Spine Trauma Flashcards

Question

What is the prognosis of central cord syndrome?

Answer 1

good prognosis although full functional recovery rare usually ambulatory at final follow up usually regain bladder control upper extremity and hand recovery is unpredictable and patients often have permanent clumsy hands

Answer 2

◦ recovery occurs in typical pattern * lower extremity recovers first * bowel and bladder function next * proximal upper extremity next * hand function last to recover

Answer 3

* Worst prognosis; 10-20% chance of motor recovery * motor dysfunction + dissociated sensory deficit below level of SCI * flexion/ compression injury * lower extremity affected more than upper extremity

Answer 4

* Penetrating trauma * Ipsilateral deficit LCS tract * Motor function * dorsal columns * proprioception * vibratory sense * contralateral * deficitLST: pain, temperature * spinothalamic tracts cross at spinal cord level (classically 2-levels below)

Answer 5

True Fehlings et al. performed a multicenter prospective cohort study on the timing of intervention for spinal cord injuries. They found improved neurological outcome for patients with complete or incomplete spinal cord injuries that were decompressed within 24 hours compared to those that were decompressed at a later time. Additionally, they found no increased risk of mortality or complications for patients who underwent early surgical intervention. **STASCIS**

Answer 6

no motor function preserved more than 3 levels below the affected neurological level is consistent with an ASIA B category injury.

Answer 7

It is not supported by current literature - recent studies have shown an increased risk of complications with no clear evidence of benefits

Answer 8

increase in systolic blood pressure of at least 20% associated with a change in heart rate and accompanied by at least one of the following signs (sweating, piloerection, facial flushing), or symptoms (headache, blurred vision, nasal congestion) due to a stimulus such as overdistended bladder or bowel impaction. due to sympathetic decentralization leads to altered regulation of the autonomic function, despite the presence of intact parasympathetic (vagal) afferent and efferent pathways in patients with SCI. Guidelines for treatment of autonomic dysreflexia include 1) patient immediately placed in a sitting position if the person is supine. 2) clothing or constrictive devices need to be loosened 3) troubleshoot etiologies for bladder distention or bowel impaction 4) a SBP \>150 mmHg may need to be treated with nifedipine or nitrates 5) close monitoring of symptoms, blood pressure, and heart rate for at least 2 hours.

Answer 9

Severity of initial neurologic injury

Answer 10

COMPLETE spinal cord injuries at C5 or C6 with 5/5 delt/biceps, but 0/5 triceps. Activities such as dressing, controlling a power wheelchair and supporting oneself while sitting are dependent on the balanced forces provided by the triceps muscle. The transfer involves detaching the posterior deltoid muscle and anchoring the tendon sutured into the triceps muscle. It is the best choice as it will allow for opposing elbow extension to his maintained bicep function - which will help patients to perform reaching movements and improve level of functional independence.

Answer 11

Traumatic occipito-cervical dislocation: most patients die of brainstem destruction Acquired occipito-cervical instability: Down's syndrome; occipital condyle hypoplasia results in limited AOJ motion and basilar invagination

Answer 12

* Atlanto-axial instability: also seen in Down syndrome patients * neurologic deficits * vertebral or carotid artery injuries * Down Syndrome

Answer 13

* Ring containing two articular lateral masses * No vertebral body or a spinous process * anatomic variation: incomplete formation of the posterior arch is a relatively common; does not represent a traumatic injury * Ligamentous structures: transverse ligament; paired alar ligaments; apical ligament ; tectorial membrane

Answer 14

**Type I** Anterior occiput dislocation **Type II** Longitudinal dislocation **Type III** Posterior occiput dislocation

Answer 15

- **_Powers ratio_** = C-D/A-B C-D: distance from basion to posterior arch A-B: distance from anterior arch to opisthion significance ratio ~ 1 is normal if \> 1.0 concern for * anterior dislocation ratio \< 1.0 raises concern for * posterior atlanto-occipital dislocation * odontoid fractures * ring of atlas fractures - **_Harris rule of 12_** basion-dens interval or basion-posterior axial interval \>12mm suggest occipito-cervical dissociation

Answer 16

**_Approach:_** midline posterior approach to base of skull Instrumentation - rigid occipito-cervical screw-rod or plate construct - aim for 3 uni-cortical occipital screws on each side of the midline (total 6 screws in occiput) - some institutions prefer bi-cortical screws but they come at increase risk extend to C2 or lower with polyaxial pedical screws to achieve fixation - **_Safe zone for Occipital screws_** : within 20mm lateral to the external occipital protuberance along the superior nuchal line **Structures at risk:** ***major dural venous sinuses*** located below the external occipital protuberance

Answer 17

Internal carotid artery

Answer 18

Degenerative and traumatic processes

Answer 19

**_Adult causes_** **_Degenerative_** Down's syndrome Rheumatoid Arthritis Os Odontoideum **_Traumatic_** Type I odontoid fracture (very rare) Atlas fractures Transverse ligament injuries **_Pediatric causes_** **_Degenerative_** JRA Morquio's Syndrome lysosomal storage disorder **_Trauma/infection_** rotatory Atlanto-axial subluxation

Answer 20

* flexion-extension x-rays atlanto-dens interval (ADI) adult parameters \> 3.5mm considered unstable \> 10mm indicates surgery in RA * space-available-cord (SAC) = posterior atlanto-dens-interval (PADI) in adults with RA \< 14 mm associated with increased risk of neurologic injury and is an indication for surgery * sum of lateral mass displacement if \> 8.1 mm, then a transverse ligament rupture is assured and the injury pattern is considered unstable

Answer 21

Whether os odontoideum is congenital or the residual of a traumatic process is controversial. Most authors support a post-traumatic etiology; however, some evidence exists to support a congenital origin. - Asymptomatic patients may be managed with cessation of contact sports alone. - Neurologic findings and widened ADI are both indications for a posterior C1-C2 fusion.

Answer 22

bilateral fracture of pars inter-articularis of C2 Traumatic Spondylo-listhesis of Axis

Answer 23

◦ Hyperextension + Distraction injuries: leads to fracture of pars secondary flexion: tears PLL and disc allowing subluxation

Answer 24

**_Levine and Edwards Classification_** 1. Type 1: \< 3mm displacement: Rigid collar 2. Type 2: \>3.5mm displacement: Halo/Surgery 3. Type 2A: angulated \>11deg: Reduction+Halo 4. Type 3: Type 1 with associated bilateral facet dislocation: Surgical reduction of facet + stabilization

Answer 25

* anterior C2-3 interbody fusion * posterior C1-3 fusion * bilateral C2 pars screw osteosynthesis

Answer 26

Hyperextension lateral compression axial compression

Answer 27

◦ spine fracture 50% have an associated spine injury 40% associated with axis fx

Answer 28

◦ stability dependent on degree of injury and healing potential of transverse ligament

Answer 29

**Type I** Isolated anterior or posterior arch fracture. A "plough fracture is an isolated anterior arch fracture caused by a force driving the odontoid through the anterior arch. Stable. Treat with hard collar. **Type II** Jefferson burst fracture with bilateral fractures of anterior and posterior arch resulting from axial load. Stability determined by integrity of transverse ligament. If intact, hard collar. If disrupted, halo vest (for bony avulsion) or C1-2 fusion (for intrasubstance tear)(see Dickman classification below). **Type III** Unilateral lateral mass fx. Stability determined by integrity of transverse ligament. If stable, treat with hard collar. If unstable, halo vest.

Answer 30

**_atlantodens interval (ADI)_** \< 3 mm = normal in adult (\< 5mm normal in child) 3-5 mm = injury to transverse ligament with intact alar and apical ligaments \> 5 mm = injury to transverse, alar ligament, and tectorial membrane **_lateral mass displacement_** if sum of lateral mass displacement is \> 7 mm (8.1mm with radiographic magnification) then a transverse ligament rupture is assured and the injury pattern is considered unstable

Answer 31

Transverse ligament integrity

Answer 32

Hard collar vs. halo immobilization for 6-12 weeks posterior C1-C2 fusion vs. Occipitocervical fusion

Answer 33

Type I Oblique avulsion fx of tip of odontoid. Due to avulsion of alar ligament. Although rare, atlantooccipital instability should be ruled out with flexion and extension films. Type II Fx through waist (high nonunion rate due to interruption of blood supply). Type III Fx extends into cancellous body of C2 and involves a variable portion of the C1-C2 joint.à Type IIA Non-displaced/minimally displaced with no comminution. Treatment is external immobilization Type IIB Displaced fracture with fracture line from anterosuperior to posteroinferior. Treatment is with anterior odontoid screw (if adequate bone density). Type IIC Fracture from anteroinferior to posterosuperior, or with significant comminution. Treatment is with posterior stabilization.

Answer 34

Os Odontoideum Observation **Type I** Cervical Orthosis for 6-12 weeks **Type II Young** Halo if no risk factors for nonunion Surgery if risk factors for nonunion **Type II Elderly** Cervical Orthosis if not surgical candidates Surgery if surgical candidates **Type III** Cervical Orthosis; no evidence to support Halo over hard collar

Answer 35

* Type II fractures with risk factors for nonunion AND * acceptable alignment and minimal displacement * oblique fracture pattern perpendicular to screw trajectory * patient body habitus must allow proper screw trajectory

Answer 36

1. **Sublaminar wiring techniques (**Gallie or Brooks) require postoperative halo immobilization and rarely used 2. **posterior C1-C2 transarticular screws construct** contraindicated in patients with an aberrant vertebral artery 3. **posterior C1 lateral mass screw and C2 pedicle screw construct** modern screw constructs do not require postoperative halo immobilization

Answer 37

* ≥ 6 mm displacement (\>50% nonunion rate): strongest reason to opt for surgery * age \> 50 years * fx comminution * fracture gap \> 1 mm * angulations \> 10° * delay in treatment ( \> 4 days) * posterior re-displacement ( \> 2 mm) * smoker

Answer 38

C2 develops from five ossification centers: - body - two neural arches - odontoid - secondary ossification center The subdental (basilar) **synchondrosis** is an initial cartilagenous junction between the dens and vertebral body that does not fuse until ~**6 years of age**. The **secondary ossification center** appears around age 3 and fuses with the odontoid at around 12 years of age.

Answer 39

aberrant vertebral artery The vertebral artery is an important consideration when performing posterior cervical spine surgery. Injury to this artery can lead to stroke and death. Normally the vertebral artery travels superiorly in the transverse foramen of C6 to C2. At C2 the artery deviates laterally to the pass through the transverse foramen of C1 and then wraps medially on the superior surface of the posterior arch of C1 before ascending into the foramen magnum. Anomalous variants of the vertebral arery may be present in up to 30% of individuals, and may be intraosseous or extraosseous. Intraosseous variants may be injured during posterior cervical stabilization techniques. In patients with an aberrant vertebral artery, C1-C2 transarticular screws are contraindicated due to the risk of injury to the aberrant vertebral artery.

Answer 40

\>3.5mm displacement \>10deg kyphosis \>10deg rotation difference compared with adjacent vertebra

Answer 41

1. posterior decompression and 2 level instrumented fusion 2. 2 level ACDF 3. Anterior and posterior decompression and fusion

Answer 42

hyperextension, lateral compression and rotation

Answer 43

**_1- compression fracture_**: without retropulsion into canal; often associated with posterior ligamentous injury **_2- burst fracture :_** fracture extension through posterior cortex with retropulsion into the spinal canal; often associated with posterior ligamentous injury; often associated with complete and incomplete spinal cord injury; unstable and usually requires surgery **_3- Flexion teardrop fracture:_** Anterior column failure in flexion/compression Posterior portion of vertebra retropulsed posteriorly Posterior column failure in tension Larger anterior lip fragments may be called 'quadrangular fractures' Prognosis: associated with SCI Treatment: unstable and usually requires surgery **_4- Extension teardrop avulsion:_** fracture characterized by small fleck of bone is avulsed of anterior endplate usually occur at C2 must differentiate from a true teardrop fracture Mechanism: extension Prognosis: stable injury pattern and not associated with SCI Treatment: cervical collar

Answer 44

* Stable mild compression fractures (intact posterior ligaments & no significant kyphosis) * anterior teardrop avulsion fracture

Answer 45

1. compression fracture with 11 degrees of angulation or **25% loss of vertebral body height** 2. unstable burst fracture with cord compression 3. unstable tear-drop fracture with cord compression **_Treatment_** : **_1- Decompression_**: Early decompression (\< 24 hours) has been shown to improve neurologic outcomes compared with delayed (\>/ 24 hours) decompression 2- Anterior decompression, corpectomy, strut graft and fusion with instrumentation OR Posterior decompression, & fusion with instrumentation if significant injury to posterior elements and anterior decompression not required

Answer 46

17% C7-T1 junction

Answer 47

more frequently involves superior facet

Answer 48

unilateral facet dislocation leads to ~25% subluxation on xray associated with monoradiculopathy that improves with traction inferior facet of the cephalad vertebrae encrouches the neuroforamina bilateral facet dislocation leads to ~50% subluxation on xray often associated with significant spinal cord injury (~80% of cases)

Answer 49

▪ flexion and distraction forces +/- an element of rotation rotational moment associated with unilateral facet dislocation

Answer 50

**_monoradiculopathy_** seen in patients with unilateral dislocations C5/6 unilateral dislocation presents with a C6 radiculopathy weakness to wrist extension numbness and tingling in the thumb C6/7 unilateral dislocation presents with a C7 radiculopathy weakness to triceps and wrist flexion numbness in index and middle finger **_spinal cord injury_**—\> bilateral dislocations

Answer 51

Controversial ## Footnote ▪ an MRI should always be performed prior to open reduction or surgical stabilization if a disc herniation is present with compression on the spinal cord, then you must go anterior to perform a anterior cervical diskectomy

Answer 52

important to identify as cervical lateral mass fracture separations require fusing two levels while a facet dislocation only requires fusing a single level

Answer 53

▪ bilateral facet dislocation with deficits in awake and cooperative patient ▪ unilateral facet dislocation with deficits in awake and cooperative patient

Answer 54

▪ requires close radiographic follow-up; risk of re-dislocation or subluxation morbidly obese patients may not fit or be adequately stabilized in a halo brace

Answer 55

1. Disc herniation 2. Difficulty to reduce from the front

Answer 56

▪ Application of Gardner-Wells tongs 1 cm above the pinna and in line with the external auditory meatus below the equator of the skull avoids pin migration and slippage gradually increase axial traction with the addition of weights usually in 5 to 10 lbs increments can add up to 140 lbs of weight or 70% body weight average weigh required for reduction ~9.4 to 9.8 lbs per segment above the injury level a component of cervical flexion can facilitate reduction flexion moment can be created with pulley system or posterior placement of the Gardner-Wells tongs pins once reduced, decrease traction weight be 10-15 lbs and apply an extension moment to the cervical spine adjusting pulley system placing pad underneath thorax perform serial neurologic exams and plain radiographs after addition of each weight additionabort if there is over distraction of the spinal segment \>1.5 times that if the adjacent uninjured disc space can switch to carbonfiber Gardner-Wells tongs if need to obtain MRI in traction traction limit ~80 lbs abort if neurologic exam worsens and obtain immediate MRI

Answer 57

▪ Facet dislocations reduced through closed methods with a MRI showing cervical disc herniation with significant compression on the spinal cord Unilateral facet dislocations that fail closed reduction with a disc herniation with significant compression on the spinal cord

Answer 58

▪ unilateral dislocations can be reduced by distracting vertebral bodies with **caspar pins** and then rotating the proximal pin towards the side of the dislocation bilateral dislocations are reduced by placing **converging Caspar pins (10-20° angle) and then compressing the ends together to unlock the facets** posterior directed force applied to rostral vertebral body with currette alternatively, lamina spreaders applied to the endplates not effective for reducing bilateral facet dislocations

Answer 59

**▪ reductionPenfield 4 inserted between facets and used to lever back into position** can remove the superior aspect of the superior facet of the caudad vertebrae to facilitate difficult reductions distraction of the affected level between the affected spinous processes or lamina with use of lamina spreaders usually have to fuse two levels due to inadequate lateral mass purchase at level of dislocation

Answer 60

immediate closed reduction with cervical traction

Answer 61

Ideal for upper C-spine injury Ideal for controlling **_Rotation at the atlantoaxial joint_** Allows intercalated paradoxical motion in the subaxial cervical spinetherefore not ideal for lower cervical spine injuries (**_lateral bending least controlled_**) **"snaking phenomenon"** recumbent lateral radiograph shows focal kyphosis in mid-cervical spine yet, upright lateral radiograph shows maintained lordosis in mid-cervical spine

Answer 62

**_Absolute_** * cranial fractures * infection * severe soft-tissue injury especially near proposed pin sites **_Relative_** * Polytrauma * severe chest trauma * barrel-shaped chest * obesity * advanced age recent evidence demonstrates an unacceptably high mortality rate in patients aged 79 years and older (21%)

Answer 63

CT scan prior to halo applicationindications clinical suspicion for cranial fracture children younger than 10 to determine thickness of bone

Answer 64

**_Adults_** Torque: tighten to 8 inch-pounds of torque 4 pins 2 anterior pins safe zone is a **1 cm region just above the lateral one third of the orbit (eyebrow) at or below the equator of the skull** this is anterior and medial to temporalis fossa/temporalis muscle this is lateral to supraorbital nerve 2 posterior pins: placed on opposite side of ring from anterior pins followup care can have patient return on day 2 to tighten again proper pin and halo care can be done to minimize chance of infection **_Pediatric Technique_** Pediatrics torque more pins with less torque total of 6-8 pins lower torque (**2-4 in-lbs or "finger-tight**")

Answer 65

Higher complications in children (70%) than adults (35%) 1- Loosening (36%): treated with retightening; if continues to loosen, should be treated with pin exchange 2- Infection (20%)posterior pin in temporalis fossa because pins hidden in hairline bone is thin temporalis muscle moves with chewing can be treated with **oral antibiotics if pin not loose** if pin infection and loose then pin should be removed 3- Discomfort (18%): treated by loosening skin around pin 4- Dural puncture (1%) 5- Abducens nerve (Cranial Nerve VI) palsy most commonly injured cranial nerve with halo traction injury; diplopia; loss of lateral gaze on affected side; observation most resolve spontaneously 6- Supraorbital nerve palsy: injured by medially placed anterior pins 7- Supra-trochlear nerve palsy: injured by medially placed anterior pins 8- Medical complications pneumonia ARDS arrhythmia

Answer 66

Supraorbital and supratrochlear

Answer 67

Due to reduced thickness of the pediatric skull, **higher rate of pin site infections** and **skull puncture**, and unreliability of many torque wrenches, current recommendations are to use a higher number of pins (8 to 12) with lower insertional torque (1 to 5 in-lb) in case pins need to be removed or exchanged.

Answer 68

Cranial nerve VI palsy

Answer 69

Thoraco-lumbar junction Acceleration/deceleration injuries Hyperflexion, rotation and shearing

Answer 70

**_1- Morphology_** * compression (+1 point) * burst (+2 points) * rotation/translation (+3 points) * distraction (+4 points) **_2- Neurologic status_** * Intact (0 point) * Nerve root (+2 points) * Incomplete Spinal cord or conus medullaris injury (+3 points) * Complete Spinal cord or conus medullaris injury (+2 points) * Cauda equina syndrome (+3 points) **_3- posterior ligamentous complex integrity_** * intact (0 point) * no interspinous ligament widening seen with flexion views. MRI shows no edema in interspinous ligament region * suspected/indeterminate (+2 points) * MRI shows some signal in region of interspinous ligaments * disrupted (+3 points) * widening of interspinous distance seen TLICS treatment implications score \< 4 points nonsurgical management score = 4 points nonsurgical or surgical managment score \> 4 points surgical management indicated

Answer 71

flexion-distraction injury associated with a center of rotation ***_anterior to the spine (frequently being associated with bowel or other abdominal organ injury)._***

Answer 72

**_concomitant spine fractures:_** occurs in 20% traumatic durotomy lamina fracture is associated with dural tear and entrapped nerve roots be aware when spit spinous process **_chest and intra-abdominal injuries:_** common flexion-distration and fracture-dislocations bowel rupture, major vessel injury, upper urinary tract injury, hepatic, splenic, and pancreatic lacerations long bone fractures

Answer 73

▪ patients that are **neurologically intact and mechanically stable** **posterior ligament complex preserved** **no focal kyphosis on flexion and extension lateral radiographs** **kyphosis \< 30° (controversial)** **vertebral body has lost \< 50% of body height (controversial)** TLICS score = 3 or lower

Answer 74

**_posterior approach favored when_** below conus --\> possible to medialize thecal sac to perform decompression of canal / posterior corpectomy and expandable cage injury to PLC fracture dislocations **_anterior/direct lateral approach favored when_** above the conus medullaris (above L2) allow for thorough decompression of the thecal sac substantial vertebral body comminution in order to reconstitute the anterior column kyphotic deformity \>30° chronic injuries greater than 4-5 days from the injury

Answer 75

**_lumbar spine:_** **_Anterior Retroperitoneal or transperitoneal approach_** Left paramedian incision suitable for levels **below L1** **_thoracolumbar junction : lateral lumbotomy_** suitable for injuries at **T11-L1** left-sided approach to avoid liver obstructing access **_thoracic spine: lateral thoracotomy_** right-sided approach to avoid major vessels appropriate for injuries **above T11**

Answer 76

**_1- Entrapped nerve roots and dural tear_** from associated lamina fractures can be iatrogenic from decompression decreased risk of dural tears with anterior approach due to improved visualization of the thecal sac during decompression requires closure primarily or reinforced with dural patch prolonged recumbency postoperatively **_2- Pain_** most common; over distraction with instrumentation **_3- Progressive kyphosis_** common with unrecognized injury to PLL increased comminution of the vertebral body loss of anterior column support **_4- Flat back_** leads to pain, a forward flexed posture, and easy fatigue post-traumatic syringomyelia **_5- Surgical site infection_**: can occur in up to 10% of cases trauma predisposes to infection catabolic state increased soft tissue damage requires irrigation and debridement with culture specific antibiotics **_6- Pseudo-arthrosis_**: can result from overdistraction instrumentation **_7- Iatrogenic neurologic injury_** can occur in 1% of cases causes include over medialized pedicle screws inadvertant manipulation of the spinal cord

Answer 77

Bailey et al. conducted a multicenter, randomized controlled trial of T11-L3 burst fractures without neurologic deficit treated with or without TLSO and early mobilization. They found equivalent disability scores between the groups at 3 months, indicating that the discomfort and deconditioning associated with brace use might be avoidable.

Answer 78

T12 and L2

Answer 79

Osteoporotic Vertebral Compression Fracture

Answer 80

bone is normal quality but decreased in quantity cortices are thinned cancellous bone has decreased trabecular continuity

Answer 81

peaks at: between 33 to 40 yrs in women; between 19 to 33 years in men correlate well with bone strength and is a good predictor of fragility fracture

Answer 82

T score below -2.5

Answer 83

compromised pulmonary function increased kyphosis can affect pulmonary function **each VCF leads up to 9% reduction in FV** increased risk of mortality from pulmonary dysfunction

Answer 84

mortality 1-year mortality ~ 15% (less than hip fx) 2-year mortality ~20% (equivalent to hip fx)

Answer 85

* acute vs chronic nature of compression fracture * injury to anterior and posterior ligament complex * spinal cord compression by disk or osseous material * cord edema or hemorrhage

Answer 86

* fractures above T5 * atypical radiographic findings * failure to thrive and constitutional symptoms * younger patient with no history of fall

Answer 87

1- Observation, bracing and medical management 2- Kyphoplasty 3- Surgical decompression and stabilization

Answer 88

Observation, bracing, and medical management majority of patients can be treated with observation and gradual return to activity PLL intact (even if \> 30 degrees kyphosis or \> 50% loss of vertebral body height) Calcitonin- Biphosphonates- Extension orthosis

Answer 89

if the fracture is less than five days old ; calcitonin can be used for four weeks to decrease pain

Answer 90

▪ very rare in standard VCF progressive neurologic deficit PLL injury and unstable spines techniqueto prevent possible failure due to osteoporotic bone consider long constructs with multiple fixation points consider combined anterior fixation

Answer 91

under fluoroscopic guidance; percutaneous trans-pedicular approach used for cannula **_Vertebroplasty_** PMMA injected directly into cancellous bone without cavity creation performed when cement is more liquid requires greater pressure because no cavity is created increased risk of extravasation into spinal canal is greater Indications: controversial; AAOS recommends strongly against the use of Vertebroplasty in 2011 but then changed their stance in 2014 based on recent studies Outcomes: randomized, double-blind, placebo-controlled trials have shown no beneficial effect of Vertebroplasty ; Vertebroplasty has higher rates of cement extravasation and associated complications than Kyphoplasty **_Kyphoplasty_** cavity created with expansion device (e.g., balloon) prior to PMMA injection performed when cement is more viscous may be possible to obtain partial reduction of fracture with balloon expansion Indications: **_patient continues to have severe pain symptoms after 6 weeks of nonoperative treatment:_** AAOS recommend may be used, but recommendation strength is limited

Answer 92

patient continues to have severe pain symptoms after 6 weeks of nonoperative treatment:

Answer 93

Vertebral body osteonecrosis (aka Kummell's disease) Delayed post-traumatic osteonecrosis

Answer 94

The **MR fluid sign** is highly suggestive of an osteoporotic vertebral compression fracture (VCF). 1. **MR signs suggestive of a benign, osteoporotic VCF** include: * band-like low T1 signal * fluid sign * retropulsion of a vertebral bone fragment. * Acute fractures show low signal on T1-weighted and high signal on T2-weighted and STIR images. **_2- MR signs suggestive of malignant VCF_** * complete replacement of normal marrow signal * convex posterior vertebral border * pedicle involvement * focal paraspinal mass * epidural mass.

Answer 95

1. "strong recommendation": was AGAINST the use of vertebroplasty. 2. "moderate recommendation: The use of calcitonin for acute injuries (presenting within 5 days of symptom onset) received a Calcitonin directly inhibits osteoclast activity by binding to surface cell-surface receptors. 3. limited evidence or were simply inconclusive: ibandronate or strontium use, bed rest and opiate analgesics, L2 nerve block for a L3 or L4 fracture, exercise program, electrical stimulation, kyphoplasty, use of a brace, improvement of kyphosis angle, any treatment in a patient with concomitant neurological deficits.

Answer 96

Buchbinder et al. performed of randomized, double-blind, placebo-controlled trial. Patients were given a sham procedure to greaten the double blind effect. Outcomes were assessed at 1 week and at 1, 3, and 6 months. The primary outcome was overall pain (on a scale of 0 to 10, with 10 being the maximum imaginable pain) at 3 months. They found vertebroplasty did not result in a significant advantage in any measured outcome at any time point. There were significant reductions in overall pain in both study groups at each follow-up assessment.

Answer 97

Hip fracture \> vertebral compression fracture \> distal radius fracture

Spine Trauma Flashcards

(122 cards)