23. Spinal fracture. Spinal dislocation

Essay 23- Fracture of the spine, dislocation of the spine

• General info
• Spine and spinal cord trauma can be considered as one of the most severe injuries
• Almost half of the spinal fractures are accompanied by a spinal cord injury
• Spinal column is a bony structure composed of 24 true and 9-10 false vertebrae
• True- 7C, 12T, 5A
• False- 5S, 4-5C
• Classification of spinal injuries
• Major- vertebral body compression fractures, burst fractures of vertebral bodies, extension fractures
• Minor- injury of transverse, spinous and articular process, isolated arch fractures

Cervical spine trauma

• Contusion
• 19% of total spine injuries
• Contision- pain, limitation of mobility, bruises of different size and swelling
• Treatment- compresses, physiotherapy
• Distortions
• Transient or temporary deviation from normal range of mobility
• Mechanism of occurence is indirect force on neck!
• Hyperextension-hyperflexion syndrome (occurs after forceful hyperextension and hyperflexion of spine)
• Seen in car accidents
• AKA whiplash injury
• Local pain and limitation of neck mobility
• Treatment- rest and neck immobilisation with Shantz’s collar for 10 days!
• Physiotherapy and novocaine blockades are recommended
• Atlas dislocation
• Common in case of fall on the head or when heavy objects fall on the head
• 99% of the dislocations are anterior!
• Symptoms- depends on degree of damage:
• Slight headache
• Neck pain
• Painful swallowing
• Limited mobility
• Immediate death
• Hirtz position taken for X-ray imaging
• Treatment- Minerva plaster cast until complete healing achieved
• If odontoid process fractured, fixed manually or by direct Crutchfield skull traction
• Lower cervical vertebrae dislocations and fractures
• C2-C7 most commonly affected
• Etiology- lordosis, tilting of vertebral bodies, wider intervertebral disks, extreme neck mobility
• Type of vertebral dislocation is determined by the proximal vertebra
• If there is forward displacement of the fourth cervical vertebra, this is anterior dislocation of C4!
• Subluxation is displacement of the proximal articular process to the distal one, without loss of contact between the adjacent planes of the articular surface
• Symptoms of subluxation- pain which increases on passive movements, limited neck mobility, torticolis and rigidity, muscle pain
• Treatment- if mild, neck traction is enough
• In case of unilateral subluxations, alongside with traction, backward rotation must be applied as well
• After fixation, the neck is immobilized by means of Shantz's collar or Glisson's sling for a period of 1 to 3 months
• Fixation of dislocated vertebrae can be achieved by:
• One stage manual repositioning
• Constant cranial traction
• Surgery