X ray spine. SPINE TRAUMA CERVICAL SPINE INJURY THORACO-LUMBAR SPINE INJURY.
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Transcript of X ray spine. SPINE TRAUMA CERVICAL SPINE INJURY THORACO-LUMBAR SPINE INJURY.
X ray spine
SPINE TRAUMA
CERVICAL SPINE INJURY
THORACO-LUMBAR SPINE INJURY
CERVICAL SPINE INJURY
COMMON MECHANISMS OF INJURY
HYPERFLEXION- MVA CAR COMES TO SUDDEN STOP
HYPEREXTENSION- MVA CAR STRUCK FROM BEHIND
COMPRESSION- HEAD FIRST DIVE IN SHALLOW WATER
HIGH RISK FACTORS FOR SPINE INJURY
HIGH-VELOCITY BLUNT TRAUMA
MULTIPLE SEVERE LONG BONE FRACTURES
DIRECT CERVICAL REGION INJURY
ALTERED MENTAL STATUS
FALL FROM GREATER THAN 10 FEET
DROWNING HEAD FIRST DIVING ACCIDENT
SIGNIFICANT HEAD OR FACIAL INJURY
NECK PAIN TENDERNESS OR DEFORMITY
ABNORMAL NEUROLOGICAL EXAMINATION
THORACIC OR LUMBAR VERTEBRAL FRACTURE
HXISTORY OF PRE-EXISTING VERTEBRAL DISEASE
CLINICAL PROCEDURE INVOLVING PTS WITH SUSPECTED SPINE INJURY
PATIENT KEPT IN CERVICAL COLLAR AND IMMOBILIZED ON SPINE BOARD
ldquoABCDEFrdquo ER PROTOCOL FOLLOWED (AIRWAY BREATHING CIRCULATION DISABILITYDRUGS EXPOSURE FOLEY CATHETER)
HISTORY AND PHYSICAL (PT HANDLED AS THOUGH SERIOUS INJURY PRESENT)
DECIDE IF IMAGING IS NECESSARY
CERVICAL VERTEBRAL ANATOMY
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
SPINE TRAUMA
CERVICAL SPINE INJURY
THORACO-LUMBAR SPINE INJURY
CERVICAL SPINE INJURY
COMMON MECHANISMS OF INJURY
HYPERFLEXION- MVA CAR COMES TO SUDDEN STOP
HYPEREXTENSION- MVA CAR STRUCK FROM BEHIND
COMPRESSION- HEAD FIRST DIVE IN SHALLOW WATER
HIGH RISK FACTORS FOR SPINE INJURY
HIGH-VELOCITY BLUNT TRAUMA
MULTIPLE SEVERE LONG BONE FRACTURES
DIRECT CERVICAL REGION INJURY
ALTERED MENTAL STATUS
FALL FROM GREATER THAN 10 FEET
DROWNING HEAD FIRST DIVING ACCIDENT
SIGNIFICANT HEAD OR FACIAL INJURY
NECK PAIN TENDERNESS OR DEFORMITY
ABNORMAL NEUROLOGICAL EXAMINATION
THORACIC OR LUMBAR VERTEBRAL FRACTURE
HXISTORY OF PRE-EXISTING VERTEBRAL DISEASE
CLINICAL PROCEDURE INVOLVING PTS WITH SUSPECTED SPINE INJURY
PATIENT KEPT IN CERVICAL COLLAR AND IMMOBILIZED ON SPINE BOARD
ldquoABCDEFrdquo ER PROTOCOL FOLLOWED (AIRWAY BREATHING CIRCULATION DISABILITYDRUGS EXPOSURE FOLEY CATHETER)
HISTORY AND PHYSICAL (PT HANDLED AS THOUGH SERIOUS INJURY PRESENT)
DECIDE IF IMAGING IS NECESSARY
CERVICAL VERTEBRAL ANATOMY
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
CERVICAL SPINE INJURY
COMMON MECHANISMS OF INJURY
HYPERFLEXION- MVA CAR COMES TO SUDDEN STOP
HYPEREXTENSION- MVA CAR STRUCK FROM BEHIND
COMPRESSION- HEAD FIRST DIVE IN SHALLOW WATER
HIGH RISK FACTORS FOR SPINE INJURY
HIGH-VELOCITY BLUNT TRAUMA
MULTIPLE SEVERE LONG BONE FRACTURES
DIRECT CERVICAL REGION INJURY
ALTERED MENTAL STATUS
FALL FROM GREATER THAN 10 FEET
DROWNING HEAD FIRST DIVING ACCIDENT
SIGNIFICANT HEAD OR FACIAL INJURY
NECK PAIN TENDERNESS OR DEFORMITY
ABNORMAL NEUROLOGICAL EXAMINATION
THORACIC OR LUMBAR VERTEBRAL FRACTURE
HXISTORY OF PRE-EXISTING VERTEBRAL DISEASE
CLINICAL PROCEDURE INVOLVING PTS WITH SUSPECTED SPINE INJURY
PATIENT KEPT IN CERVICAL COLLAR AND IMMOBILIZED ON SPINE BOARD
ldquoABCDEFrdquo ER PROTOCOL FOLLOWED (AIRWAY BREATHING CIRCULATION DISABILITYDRUGS EXPOSURE FOLEY CATHETER)
HISTORY AND PHYSICAL (PT HANDLED AS THOUGH SERIOUS INJURY PRESENT)
DECIDE IF IMAGING IS NECESSARY
CERVICAL VERTEBRAL ANATOMY
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
COMMON MECHANISMS OF INJURY
HYPERFLEXION- MVA CAR COMES TO SUDDEN STOP
HYPEREXTENSION- MVA CAR STRUCK FROM BEHIND
COMPRESSION- HEAD FIRST DIVE IN SHALLOW WATER
HIGH RISK FACTORS FOR SPINE INJURY
HIGH-VELOCITY BLUNT TRAUMA
MULTIPLE SEVERE LONG BONE FRACTURES
DIRECT CERVICAL REGION INJURY
ALTERED MENTAL STATUS
FALL FROM GREATER THAN 10 FEET
DROWNING HEAD FIRST DIVING ACCIDENT
SIGNIFICANT HEAD OR FACIAL INJURY
NECK PAIN TENDERNESS OR DEFORMITY
ABNORMAL NEUROLOGICAL EXAMINATION
THORACIC OR LUMBAR VERTEBRAL FRACTURE
HXISTORY OF PRE-EXISTING VERTEBRAL DISEASE
CLINICAL PROCEDURE INVOLVING PTS WITH SUSPECTED SPINE INJURY
PATIENT KEPT IN CERVICAL COLLAR AND IMMOBILIZED ON SPINE BOARD
ldquoABCDEFrdquo ER PROTOCOL FOLLOWED (AIRWAY BREATHING CIRCULATION DISABILITYDRUGS EXPOSURE FOLEY CATHETER)
HISTORY AND PHYSICAL (PT HANDLED AS THOUGH SERIOUS INJURY PRESENT)
DECIDE IF IMAGING IS NECESSARY
CERVICAL VERTEBRAL ANATOMY
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
HIGH RISK FACTORS FOR SPINE INJURY
HIGH-VELOCITY BLUNT TRAUMA
MULTIPLE SEVERE LONG BONE FRACTURES
DIRECT CERVICAL REGION INJURY
ALTERED MENTAL STATUS
FALL FROM GREATER THAN 10 FEET
DROWNING HEAD FIRST DIVING ACCIDENT
SIGNIFICANT HEAD OR FACIAL INJURY
NECK PAIN TENDERNESS OR DEFORMITY
ABNORMAL NEUROLOGICAL EXAMINATION
THORACIC OR LUMBAR VERTEBRAL FRACTURE
HXISTORY OF PRE-EXISTING VERTEBRAL DISEASE
CLINICAL PROCEDURE INVOLVING PTS WITH SUSPECTED SPINE INJURY
PATIENT KEPT IN CERVICAL COLLAR AND IMMOBILIZED ON SPINE BOARD
ldquoABCDEFrdquo ER PROTOCOL FOLLOWED (AIRWAY BREATHING CIRCULATION DISABILITYDRUGS EXPOSURE FOLEY CATHETER)
HISTORY AND PHYSICAL (PT HANDLED AS THOUGH SERIOUS INJURY PRESENT)
DECIDE IF IMAGING IS NECESSARY
CERVICAL VERTEBRAL ANATOMY
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
CLINICAL PROCEDURE INVOLVING PTS WITH SUSPECTED SPINE INJURY
PATIENT KEPT IN CERVICAL COLLAR AND IMMOBILIZED ON SPINE BOARD
ldquoABCDEFrdquo ER PROTOCOL FOLLOWED (AIRWAY BREATHING CIRCULATION DISABILITYDRUGS EXPOSURE FOLEY CATHETER)
HISTORY AND PHYSICAL (PT HANDLED AS THOUGH SERIOUS INJURY PRESENT)
DECIDE IF IMAGING IS NECESSARY
CERVICAL VERTEBRAL ANATOMY
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
CERVICAL VERTEBRAL ANATOMY
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
ANT LONGITUDINAL LIG
POST LONGITUDINAL LIG
LIGAMENTA FLAVA
SUPRASPINOUS LIG
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
MENU OF IMAGING OPTIONS
CERVICAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
STANDARD FIRST LINE IMAGING MODALITY IN ASSESSING CERVICAL VERTEBRAL INJURY
SWIMMERrsquoS VIEW
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Anteroposterior (A-P) View
bull Spinous process deviationbull Lateral Translationbull Coronal deformity
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Open Mouth View
bull Mostly C1-C2 lateral massbull Occipital CondylesCO-C1bull Odontoid Process
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Swimmerrsquos View
bull Cervico-thoracic junctionndash obliques sometimes helpful
CASETTE
X-ray BEAM
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
NORMAL C-SPINE VIEWS
LATERALAP
ODONTOID
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
C-SPINE FILM INTERPRETATION 7 STEP PROCESS
1 COUNT VERTEBRAE
-C1 THROUGH C7-IF T1 NOT SEEN 1048774SWIMMERrsquoS VIEW
2 ASSESS CURVATURE
3 ASSESS VERTEBRAL ALIGNMENT (4 LINES)-ANT VERTEBRAL LINE-POST VERTEBRAL LINE-SPINOLAMINAL LINE-POST SPINAL LINE
4 ASSESS BONY INTEGRITY
5 ASSESS INTERVERTEBRAL DISK SPACES
6 ASSESS OAA JOINT7 SOFT TISSUES
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
THE 4 CONTOUR LINES
1-ANT VERTEBRAL LINE
2-POST VERTEBRAL LINE
3-SPINOLAMINAL LINE
4-POST SPINAL LINE
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Lower Cervical Detection
bull Spinous process gapping
bull Facet joint Apposition
bull Inter-vertebral Gapping
bull Angulationbull Translation
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
JEFFERSON FRACTURE
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
HANGMANrsquoS FRACTURE
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
DENS FRACTURE
FRACTURE OF THE BASE OF THE DENS (ODONTOID) OF C2ANTERIOR OR POSTERIOR DISPLACEMENT OF THE DENSCAN OCCUR AT VARIOUS LEVELS ON THE DENSVIA HYPERFLEXION OR HYPEREXTENSION OF HEAD ON NECKUNSTABLE IF DISPLACEMENT OCCURS
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
COMPRESSION FRACTURE
VARIABLE SEVERITY FROM MINIMAL ANTERIOR WEDGING TO COMPLETE DISRUPTION OF VERTEBRAL BODY (BURST)LOOK FOR LOSS OF VERTICAL HEIGHT OF VERTEBRAL BODYDUE TO LONG AXIS COMPRESSION OR HYPERFLEXIONDIVING INTO SHALLOW POOLSTABLE 1048774UNSTABLE
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
TEARDROP FRACTURE
AVULSION FRACTURE OF ANTERIOR MARGIN OF VERTEBRAL BODYANTERIOR LONGITUDINAL LIG INSTABILITY (RUPTURE AVULSION)HYPEREXTENSION INJURYUNSTABLE INJURYLAMINA MAY JAM TOGETHER CAUSING LIGAMENTA FLAVA TO BUCKLE INWARD AND COMPRESSCONTUSE THE SPINAL CORD
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
CLAY SHOVELERrsquoS FRACTURE
AVULSION FRACTURE OF SPINOUS PROCESS BY SUPRASPINOUS LIGAMENTUSUALLY OCCURRING FROM C6-T2HYPERFLEXION DIRECT TRAUMA DOWNWARD FORCE VIA THORACOSCAPULAR MUSCLE (AS IN SHOVELING MOTION)STABLE
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
THORACO-LUMBAR SPINE INJURY
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Anatomy
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
MENU OF IMAGING OPTIONS
DORSAL SPINE PLAIN FILMS
ANTERO- POSTERIOR AND
LATERAL VIEW
LUMBO SACCRAL SPINE
ANTERO- POSTERIOR AND
LATERAL VIEW
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Thoracic Spine
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Lumbar Spine
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Determinants of Stability
bull T amp L spines are more stable than C-spinendash Strong ligamentsndash Stabilization by ribsndash Bigger intervertebral discsndash Larger facet jointsndash Less mobility
bull Fractures amp dislocations tend to occur where curvature changesndash T11-12 (thoracolumbar junction)ndash L5-S1 (lumbosacral junction)
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Mechanisms of Injury
bull Hyperflexion +- rotationndash Commonestndash Usually see anterior wedge rsquos or Chance
bull Shearingndash Ant or post translation
bull Hyperextensionbull Axial loading
ndash Compression or burst rsquos
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
3 Column Modelbull Anterior column
ndash Ant longitudinal ligndash Ant annulus fibrosisndash Ant vertebral body
bull Middle columnndash Post longitudinal ligndash Post annulus fibrosisndash Post vertebral body
bull Posterior columnndash Spinous processesndash Transverse processesndash Laminandash Facet jointsndash Pediclesndash Post ligamentous complex
bull 2 or more columns disrupted = unstablebull Most disruption of middle columns are
unstable
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Stable or Unstable
bull Radiographic findings suggestive of instabilityndash Vertebral body collapse w widening of pediclesndash gt 33 canal compromise on CTndash gt 25 mm translation bw vertebral bodies in any planendash Bilateral facet dislocationndash Abnormal widening bw spinous processes or lamina and gt
50 anterior collapse of vertebral body
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Stable or Unstable
bull Checklist for Instabilityndash Anterior elements disrupted 2 ptsndash Posterior elements disrupted 2 ptsndash Saggital plane translation gt 25 mm 2 ptsndash Saggital plane rotation gt 5o 2 ptsndash Spinal cord or cauda equina damage 2 ptsndash Disruption of costovertebral articulations 1 ptndash Dangerous loading anticipated 2 pts
ndash 5 or more pts unstable until healed or surgically stabilized
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Stable or Unstable
bull Risk of neurologic injury increases withndash gt 35 canal narrowing
at T11-12ndash gt 45 canal narrowing
at L1ndash gt 55 canal narrowing
at L2 amp below
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Approach to T amp L Spinesbull A ndash adequacy amp alignment
ndash All vertebrae need to be visiblendash Ant amp post longitudinal linesndash Facet joints should lie on smooth curvendash Normal kyphosis amp lordosisndash All spinous processes should lie in straight line
bull B ndash bonesndash Trace cortical margins of each vertebraendash Difference bw ant amp post body ht lt 2 mmndash Progressive increase in vertebral body ht moving down
spinendash Wink sign amp interpedicular distancendash Donrsquot forget to look at transverse processes
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Approach to T amp L Spines
bull C ndash cartilagendash Progressive increase in disc space moving down
spine (except L5-S1)ndash Facet joint alignment
bull S ndashsoft tissuendash Look at paraspinal stripe and prevertebral space
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines
Lateral Viewndash Posterior VB linendash Anterior VB linendash Inter-spinous Distancendash Translation
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Injury DetectionThoracic and Lumbar Spines
bull Same principlesbull Landmarks and Lines A-P
Viewndash Spinous process to Pediclesndash Inter-pedicular Distancendash Translation
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Thoracic and Lumbar Injuries
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Height Loss
Adjacent fracture
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
Transverse process fracturesof L2-4
Significance of transverse processfractures is not the fractures in andof themselves but rather the high incidence of associated seriousintraabdominal injury (~20)
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-
AnterolisthesisOf L4 on L5
- X ray spine
- SPINE TRAUMA
- CERVICAL SPINE INJURY
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Anteroposterior (A-P) View
- Open Mouth View
- Swimmerrsquos View
- Slide 13
- Slide 14
- Slide 15
- Lower Cervical Detection
- Lower Cervical Detection (2)
- Lower Cervical Detection (3)
- Lower Cervical Detection (4)
- Lower Cervical Detection (5)
- Lower Cervical Detection (6)
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Slide 27
- THORACO-LUMBAR SPINE INJURY
- Anatomy
- Slide 30
- Thoracic Spine
- Lumbar Spine
- Determinants of Stability
- Mechanisms of Injury
- 3 Column Model
- Stable or Unstable
- Stable or Unstable (2)
- Stable or Unstable (3)
- Approach to T amp L Spines
- Approach to T amp L Spines (2)
- Injury Detection Thoracic and Lumbar Spines
- Injury Detection Thoracic and Lumbar Spines (2)
- Thoracic and Lumbar Injuries
- Height Loss
- Slide 45
- Slide 46
-