Sacral Fractures and Spinopelvic

Background  25% associated neuro  33-100% of SPD have neupp  Transvese pattern  Classification Denis  Zone 1 – lateral to foramen  Most common  5% neve – if so, L5  Zone 2 – through  Sstable or unstable  Shear is unstable  Zone 3 – medial  High rate neuro  Transverse  U Type  Spinopelvic  Gibbon’s for Neuro (SPD)  1 – none  2 – parrassthesia  3Continue reading “Sacral Fractures and Spinopelvic”

Thoracolumbar Fractures

Background  Most common injured part of spinal column  30% have FND  T11-L2 injured   Transition zone from stable to mobile  Rotational and shear forces  Anterior Column – 80% axial  Posterior 80% torsion/ shear  6 forces  Flex  Ex  Axial  LC  Rotation  Distraction  shear  Classification Systems  Denis  3 column theory  2 violated; instability  Burst – Anterior and MiddleContinue reading “Thoracolumbar Fractures”

Subaxial Facet Dislocations

Background  Spectrum of illness  Bimodal  20% at C7-T1 junction  Mechanism  Flexion distraction  Flexion distraction rotation  Progression of Injury  Facet subluxation  Unilateral dislocation  25% displacement anterolisthesis (this is a cool trick to tell on XR what it is)  Radiculopathy  Disc herniation 56%  50% displacement  SCI  Disc herniation 82%  Complete dislocation  100% displacement  SCI  Disc Herniation Significance Continue reading “Subaxial Facet Dislocations”

Subaxial Vertebral Body Fracture  

Classification (SLICS)  Morphology, DLC, neuro  4 is the midpoint (above 4 is surgery)  Morphology  None  Compression 1  Burst 2  Distraction 3   Rotation/ Translation 4  PLC  Intact  Indeterminate 1  Disrupted 2  Neuro  Intact 0  Root 1  Complete2  Incomplete 3  Ongoing compression 4  Studies  3 NASCIS studies – steroids  Lack of clear evidence supporting neurological improvement  Early decompressionContinue reading “Subaxial Vertebral Body Fracture  “

C2 Hangman’s

Background  Bilateral pars fracture  Classification  Type 1  Axial and hyperextension  <3mm displacement stable  Management  Collar  Type 1A   pars on one side body on the other (more unstable)  Management  Halo  Type 2  Type 1 then rebound flexion  >3mm  Management  Halo  C23 ACDF  C1-3 PSIF  Type 2A  Flexion distraction  Angulated  Management  Reduction with Halo  C23 ACDF  C1-2Continue reading “C2 Hangman’s”

Odontoid C2  

Background  Bimodal  Low energy elderly – increase morbidity vs younger, often missed  High energy young  Children – basical synchondrosis, rare  C2 is the axis  Odontoid fracture most common fracture of axis  Pathophys  Anterior displacement – TL failure and AA instabiltiy  Posterior displacement – dirrect impactt from anterior arch during hyperextension  Od odontodieum  Looks like type 2 odontoid  Failure of fusion vs residualContinue reading “Odontoid C2  “

Atlas C1

Background  High energy axial load – Jefferson facture  Low enegy eledely  50% associated spine  40% assocaited Axis  Neuro injury low (capacious canal)  Classification  Landell  Type 1 – isolated posterior or anterior arch  Type 2 – bilateral A and P arch (Jefferson burst)  Type 3 – unilateral lateral mass  TL Classification  Intrasubstance  Avulsion  Radiographs  ADI  ❤ normal  3-5 TL damaged,Continue reading “Atlas C1”

Occipital Condyle Fracture

Background  Traumatic  Bimodal usual  CT Dx  Flex ex radiographs for associated OC instability  Fusion for OC instability, otherwise ortthosis only  Incidence increase as more CT scans  Anatomy  Lots of flex ex  Condyles on either side of foramen magnum  Nerves nearby  Cranial nerves (jugular foramen adjacent)  9 – Glossopharyngeal  10 – Vagus  11 – Accessory  12 – Hypoglossal  ClassificationContinue reading “Occipital Condyle Fracture”