Spine Trauma

Trauma of the spine Dr. Ben Ely Anna

Trauma of Spine • Motor vehicle accident • Falls • Sport injuries

Trauma of Spine Most common: Upper (C1-C2) cervical spine Lower (C5-C7) cervical spine Thoracolumbar junction (T9-L2)

Imaging studies • X-rays • CT -bony fractures • MRI- soft tissues, spinal cord, CSF, neural roots

Radiology of trauma • Always get two radiographs at 90 degrees to each other! • Look for the second fracture!

Trauma of cervical spine

nterior - flexion forces Following hyperextension forses

Examination of cervical spine 1. Cross - table LATERAL view: • 7 vertebral bodies must be seen • 5 lines • C1-2 area • Disk spaces • Cervical

C - spine initial radiograph after diving into a shallow pool

C1 C2 C3 C4 C5

C - spine initial radiograph after diving into a shallow pool with the shoulders lowered C1

C 7 is not visualized -

C2 C3 C4

Dislocation of C5 on C6

C5 C6

the shoulders must be lowered even more

Examination of cervical spine Swimmer’s view: raises one shoulder and lowers the other

Examination of cervical spine 1. Cross - table LATERAL view: • 7 vertebral bodies must be seen • 5 lines • C1-2 area • Disk spaces • Cervical

‫‪Examination of cervical spine‬‬ ‫קו ‪ - 1‬רקמות הרכות ‪:‬‬ ‫מספר ממ’ בגובה‬ ‫‪C1-3‬‬ ‫ורוחב של פחות‬ ‫מגוף‬ ‫החוליה בגובה ‪C4-‬‬ ‫‪7‬‬ ‫קו ‪ - 2‬גבול הקדמי של‬ ‫החוליות‬ ‫קו ‪ - 3‬גבול האחורי של‬ ‫גופי החוליות‬

‫‪5‬‬

C - spine radiograph

• Soft tissue

swelling Anterior gaping

C3

Examination of cervical spine 1. Cross - table LATERAL view: • 7 vertebral bodies must be seen • 5 lines • C1-2 area • Disk spaces • Cervical

Normal C1 - C2

Dislocation C1 - C2

Dislocated de

Examination of cervical spine 1. Cross - table LATERAL view: • 7 vertebral bodies must be seen • 5 lines • C1-2 area • Disk spaces • Cervical

Reversal lordosis

Examination of cervical spine 2. If LATERAL C - spine view appear normal and if the patient can cooperate FLEXION and EXTENSION views are obtained ) patient makes them without help ! (

Flexion

Extension

Examination of cervical spine 3. Anterior view with closed mouth: • lower cervical spine • alignment • oblique fractures

Examination of cervical spine 4. Open-mouth view of dens: • Dens • C1 )inferior and lateral margins ( • C2 )superior and lateral

Examination of cervical spine 5. Oblique views: Neural foramina )C2T1( Articular facets

Examination of cervical spine 6. Computed tomography: • Narrow slices • Bone window • MPR

Atlanto - occipital dislocation Widening > 12 mm between base of the skull and the Dens

FRACTURE OF C1 Jefferson’s fracture • Combination or bust fracture of C1 • Vertical compression injury • Unstable • Widened lateral masses of C1 on openmouth odontoid view

FRACTURE OF C1 Jefferson’s fracture

‫שבר של הלסת‬ ‫תחתונה‬

DENS FRACTURE 10 % of all cervical # Hyperflexion injury Most commonthrough base of dens

DENS FRACTURE

DENS FRACTURE

FRACTURE OF C2 Hangman’s fracture

Posterior elements of the C2 fractured and displaced inferiorly

‫‪FRACTURE OF C2‬‬ ‫‪Hangman’s fracture‬‬ ‫שבר של אלמנטים אחוריים‬ ‫ותזוזה של ‪ C2‬קדימה לעומת ‪C3‬‬

FRACTURE OF C2 Hangman’s fracture Spinolaminar line is offset

Teardrop fracture Disruption of posterior ligaments and anterior compression of a vertebral body • Hyperflexion • Most severe and unstable injury of the C-spine • Avulsion of anterioinferior corner of cervical vertebral body by anterior ligament

Clay - shoveler’s fracture Supraspinous ligaments pull on the spinous process and avulse it : fracture of spinous process of the C6 or C7

Unilateral locked facets: dislocation of facet joint C6-7 disk space is wider than normal, C7 body is narrower than C6 body owing to abnormal rotation

TRAUMA SEVERE BURST FRACTURE WITH POSTERIOR DISLOCATION OF C5 BODY

COMPRESSED FRACTURE OF C6 BODY

TRAUMA

FRACTURE OF VERTEBRAL BODY EPIDURAL HEMATOMA SEVERE TRAUMATIC SPINAL STENOSIS CORD COMPRESSION

T12 compression fracture

Thoracic spine fractures

Seat belt fracture • Usually - L1 or L2 • fracture of the posterior body Smith’s fracture • fracture

Seat belt fracture Horisontal fracture of the pedicles, laminae, transverse processes

Fracture - dislocation

SPONDYLOLYSIS- “scottic dog appearance”

SPONDYLOLYSIS- “scottic dog appearance” pedicle -‫עין‬ superior articular facet - ‫אוזן‬ Pars interarticularis

inferior articular facet - ‫ל‬

‫‪SPONDYLOLYSIS‬‬

‫מפרק פצטלי‬

‫שבר דו”צ של החלק בין מפ‬

‫‪SPONDYLOLISTHESIS‬‬

‫ה ‪ - I‬פחות מ ‪ 1/4‬של אורך‬ ‫ה‪ ENDPLATE‬של ‪S1‬‬

‫ה ‪ - II‬יותר מ ‪ 1/4‬אך פחות מ ‪1/2‬‬ ‫של אורך ה‪ENDPLATE‬‬ ‫של ‪S1‬‬

‫ה ‪ - III‬יותר מ ‪ 1/2‬של אורך‬ ‫ה‪ ENDPLATE‬של ‪S1‬‬

‫ה ‪ - IV‬יותר מ ‪3/4‬‬

Spondylolysis

Spondylolisthesis

‫פריצת דיסק‬

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