Content: 3 classifications for fractures of the spine
1 = stable
2 = unstable
3 = unstable
Content: What 5 factors that determine spine fracture management
3. neurologic involvement
Q: What 2 areas of the spine are most commonly injured?
1. lower c-spine
2. T-L junction
Q: _____ of spinal injuries involve the c-spine.
Q: ________ injuries common in adults, ________ injuries common in children.
Q: _____ of spinal fractures are associated with neurologic involvement.
Content: Define the location of the anterior column
Anterior longitudinal ligament, anterior 2/3 of vertebral body, and annulus fibrosus
Content: Define the location of the middle column
Posterior longitudinal ligament, posterior 1/3 of vertebral body, and annulus
Content: Define the location of the posterior column
Posterior ligament complex and vertebral arch structures
Diagram: Anterior, middle, and posterior columns
Term: refers to immediate or subsequent risk or spinal cord and spinral nerve root injury
Q: __________ injuries do not have significant bone or joint displacement, ______________ structures remain intact.
Q: What are some examples of stable injuries?
Compression, traumatic disc herniation, unilateral facet dislocation
Q: __________ injuries show or have potential for significant ________________.
Q: What are some examples of unstable injuries?
Fracture-dislocations, bilateral facet dislocations
Q: Fractures involving ____ column are stable while fractures involving ____ columns are unstable.
Q: Fractures involving 2 columns usually follow the __________ column.
Q: What is the typical MOI for cervical fractures?
MVA, fall, violence, sports
Content: Types of cervical fractures (5)
1. Occipital cervical
2. Subaxial (C3-C7)
Q: Why are cervical fractures above C4 high mortality?
Due to control of the diaphragm occuring at C3,4,5
T/F: The cervical spine has a relatively small cord space compared to the T/L-spine.
Content: Treatment of C-spine injury (4)
2. Ongoing neurological examination
Content: Conservative stabilization methods (3)
1. Closed reduction
Content: Surgical stabilization methods (2)
2. Posterior/Anterior fusion/instrumentation
Q: Which surgical approach appears to offer increased stability?
Diagram: Identify the type of brace
Halo with vest
Diagram: Identify the type of brace
T/F: Occipital condyle fractures are common.
Content: Typical treatment for a type 1 or 2 occiptial condyle fracture (2)
- Cervical orthosis for 6-8 wks OR
- Halo for 8-12 wks
Content: Typical treatment for a type 3 occipital condyle fracture (3)
- Cervical orthosis if no AO instability
- Halo if minimally displaced
- Occ-C2 posterior spinal fusion (PSF)
Q: What is another name for an atlanto occipital dislocation?
T/F: Atlanto-occipital dislocations are rare.
Content: Atlanto-occipital dislocation (3)
1. associated with spinal cord involvement
2. careful immobilization and reduction with positioning and halo
3. often require Occ-C2 PSF
Content: Atlas Fracture (4)
1. Usually due to axial loading of the occiput
2. "Burst" fracutre of the bilateral anterior and posterior arches
3. 1/2 assoc. with other c-spine injuries (typically C2)
4. Often accompanied by transverse ligaments tear or avulsion fracture
Q: What is another name for an atlas fracture?
T/F: Atlas fractures are commonly associated with neurologic injury.
Diagram: Identify the type of fracture
Content: Treatment of an atlas fracture (3)
1. < 2mm displaced = cervical orthosis
2. > 2mm displaced/other fractures = traction and halo
3. significant instability = AA fusion
A fracture that does not heal and remains unstable due to a lack of blood supply
Content: C2 (odontoid) fracture population (2)
1. Risk taking youth
2. Osteoporotic elderly
T/F: C2 (odontoid) fractures have high non union rates.
T/F: C2 (odontoid) fractures are rarely associated with other c-spine fractures.
Q: _____% incidence of neurlogic compromis with C2 (odontoid) fractures.
Diagram: Types of occipital cervical injuries
Q: What is the typical treatment for a type 1 occipital cervical injury
Q: What is the typical treatment for a type 2 occipital cervical injury with < 5mm displacement and 10 degrees of angulation?
Q: What is the typical treatment for a type 2 occipital cervical injury with > 5mm displacement and 10 degrees of angulation?
Traction and PSF or anterior screw placement
Q: What is the typical treatment for a type 3 occipital cervical injury with < 5mm displacement and 10 degrees of angulation?
Q: What is the typical treatment for a type 3 occipital cervical injury with > 5mm displacement and 10 degrees of angulation?
Traction and halo
Q: What is another name for a C2 (axis) fracture?
Hangman's fracture or traumatic spondylolisthesis
Q: What causes C2 (Axis) fractures?
Diagram identify which is a type 1 and type 2 C2 (axis) fracture
Type 1 on left, Type 2 on right
Q: What type of C2 (axis) fracture causes neuro compromise?
Distraction (not fracture)
Q: What is the treatment plan for a type 1, 2, and 3 C2 (axis) fracture?
Type 1 = cervical orthosis
Type 2 = halo with or without traction
Type 3 = open reduction internal fixation (ORIF) of C2, with C2-3 PSF
Content: Typical Type 1, 2, 3, fracture treatments
Type 1 = cervical orthosis
Type 2 and 3 = halo with or without traction
T/F: Lower c-spine injury is assumed until proven otherwise.
Q: Early _______________ use and _________ stabilization are indicated for ____ cases of radiographic neurologic compromise.
Corticosteroid, surgical, all
Q: How are subaxial cervical injuries usually managed?
With anterior cervical decompression/fusion (ACDF)
Content: Subaxial cervical distraction-flexion injury (4)
1. distraction load on flexed neck
2. common MOI = MVA
3. most vulnerable regions = C5-6 and C6-7
4. facet dislocation (U/B) and posterior longitudinal ligament compromise
Q: What causes a bowtie sign?
A unilateral facet dislocation or subluxation of the subaxial servical spine
Content: Treatment of subaxial cervical injuries (3)
1. Immediate closed reduction
2. Posterior stabilization and anterior decompression with stabilition if disc is herniated
3. Immobilization with a cervical orthotic
Content: Subaxial cervical - vertical compression injury (3)
1. MOI = MVA or diving
2. Most vulnerable = C5-7
3. Compresses and shortens anterior and middle columns
Q: What is the treatment for a subaxial cervical vertical compression that is stable with little kyphosis?
Q: What is the treatment for a subaxial cervical vertical compression that is unstable with kyphosis or canal compromise? (2)
1. ACDF with/without PSF
2. Rigid othrosis, potentially a halo
Q: What is the name of a compresion flexion injury to the subaxial c-spine?
Tear drop fracture
Q: What often accompanies a tear drop fracture?
Q: What is the treatment for a tear drop fracture?
ACDF with/without PSF and cervical orthosis
Content: Subaxial cervical lateral flexion injury (4)
1. MOI = MVA, blow to head
2. Usually minimal clinical findings
3. Rarely involve ligament injury requiring surgery
4. Often managed with soft/rigid collars
Q: What is the most frequently fractured thoracic spine?
T12 and L1
Q: Which thoracic spine zones are most commonly affected?
The transitional vertebrai T1-4 and T9-12
Q: What % of thoracic spine fractures involve neurological compromise?
Q: What is the MOI for thoracic spine fractures? (3)
2. Metastatic disease
Q: What type of force typically causes thoracic spine injury?
T/F: Thoracic spine fractures have a bimodal distribution of incidence.
Q: Where does cauda equina being?
Content: Management basis for thoracic spine fractures (3)
1. stability, spinal cord compromise
2. presence of rib or sternal involvement
3. loss of vertebral height
Q: Opposition of ____________ C/L-spine against ________T-spine place transitional zones at ______ risk.
flexible, rigid, high
Term: Thoracic spine fractures: Failure of anterior column, low risk of neurologic compromise
Term: Thoracic spine fractures: Result of axial loading, often associated with neurologic compromise
Term: Thoracic spine fractures: Transverse facture line, rather rare
Flexion distraction (seatbelt)
Term: Thoracic spine fractures: Considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation
Q: What is the conservative approach to T-spine fractures? (3)
1. Postural reduction
3. Functional bracing
Q: What is the surgical approach to T-spine fractures?
Anterior/posterior decrompression and fusion
Q: What region of the lumbar spine is most susceptible to fractures?
Q: What is the most common MOI for L-spine fractures?
Q: With L-spine fractures, the need for surigcal stabilization is predicted by the presence of lumbar ___________.
Q: Which region of the L-spine's structure size and protective musculature sabilize the joints?
Q: Which region of the L-spine is unstable, largely due to force necessary to casue injury?
Q: What type of orthosis is used for L-spine fracture?
TLSO (rigid), Jewett hyperextension brace, lumbosacral corset
Q: What should be the focus of acute PT interventions post fracture or fusion?
mobility rather than strengthening specific back musculature
Q: What movements should be avoided post fracture or fusion?
Flexion and rotation
Q: When is surgery appropriate for scoliosis?
If the curvature is > 40-50 degrees and after growth is complete
Q: How long do activity limitations remain after a surgical scoliosis repair?