Fracture and dislocation of the spine

Cervical spine injury

-                    Neck sprain

• Treatment
  • Rest
  • heat, soft collar
  • NSAIDs, muscle relaxant analgesic

-                    Whiplash injury

• Mechanism of injury : hyper extension
• Clinical feature
  • Neck pain
  • Neck tenderness
• Investigation
• Plain radiograph: C-spine AP, lateral
• MRI
• Treatment
  • Medication: NSAIDs, muscle relaxant, analgesics
  • Physiotherapy: isometric ,ROM exercise

-                    C1 burst fracture (Jefferson’s fracture)

• Mechanism of injury
  • axial load
• Clinical feature
• Investigation
  • Open mount: overhanging lateral mass > 7 mms.
  • CT scan
• Treatment
  • Conservative treatment
    • Stable type :semi-rigid collar
    • Unstable type : halo vest
  • Surgical treatment: posterior C1-C2 fusion

-                    Odontoid Fracture

• Mechanism of injury
  • forced flexion injury
  • hyperextension
• Clinical feature
  • Neck pain
  • Neuro deficit
• Classification
  • Type I fracture tip of odontoid
  • Type II junction between odontoid and C2 body
  • Type III C2 body
• Investigation
• Treatment
  • Type I : Rigid collar
  • Type II : reduction withposterior fusion

: anterior screw fixation

• Type III : Halo Vest

-                    Traumatic Spondylolithesis of C2 (Hangman’s fracture)

• Mechanism of injury
  • extension, compression and flexion
• Clinical feature
  • Neck pain
  • Neck tenderness
  • neurodeficit
• Investigation
  • C- spine AP, Lateral Flexion Extension
  • CT scan
• Treatment
  • Stable fracture : semi-rigid collar
  • Unstable fracture : reduction àhalo vest
• Mechanism of injury
  • Flexion และflexion-rotation
  • Axial compression
  • Hyperextension
• Clinical feature
  • Neck pain
  • Neck tenderness
  • neurodeficit
• Investigation
  • X ray
  • CT scan
• Treatment
  • Wedge compression fracture : Collar 6-12 weeks
  • Burst fracture
    • No neurodeficit: bed rest with skull traction
    • Neurodeficit: anterior corpectomy with bone graft & plate fixation
  • Fracture-dislocation
    • Reduction with skull traction
    • posterior open reduction & fusion

Lower cervical spine fracture

Thoracolumbar Spine Injury

-                    3 column theory

• Anterior column
• Middle column
• Posterior column ( Posterior ligamentous complex)

-                    Mechanism of injury

• Low-energy fracture
  • Transverse process fracture (avulsion fracture)
  • Pars interarticularis fracture (traumatic spondylolysis)
• High-energy fracture
  • Compression fracture
  • Axial compression (burst fracture)
  • Flexion-distraction
  • Fracture-dislocation

-                    Investigation

• Plain X-ray :AP,lateral
  • Loss of vertebral height/wedging
  • Widening of interpedicular distance
  • Widening of interspinous distance
  • Kyphotic angle
• CT scan
• MRI

-                    Treatment

• Stable fracture(compression fracture ที่anterior height loss < , burst fracture ที่ไม่มี neurodeficit และChance fracture
  • thoracolumbar brace หรือbody cast ในท่าextension

• Unstable fracture(burst fracture ที่มีneurodeficit, flexion-distraction injury และ
  • Operative treatment

• Fracture with spinal cord injury
  • Operative treatment