Spine Trauma

Radiologic Investigations
PlainX ray
CT scan
MSCT Scan
Radionucleide Bone Scan
MRI
MRA
Spine
Plain X ray
Cross-sectional Imaging :
◦ CT scan
◦ MRI
USG
Fluoroscopy/Image Intensifyer
Plain X Ray
Primary screening method
Comprehensive overview
Osseus changes which is not
detectable on CT scan or MRI
Cervical Injury
AP and Lateral ( swimmer’s view
)
Must be able to view C7-T1
interval
Swimmer’s view difficult in :
◦ Intoxicated
◦ Neurologic impairment
◦ Co-existing upper extr injury
May need CT studies
C7

T1?
C6

C7
White’s Diagnostic Checklist
( > 5 is unstable )
 Anterior elements = 2
 Posterior elements = 2
 Sagittal translation > 3.5 mm
=2
 Sagittal plane rotation > 110 =
2
 Positive stretch test = 2
 Cord damage = 2
 Root damage = 1
 Abnormal disc narrowing = 1
 Dangerous loading anticipated
=1
Most Common in
UCS
Jefferson’s # of C1
Hangman’s # of C2
Odontoid #
Occipito Atlantal
Dislocation
Jefferson’s #
Caused by axial loading
injury
w/ head injury
Associated w/ other cervical
#
Classic : 4 # in the ring of C1
Jefferson’s #
Open mouth X ray
> 6.9 mm lateral mass
displacement  transverse
ligament insufficiency
CT scan
Odontoid Fractures
Anderson-D’Alonzo
Type I : rare
avulsion # of the
tip
Type II : # at
base of odontoid
Type III : # thru
body
Odontoid Fractures
Treatment
Type I : stable, cervical collar
Type II : high non-union rate,
early odontoid screw
fixation, neglected  C1-2
fusion
Type III : cervical orthosis or
halo
Neglected Odontoid #
 Fractures thru pedicle C2
(Hangman’s fracture / traumatic spondylolisthesis of the
axis)

Type I : minimal displacement

(<3mm)
Type II : displc > 3mm, angul.
>110
Type III : + facet disloc
Lower C-Spine #
Allen-Ferguson Classification

Mechanism of injury
6 groups :
◦ Compressive flexion
◦ Vertical compression
◦ Distractive flexion
◦ Compressive extension
◦ Distractive extension
◦ Lateral flexion
Allen-Fergusson Classification
Compressive Flexion Injury
 Teardrop Fractures
Due to axial load w/ compression
and rotation mechanism
Always unstable
Significant bony comminution
Disruption anterior ligamentous
complex
Disruption posterior ligamentous
complex
Allen-Fergusson Classification
Vertical Compression Injury
Burst Fractures
Stable : minimal
displacement w/o
ligamentous disruption and
w/o neurological deficits
Unstable : post part of body
split posteriorly, widening
interpedicular distance,
lamina # or pedicle #.
 Treatment of burst
fractures
Unstable w/o neurological
deficits : posterior
instrumentation and fusion
Late kyphosis : anterior strut
graft w/ anterior
instrumentation ( ACCF )
Fractures w/ neurological
deficits : ACCF
Allen-Fergusson Classification
Distractive Flexion Injury
Thorakolumbal Fractures
 Etiology
High energy trauma (MVA, fall
from heights)
Osteoporosis : minimal trauma
w/o longterm steroid intake.
Pathological # : minimal
trauma w/ infections, tumors
etc.
 Radiographic
Assessment
Plain films : AP/Lat
◦ AP
 Interpedicular distance
 Interspinous distance
 Alignment of spinous process
◦ Lateral
 Loss of height of ant wall
 Loss of normal concavity post cortex
 Kyphosis
 Translation
 Radiographic Assessment
CT Scan
Plain x-ray may miss 25% burst #
Best for evaluation middle column
Calculation of canal compromise
Axial cuts + sagittal reconstruction !
Must include non-# vertebra above
and below
MSCT
Radiographic Assessment
MRI
•Important in neurologic injury
Identify :
◦ Spinal cord compression
◦ Spinal cord anatomy
◦ PLC
◦ Epidural hematoma
◦ Disc herniation
Denis Classification
Compression #
Stable burst #
Unstable burst #
Flexion-distraction injury
(Chance #)
Fracture-dislocation (A to F)
3-column theory
Denis
Compression #
Back wall of VB intact
Most are relatively stable injury
 Denis
Stable burst #

Minimal kyphosis
Neurologically intact
No cleavage
component
Denis
Unstable burst #

Neurological injury
Posterior column disruption
Significant kyphosis
Cleavage component
Denis
Flexion/Distraction

Posteriorcolumn disruption
Usually anterior column
compression
 AO Mechanistic Classification
(Magerl et al)

A : Compression injury
B : Distraction injury
C : Rotational injury
(multidirectional injury w/
translation)
Compression injury
Distraction injury