Fractures of the spine | thoracolumbar fractures | broken back | colorado spine surgeon
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Transcript of Fractures of the spine | thoracolumbar fractures | broken back | colorado spine surgeon
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Thoracolumbar Fractures
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Types of Fractures
• Simple compression fractures• Burst fractures• Flexion distraction fractures• Chance fractures• Fracture dislocations• Posterior fractures
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Anatomy
• Anterior column- ant ½ of the disc and ALL• Middle Column- post ½ of disc and PLL• Posterior Column- facets, supra and
interspinous ligaments
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Biomechanics (3 column theory)
• Anterior and middle column together (vertebral bodies) carry 70-80% of the total weight
• Facets carry the other 20-30%• Upper lumbar spine is at the transition of a
stiff segment (thoracic spine) and a mobile segment (lumbar spine)
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Injury Mechanics
• Direct blow- normally will cause TP fractures- (asso with kidney contusions)
• Seat belt injury (without shoulder restraint) causes fulcrum anterior to spine so all three columns fail in tension (chance fracture)
• Direct fall onto buttocks causes axial compression- either compression or burst
• Direct fall onto buttocks with some flexion causes either simple compression or flexion distraction
• Fall onto buttocks with extension can cause facet or pars (spondylolysis) fracture
• Fracture dislocations asso with ejection from car
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Simple Compression Fractures
• On X-Ray- only anterior column injury.• Less than 30% anterior column injury• Less than 10 degrees kyphosis• No splaying of spinous processes• No splaying of pedicles• No laminar fractures• Posterior body line intact
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Examination
• Neuro exam includes motor, sensory, anal motor and sensation, superficial and deep reflexes, bulbocavernosis reflexes