression fracture

2. Stable burst fracture

3. Unstable burst fracture

4. Chance fracture

5. Flexion-distraction injury

6. Translational injuries

Management • Prevent secondary insult• Analgesia• Respiratory• GI protection• Prevent hypothermia• Bladder/Bowels• Joints• Bed sores• Psychological

QUESTIONS