Spine Fracture

Spine fracture
ANATOMY
ANATOMY
Functional Spinal unit
Each 2 consecutive vertebra with the ligaments and connecting structures.

Bodies are connected by the discs (25% of the height) , anterior and posterior long.
Articular processes.
Posterior bony ligamentum complex ligaments
Functions of the spine
Maintain the erect position of the back.
Protection of the neural tissure.
Provide the mobility and stability of the back.
3-Transfer of body weight and shock absorption
.
Mechanism of injury
• MVA 50%
• Falls 25%
• Gunshot 15%
• Sport 10%
Classification of
Thoracolumbar spine Fracture
Anatomy according Denis concept
Very important
Unstable fracture: is one which is liable to di
splace during healing. It is associated with di
sruption of more than 1 column especially p
osterior column.
Neural damage: caused by
1. dislocation
2. Compression of displaced bone fragment
3. Vascular impairment
4. Stretching the cord
The spinal cord ends at the lower border of L
2 and the cauda equina continues in the lum
ber canal. So injuries above D12 are cord lesi
ons, opposite to L1 are combined cordand ca
uda equina lesions, and below L1 are cauda
equina lesions.
Mechanism and types of fractures
• 1) Flexion injury:
The anterior column is subjected to compression, while the middle
and posterior column are subjected to tension. The result is comp
ression or wedging of the anterior column
Compression Fracture
.
Type A: Fracture of both endplates (16%)

Type B: Fracture of superior endplate (62%)
Type C: Fracture of inferior endplate (6%)
Type D: Both endplates intact (15%)
• 2) Flexion distraction:
• like the passenger using a lap seat belt may be subjected to sever
e flexion on sudden deceleration causing force distracting whole s
pine leading to a fracture occur either through the bone, soft tissu
e or both
Flexion Distraction
.
Type A: One-level bony injury (47%)

Type B: One-level ligamentous injury (11%)
Type C: Two-level injury through bony middle
column (26%)
Type D: Two-level injury through ligamentous
middle column (16%)
3)Flexion rotation injury

(Fracture dislocation):
Flexion force compined with rotation will disrupt the posterior liga
ment complex causing dislocation of the facet joints.
Fracture Dislocation
.
flexion-rotation type of fracture-dislocation

shear-type fracture-dislocation.
flexiondistraction type of dislocation
4) Vertical compression injury (burst fracture):

The body compressed into multiple fragments.
The neural damage may occur due to retropulsion of bone fragmen
t into the spinal canal .
Burst Fracture
.
Type A: Fracture of both endplates (24%)

Type B: Fracture of the superior endplate (49%)
Type C: Fracture of inferior endplate (7%)

Type D: Burst rotation (15%)
Type E: Burst lateral flexion (5%)
5 ) Hyperextension injury:
Rare in dorsolumber spine, cause fracture of the pedicles and separ
ation fracture of the anterior part of the body or the disc.
6) Penetrating injury:
Like knife or gun shot
• Most of patient with spine injury have an associated injuries
• 80% multiple injuries

• 26% head & face injury
• 16% major chest injury
• 10% major abdominal injury
• 8% long bone/ pelvic fractures
Multiple Spinal Fracture
• Calenoff, Chessare,&
.
Rogers reported an
incidence of 4.5%
Leading cause of death in SCI
• Respiratory disease 20.5%

• Accident, poisoning, violence 9.7%
• Circulatory disease 8.8%
• Infections 8.8%
• Genitourinary disease 4.0%
• Neoplasm 3.9%
Approach to Spine Trauma
• Pre Hospital Care
• The aim is to retrieve the patient from the site of injury
safely and rapidly
• Transfer to a suitable facility.
• spinal trauma should be suspected in
1. all unconscious patients
2. High energy trauma
3. Evidence of neurological deficit
4. Multiple injuries
• Proper extraction
• Intubation
• Immobilization
• Cervical collar, sand
bag, tape,
• ? Neck position
• ?pediatrics
Emergency Assessment
ATLS
History
• Mechanism of injury
• Position of the patient when found
• Transient motor or sensory loss
• Paradoxical breathing
• Seat belt
Inspection
• All clothing should be carefully removed

• Any bleeding , abrasion or lacerations
• Limb asymmetry
• Voluntary limb movement
• Chest expansion
Palpation
• Cervical collar removed carefully

1. Tenderness
2. Interspinous widening
3. Malialignement of spinouse process
4. Step off
Neurological Evaluation
• Neurological examination
1. Sensory evaluation
2. Motor evaluation
3. Reflexes
Neurological examination
Spinal shock
Spinal reflexes
Bulbocavernosus reflex
• Pull glans or press

clitoris  anal
contraction (int.
sphincter) around
gloved finger
• Absence is indicator of
spinal shock
Skeletal Trauma
Sacral Sparing
1. Perianal/perineal sensation
2. Rectal tone
3. Big toe flexion
• Implies partial structural
continuity of white matter
long tracts
• May be only evidence of incomplete injuryhigher chance of
recovery
• Essential to check and document
RADIOLOGICAL ASSESMENT
• PLAIN FILM
• AP & LATERAL
CT
• Injury suspected on plain films
• Better visualize fracture (specificity and sensitivity)
• Unable to adequately assess on plain films
• Fracture or soft tissue injury in the plane of the CT can be
missed
CT
MRI
• Valuable for assessing cord and soft
tissues
• R/O associated disc herniation
( facet dislocations)
• Hemorrhage vs edema in soft
tissues ????
• Ligamentous tears and facet capsule
disruptions visualized with fat
suppression
• May allow prognostic assessment of
final motor function
• Intrasubstance hematoma
MRI
T1 T2 GRE
Management
• Stable with no neuro • In unstable fracture
logical injury: with or without neur
1) brace ological manifestatio
2) Bed rest n:
3) Pain killer 1) Reduction: should be do
ne as early as possible. Ope
4) Follow up n is better than closed redu
ction to avoid neural dama
ge.
2) Fixation after reduction by
screws and rods.
Non-Operative Management
Surgical intervention
Balloon kyphoplasty
Complications of spine fracture
• Neurological injury
• Instability ( pain & deformity)
• Complication of surgery
Cervical spine injuries
-Extremely vulnerable to injury .
-Some have no obvious radiological evidence (in
the plain X ray) .
-Stable or unstable .
-With or without cord damage .
ANY PATIENT WITH HEAD INJURY SHOULD HA
VE X-RAYS OVER CERVICAL SPINE
MRI
• History of: • Types and mechanism of i
Fall from height njury:
Diving accident 1)flexion injury (wedge frac
Vehicle accident ture).
Un conscious patient: 2)Flexion rotation (fracture
dislocation)
Fracture cervical spine s
hould be assumed unti 3) Lateral flexion
l proved otherwise. 4) Hyper extension
5) Vertical compresiion (bur
st fracture)
• History of: • Types and mechanism of i
Fall from height njury:
Diving accident 1)flexion injury (wedge frac
Vehicle accident ture).
Un conscious patient: 2)Flexion rotation (fracture
dislocation)
Fracture cervical spine s
hould be assumed unti 3) Lateral flexion
l proved otherwise. 4) Hyper extension
5) Vertical compresiion (bur
st fracture)
Management of Cervical spine injuries
Conserve by rigid collar in stable n

on displaced fractures
Reduction if dislocated
Decompression if stenosis is prese
nt
Fixation till healing if fractured
Types of surgery
1) Ant decompression, corpectomy (removed of fractured body) with bone graft

and fixation by
plate and screws with or without cage.
2) posterior decompression laminectomy with fixation by screws and rods
3) Anterior and posterior surgery in sever cases.
C1 fracture
1)Undisplac
ed stable can be treated by ri
gid collar.
2)Undisplaced unstable can b
e trayed by Halo vest cast
3) Displaced fracture can be t Jefferson fracture is a burst fract
ure of the ring of C1 with lateral
reated by occipitocervical fus displacement of both articular m
ion by plate and screws. asses
C2 fracture
1)Undispl
aced stable can be treated
by rigid collar.
2)Undisplaced unstable can
be trayed by Halo vest cast
3) Displaced fracture can be
treated by open reduction a
nd internal fixation (anterio
r, posterior or both.
Traumatic paraplegia and quadreplegia
1. damage to the spinal cord or cauda equina.

2. Types of neural damage
• Root injury leads to flaced paralysis and sensory loss
in the distribution of the affected root. Recovery is p
ossible.
• Complete cord lesion, there is no motor or sensory r
ecovery and the prognosis is poor.
Incomplete cord lesion there is some motor or sensory r
ecovery in some innervated area.
Care for Paraplegic & quadriplegic
General condition, Chest
Bowel,Bladder‫ و‬Skin
Joint [ physiotherapy
Psychological aspect
Rehabilitation
THANK YOU

Spine Fracture

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Spine fracture

Each 2 consecutive vertebra with the ligaments and connecting structures.

Type A: Fracture of both endplates (16%)

Type A: One-level bony injury (47%)

3)Flexion rotation injury

flexion-rotation type of fracture-dislocation

4) Vertical compression injury (burst fracture):

Type A: Fracture of both endplates (24%)

Type C: Fracture of inferior endplate (7%)

• 80% multiple injuries

• Respiratory disease 20.5%

• All clothing should be carefully removed

• Cervical collar removed carefully

• Pull glans or press

Conserve by rigid collar in stable n

1) Ant decompression, corpectomy (removed of fractured body) with bone graft

1. damage to the spinal cord or cauda equina.

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