Fracture Spine / Thoracolumbar Spine Fractures
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Pradeep Chockalingam Snr-2 Physiotherapist
www.pdfcoke.com/cpradheep
Osteoporosis Metastasis (Breast, Lung & Prostate CA) Multiple Myeloma Infections Chronic Steroid use Alcoholism IV Drug misuse
Spinal fracture with neurological compromise can occur in this group of patients even without trauma Levitan R 2002, WSCN 2007.
www.pdfcoke.com/cpradheep
C7 & T1 Junction
T6
Wedge Compression
Burst Fracture
Crush Fracture
T12 & L1 Junction L5 & S1 Junction
Kim DH et al 2006, Levitan R 2002, Aebi M et al 2005.
www.pdfcoke.com/cpradheep
Anterior longitudinal ligament, anterior half annulus fibrosus and vertebral body. Posterior longitudinal ligament, posterior half annulus fibrosus and vertebral body. Osseous and ligamentous structures posterior to the posterior longitudinal ligament
Levitan R 2002, Quraishi NA et al, Campbell SE et al 1995.
www.pdfcoke.com/cpradheep
Anterior vertebral body height loss >50% Degree of spinal wedging >15° Thoracolumbar kyphosis >30° Spinal fractures at multiple levels Two columns fracture Any changes to the posterior vertebral line or height Posterior column fractures (excluding spinous and transverse process) Vertebral body displacement Widening of interspinous space, facet joints and interpediculate distance Spondylolisthesis Grade – 3 & 4 (+ Grade 2)
Levitan R 2002, Quraishi NA et al, Nasca R, McRae R 2008, Campbell SE et al 1995, Gehweiler JA et al 1981, Kaji A 2008.
www.pdfcoke.com/cpradheep
Muscle weakness
Urinary and / or faecal incontinence
Saddle anaesthesia
Radiating pain
Pins and needles
Neurological deficits
Severe thoracolumbar pain
Abnormal gait pattern (Mainly ataxic gait)
Nocturnal pain
WSCN 2007.
www.pdfcoke.com/cpradheep
STABLE
UNSTABLE
Surgical stabilisation
Vertebroplasty
Balloon kyphoplasty
Orthosis
Conservative (patients
Conservative Pain management Short period of rest
preference following
Mobilisation
discussion of risks)
Quraishi NA et al, Kim DH 2006, NICE 2008, WSCN 2007.
www.pdfcoke.com/cpradheep
Assume all fall at home has spinal cord injury
Patient should be nursed flat in bed until spinal stability is established
40% of the thoracolumbar fracture may cause neurological
compromise (spinal canal is narrower)
Once neurological deficit is notice it is less likely to regain
At the uppermost limits of non-operative treatment, an Orthosis must be considered
Quraishi NA et al, NICE 2008, WSCN 2007, Levitan R 2002
www.pdfcoke.com/cpradheep
Plain X-rays are the first line of evaluation
CT is superior for the comprehensive evaluation of spinal fractures
CT should be considered in all acute wedge fractures
MRI is the procedure of choice for paraspinal and intraspinal infections
Levitan R 2002, Quraishi NA et al, Campbell SE et al 1995, Kim DH 2006, Kaji A et al 2008.
www.pdfcoke.com/cpradheep
Aebi M et al 2005, The Aging Spine; Springer Cambell SE et al 1995, The Value of CT in Determining Potential Instability of Simple Wedge-Compression Fractures of the Lumbar Spine; AJNR 16: 1385-1392. Gehweiler JA 1981, Relevant Signs of Stable and Unstable Thoracolumbar Vertebral Column Trauma; Skeletal Radiology 7: 179-183. Kaji A et al 2008, Spinal column injuries in adults: Definitions and mechanisms; www.uptodate.com (Accessed on 28/06/2009).
www.pdfcoke.com/cpradheep
Kim DH et al 2006, Contemporary Concept in Spine Care: Osteoporotic compression fractures of the spine; current options and considerations for treatment; The Spine Journal 6: 479-487. Levitan R 2002, Chapter-14 The Thoracolumbar Spine; in Emergency Radiology by Schwartz DT el al; McGraw-Hill. Page 319-347 McRae R et al 2008, Chapter-10 The Spine in Practical Fracture Treatment; Fifth edition, Elsevier, Page 237-274. Nasca R, Spine; in Wheeless’ Textbook of Orthopaedics;www.wheelessonline.com/ortho/spin e_index (Accessed on 28/06/2009).
www.pdfcoke.com/cpradheep
NICE 2008, Metastatic spinal cord compression: CG57; NICE. Quraishi NA et al, Osteoporotic spinal compression fracture; BMJ Evidence Centre; http://bestpractice.bmj.com/bestpractice/monograph/819/highlights.html (Accessed on 12/07/2009). Tator CH 2001, Chapter – 4 Clinical Manifestations of Acute Spinal Cord Injury; in Contemporary Management of SCI: from Impact Rehabilitation; AANS Press, Page: 21-32. WSCN 2007, West of Scotland Guideline for Malignant Spinal Cord Compression; West of Scotland Cancer Network.
Pradeep Chockalingam Snr-2 Physiotherapist
www.pdfcoke.com/cpradheep
Osteoporosis Metastasis (Breast, Lung & Prostate CA) Multiple Myeloma Infections Chronic Steroid use Alcoholism IV Drug misuse
Spinal fracture with neurological compromise can occur in this group of patients even without trauma Levitan R 2002, WSCN 2007.
www.pdfcoke.com/cpradheep
C7 & T1 Junction
T6
Wedge Compression
Burst Fracture
Crush Fracture
T12 & L1 Junction L5 & S1 Junction
Kim DH et al 2006, Levitan R 2002, Aebi M et al 2005.
www.pdfcoke.com/cpradheep
Anterior longitudinal ligament, anterior half annulus fibrosus and vertebral body. Posterior longitudinal ligament, posterior half annulus fibrosus and vertebral body. Osseous and ligamentous structures posterior to the posterior longitudinal ligament
Levitan R 2002, Quraishi NA et al, Campbell SE et al 1995.
www.pdfcoke.com/cpradheep
Anterior vertebral body height loss >50% Degree of spinal wedging >15° Thoracolumbar kyphosis >30° Spinal fractures at multiple levels Two columns fracture Any changes to the posterior vertebral line or height Posterior column fractures (excluding spinous and transverse process) Vertebral body displacement Widening of interspinous space, facet joints and interpediculate distance Spondylolisthesis Grade – 3 & 4 (+ Grade 2)
Levitan R 2002, Quraishi NA et al, Nasca R, McRae R 2008, Campbell SE et al 1995, Gehweiler JA et al 1981, Kaji A 2008.
www.pdfcoke.com/cpradheep
Muscle weakness
Urinary and / or faecal incontinence
Saddle anaesthesia
Radiating pain
Pins and needles
Neurological deficits
Severe thoracolumbar pain
Abnormal gait pattern (Mainly ataxic gait)
Nocturnal pain
WSCN 2007.
www.pdfcoke.com/cpradheep
STABLE
UNSTABLE
Surgical stabilisation
Vertebroplasty
Balloon kyphoplasty
Orthosis
Conservative (patients
Conservative Pain management Short period of rest
preference following
Mobilisation
discussion of risks)
Quraishi NA et al, Kim DH 2006, NICE 2008, WSCN 2007.
www.pdfcoke.com/cpradheep
Assume all fall at home has spinal cord injury
Patient should be nursed flat in bed until spinal stability is established
40% of the thoracolumbar fracture may cause neurological
compromise (spinal canal is narrower)
Once neurological deficit is notice it is less likely to regain
At the uppermost limits of non-operative treatment, an Orthosis must be considered
Quraishi NA et al, NICE 2008, WSCN 2007, Levitan R 2002
www.pdfcoke.com/cpradheep
Plain X-rays are the first line of evaluation
CT is superior for the comprehensive evaluation of spinal fractures
CT should be considered in all acute wedge fractures
MRI is the procedure of choice for paraspinal and intraspinal infections
Levitan R 2002, Quraishi NA et al, Campbell SE et al 1995, Kim DH 2006, Kaji A et al 2008.
www.pdfcoke.com/cpradheep
Aebi M et al 2005, The Aging Spine; Springer Cambell SE et al 1995, The Value of CT in Determining Potential Instability of Simple Wedge-Compression Fractures of the Lumbar Spine; AJNR 16: 1385-1392. Gehweiler JA 1981, Relevant Signs of Stable and Unstable Thoracolumbar Vertebral Column Trauma; Skeletal Radiology 7: 179-183. Kaji A et al 2008, Spinal column injuries in adults: Definitions and mechanisms; www.uptodate.com (Accessed on 28/06/2009).
www.pdfcoke.com/cpradheep
Kim DH et al 2006, Contemporary Concept in Spine Care: Osteoporotic compression fractures of the spine; current options and considerations for treatment; The Spine Journal 6: 479-487. Levitan R 2002, Chapter-14 The Thoracolumbar Spine; in Emergency Radiology by Schwartz DT el al; McGraw-Hill. Page 319-347 McRae R et al 2008, Chapter-10 The Spine in Practical Fracture Treatment; Fifth edition, Elsevier, Page 237-274. Nasca R, Spine; in Wheeless’ Textbook of Orthopaedics;www.wheelessonline.com/ortho/spin e_index (Accessed on 28/06/2009).
www.pdfcoke.com/cpradheep
NICE 2008, Metastatic spinal cord compression: CG57; NICE. Quraishi NA et al, Osteoporotic spinal compression fracture; BMJ Evidence Centre; http://bestpractice.bmj.com/bestpractice/monograph/819/highlights.html (Accessed on 12/07/2009). Tator CH 2001, Chapter – 4 Clinical Manifestations of Acute Spinal Cord Injury; in Contemporary Management of SCI: from Impact Rehabilitation; AANS Press, Page: 21-32. WSCN 2007, West of Scotland Guideline for Malignant Spinal Cord Compression; West of Scotland Cancer Network.
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