Flashcards in Thoracolumbar injuries Deck (18):
Why is the upper thoracic spine less susceptible to trauma/
t1-t10 stabilised by ribs and sternum so more stable
Why is the thoracolumbar junction most common area for fracture?
Transitional area from relatively rigid movements to more mobile movement
Where does the spinal cord end?
L1/2 so lesions below L1 have better prognosis because the nerve roots not the spinal cord are affected.
Can you name a classification system for thoracolumbar fractures ?
Thoracolumbar injury and classification severity score
Can you describe the classification system for thoracolumbar fractures ?
Broken down into
POST LONGITUDINAL LIGAMENT
COMPRESSION FRACTURE - 1 POINT
BURST FRACTURE- 2 POINTS
ROTATION/TRANSLATION- 3 POINTS
DISTRACTION- 4 POINTS
COMPLETE CORD INJURY=2
INCOMPLETE CORD INJURY=3
INJURY SUSPECTED =2
INJURED=3 palpable gap between spinous processes/ interspinous widening
How does TLICS aid management?
A score of 5> - unstable and requires OP fixation
a score of <3 - stable no operation
a score 4 - indistinct
What is the mechanism for a compression fracture to occur ?
common fracture pattern
What is the mechanism for a burst fracture to occur ?
axial load with flexion
RETROPULSION OF FRAGMENTS-> canal compromise max at time of impact
What is the mechanism for a translation/rotation fracture to occur ?
What is the mechanism for a distraction fracture to occur ?
What other classification systems do you know of for these fractures ?
DENIS 3 column theory
What ligaments make up the PLL?
what investigations are helpful in dx of a burst fracture ?
X-rays- ap - widening of pedicles, coronal deformity
lateral shows retropulsion and kyphotic deformity
CT- fractrue and neurological deficit
MRI- useful to evaluate the spinal cord/ thecal sac compression by disc or osseous material. cord oedema or haemorrhage.. identity any injury to PLL
How does this classification aid management?
disruption of the middle column- widening of interpedicular distances on ap radiographs or a chance in height of the post cortex of body o lat view= UNSTABLE injury and may require OP fixation
When would a fracture be fixed?
TLICS score >5
fractures >30 degrees of KYPHOSIS
>50% loss of vertebral height
Can you describe the 3 locations of the columns?
Anterior- from Ant Longitudinal log-> ant 2/3 res of vertebral body
Middle- post 1/3 vertebral body-> Post longitudinal ligament
Posterior- everything posterior to PLL- pedicels, facets, ligamentum flavum, spinous process,
What surgery would be performed in the unstable cases?
DECOMPRESSION for progressive neurological deficit emergency or incomplete cord injury
POSTERIOR INSTRUMENTATION AND FUSION - extending 3 levels above and 2 levels below fracture. modern pedicle screws changes this to one level above and one level below. Laminectomy is avoided as it could further destabilise the spine compromising the post supporting structures