Spinal Fracture Flashcards
Aetiology of spinal fractures
Trauma
- Road traffic collisions
- Falls from height
- Sports injuries
- Violence or assault
Disease and degenerative change
- Osteoporosis (+ steroid use)
- Cancer
- Infections
- Arthritis
Investigations for suspected spinal fracture
C-spine radiograph series: AP, lateral, odontoid peg
Once stabilised
CT neck
MRI
Management for spinal fractures
- Initial assessment
- Stabilise the spine: back brace or traction
- Analgesia: NSAIDs or opioids
- Assess for (1) spinal cord injury (2) stable of unstable injury - Primary survey
- Maintain C-spine immobilisation: manually/collar + sandbags + log roll pt + do not remove helmets
- A-E (CA-E) - Secondary survey
- Log roll exam to assess spine: ?bruising, tenderness, spinal deformities - Neuro examination: pain/fine touch sensation, power, reflexes, cranial nerves
Radiological investigation
C-spine: halo vest ± surgical intervention
Thoracic: halo jacket ± urgent surgical intervention
Lumbar: bracing or cast
Sacral: surgical intervention ± spinal fusion
Follow up:
Long-term physiotherapy
Occupational therapy
Specialised spine unit contact
What constitutes an unstable spinal fracture
Fracture-dislocation
Brust fractures
Fractures of atlas and axis
Where are the majority of C-spine fractures
C2 and C6/7
Types of cervical spine fracture
Hangman: most common, spondylolisthesis of C2
Atlas: breaks atlas ring into 4 pieces (UNSTABLE)
Subluxation
Whiplash: neck extension → forward flexion with accel→decel
Odontoid-peg: base of the dens (C2) (UNSTABLE)
Anterior wedge
Facet joint dislocation
Isolated spinous process avulsion
Flexion/extension teardrop fracture (UNSTABLE)
Types of thoracic spine fracture
Burst fractures: axial compression + loss of vertebral body height (anterior/middle/posterior)
Flexion-distraction (seatbelt): extreme spinal flexion
Fracture dislocation: displacement of vertebral body
Types of lumbar spinal fracture
Transverse process: most common, ass. with crushing injury
Compression: elderly, osteoporosis
Chance: flexion distraction → horizontal body fracture
Fracture dislocation: displacement of vertebral body
Types of sacral and coccygeal fracture
Vertical: axial loading
Transverse: upper sacrum, lateral compression
Fracture dislocation: displacement of vertebral body
Types of surgical management for spinal fractures
Aims to stabilise the spine + prevent further injury
Metal plates, screws, roads to hold the spine
Vertebroplasty: a minimally invasive procedure in which bone cement is injected into the fractured vertebrae to stabilise the spine
Kyphoplasty: similar to vertebroplasty, a balloon creates a space in the fractured vertebrae before bone cement is injected
Spinal fusion: a surgical procedure in which two or more vertebrae are fused to stabilise the spine
Complications of spinal fractures
Neurological: neuropathic pain, autonomic dysreflexia, spasticity, and loss of bowel and bladder function
Orthopaedic: pressure ulcers, osteoporosis, and joint contractures
Cardiovascular: deep vein thrombosis, pulmonary embolism, and autonomic dysfunction
Respiratory: respiratory muscle weakness, pneumonia, and respiratory failure. This may relate to partial phrenic nerve palsy, intercostal paralysis, poor cough, or a ventilation–perfusion disorder.
Prognosis for spinal fractures
Depends on severity and location
- Level of injury: the higher the level of injury, the more severe the neurological deficits and the worse the prognosis
- Severity of injury: patients with complete spinal cord injury have a worse prognosis than those with incomplete spinal cord injury
- Age: younger patients generally have a better prognosis than older patients
- Time to treatment: early intervention and prompt treatment can improve the prognosis
- Comorbidities: patients with pre-existing medical conditions, such as diabetes, hypertension, or heart disease, may have a worse prognosis
Most have good prognosis
Severe fractures with spinal cord injury may lead to long-term disability and reduced QOL
