Ch64 Thoracic, Lumbar and Sacral spine fractures

Question 1

What is the Denis model of the thoracolumbar spine stability?

Answer 1

3-column model

Question 2

Which transverse process fractures can cause neurological deficits?

Answer 2

L4-5 TP fractures can cause lumbosacral plexus injuries

T1-2 TP fractures can cause brachial plexus injuries

Question 3

What are the different types of compression fracture?

Answer 3

Anterior and lateral (Rare)

Question 4

What are the different types of burst fracture?

Answer 4

fracture of both endplates
fracture of superior endplate (most common)
fracture of inferior endplate (rare)
burst + rotation
burst + lateral flexion

Question 5

What does an increase in the interpediculate distance on AP XR indicate?

Answer 5

middle column failure

Question 6

What is the TLICS score

Answer 6

Morphology

Compression 1
Burst 1
Distraction 2
Rotational 3

PLC
intact 0
undetermined 2
confirmed 3

Neurology 
in tact 0
root injury 2
complete SCI 2
Cauda equina or incomplete 3

Question 7

What is a Z-score on a DEXA scan?

Answer 7

norms of subjects of same age and sex as the patient

Question 8

What is a T score on a DEXA scan?

Answer 8

Norm for healthy young adults

Question 9

What drugs increase the risk of osteoporosis?

Answer 9

Steroids
Warfarin
AEDs (especially Phenytoin)
chronic heparin use
heavy alcohol consumption

Question 10

How do you classify sacral fractures?

Answer 10

Zone 1 - Fracture of Ala, spares central canal and neural foramina

Zone 2 - Through the foramina but sparing the canal

Zone 3 - through the canal, subdivided into horizontal (rare) and vertical (almost always associated with pelvic ring fracture)