L Spine at Charles Sturt University | Flashcards & Summaries

Lernmaterialien für l spine an der Charles Sturt University

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Fracture prevalence

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In adults:

90% of all thoracolumbar spine fractures occur between T11 and L4

60-70% occur at T12, L1 & L2

T11 / T12 should be included on all trauma lumbar spine films

20% are associated with other skeletal injuries:

- Compression fracture at the thoracolumbar junction + fractures of the os calcis

- Upper thoracic spine wedge fractures + sternum fractures

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Spondylolysis

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Pars interarticlularis defect

Unilateral / bilateral

Acute trauma / stress fracture / congenital

Usually L4 / 5-L5S1

Progresses to spondylolisthesis

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Stable versus unstable

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Generally:

- one column; Stable

- two columns; Stable / unstable

- three columns; Unstable 

• T-spine fractures (T1-10) often stable due to support from thoracic cage and orientation of facets (? injury to thoracic cage)

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Burst #

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High energy comminuted #

• Failure of anterior and middle column

• Axial compression or axial compression with rotation / anterior flexion / lateral flexion 

• Retropulsed bone fragment

• Always review posterior endplate on a compression #

• CT / MRI required


Radiographic features:


AP

- Decrease in height of body

- Lamina #

- Increased interpedicular distance

- Splaying of posterior facet joints

- +/- localized bulge paraspinal line


Lateral

- Decreased anterior & posterior vertebral body height

- Typically comminuted

- Posterior body height / cortex disrupted

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Chance # (# Distraction Injury)

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High energy distraction injury extending classically through the spinous process, pedicles, and vertebral body

May include a burst or compression element

Also called a "seat-belt" #

Acute forward flexion with distraction of the spine

Typically the posterior and middle columns are disrupted

High association with intra-abdominal trauma


Radiographic features:

- “Empty vertebral body” (posterior elements not superimposed) on AP

- Increased interspinous distance

- Horizontal #s of spinous process / lamina / pedicles running into the

vertebral endplates

- Increased interpedicular distance if burst element

- +/- compression # of vertebral body

- +/- localized bulge paraspinal line

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Fracture Dislocations

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High energy injury with many potential mechanisms

Typically disruption to all three columns

Associated with neurological deficit

CT / MRI required



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Isolated transverse process fracture:

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High energy injury

Often subtle

SOS

Overlying bowel gas

May be associated with intra-abdominal injuries

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Spondylosis

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Abnormal condition + spine

Vertebral column osteoarthritis

Reduced intervertebral disc space

Osteophytes formation (oblique or horizontal helps differentiate from

syndesmophytes)

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Ankylosis spondylitis

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Fusing inflammation + spine

Inflammatory arthritide

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Spondylolisthesis

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Ventral slip of vertebra

Result of a pars interarticularis defect or #

Graded by degree of slip onlateral: 

- Grade1 = <25% of body width

- Grade2 = 25-50%

- Grade 3 = 50-75%

- Grade 4 = 75% and over


Pseudo-spondylolisthesis

- No pars defect

- Degenerative origin

- Facet joint dislocation

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Free fragments

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For any disc extrusion it is critical to diagnose the presence of a free fragment or sequestration 

Disc material cephalad or caudal to the disc space is diagnosed as a free fragment on MRI (whether attached or not!)

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Wedge / Compression #

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75% of thoracic & lumbar vertebra #

• Anterior compression #

• Axial compression, lateral flexion or hyperflexion

• Middle column remains intact acting as a hinge

• Posterior column normal or distraction

• Pathological #?

Osteoporosis

- Metastatic deposits

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Q:

Fracture prevalence

A:

In adults:

90% of all thoracolumbar spine fractures occur between T11 and L4

60-70% occur at T12, L1 & L2

T11 / T12 should be included on all trauma lumbar spine films

20% are associated with other skeletal injuries:

- Compression fracture at the thoracolumbar junction + fractures of the os calcis

- Upper thoracic spine wedge fractures + sternum fractures

Q:

Spondylolysis

A:

Pars interarticlularis defect

Unilateral / bilateral

Acute trauma / stress fracture / congenital

Usually L4 / 5-L5S1

Progresses to spondylolisthesis

Q:

Stable versus unstable

A:

Generally:

- one column; Stable

- two columns; Stable / unstable

- three columns; Unstable 

• T-spine fractures (T1-10) often stable due to support from thoracic cage and orientation of facets (? injury to thoracic cage)

Q:

Burst #

A:

High energy comminuted #

• Failure of anterior and middle column

• Axial compression or axial compression with rotation / anterior flexion / lateral flexion 

• Retropulsed bone fragment

• Always review posterior endplate on a compression #

• CT / MRI required


Radiographic features:


AP

- Decrease in height of body

- Lamina #

- Increased interpedicular distance

- Splaying of posterior facet joints

- +/- localized bulge paraspinal line


Lateral

- Decreased anterior & posterior vertebral body height

- Typically comminuted

- Posterior body height / cortex disrupted

Q:

Chance # (# Distraction Injury)

A:

High energy distraction injury extending classically through the spinous process, pedicles, and vertebral body

May include a burst or compression element

Also called a "seat-belt" #

Acute forward flexion with distraction of the spine

Typically the posterior and middle columns are disrupted

High association with intra-abdominal trauma


Radiographic features:

- “Empty vertebral body” (posterior elements not superimposed) on AP

- Increased interspinous distance

- Horizontal #s of spinous process / lamina / pedicles running into the

vertebral endplates

- Increased interpedicular distance if burst element

- +/- compression # of vertebral body

- +/- localized bulge paraspinal line

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Q:

Fracture Dislocations

A:

High energy injury with many potential mechanisms

Typically disruption to all three columns

Associated with neurological deficit

CT / MRI required



Q:

Isolated transverse process fracture:

A:

High energy injury

Often subtle

SOS

Overlying bowel gas

May be associated with intra-abdominal injuries

Q:

Spondylosis

A:

Abnormal condition + spine

Vertebral column osteoarthritis

Reduced intervertebral disc space

Osteophytes formation (oblique or horizontal helps differentiate from

syndesmophytes)

Q:

Ankylosis spondylitis

A:

Fusing inflammation + spine

Inflammatory arthritide

Q:

Spondylolisthesis

A:

Ventral slip of vertebra

Result of a pars interarticularis defect or #

Graded by degree of slip onlateral: 

- Grade1 = <25% of body width

- Grade2 = 25-50%

- Grade 3 = 50-75%

- Grade 4 = 75% and over


Pseudo-spondylolisthesis

- No pars defect

- Degenerative origin

- Facet joint dislocation

Q:

Free fragments

A:

For any disc extrusion it is critical to diagnose the presence of a free fragment or sequestration 

Disc material cephalad or caudal to the disc space is diagnosed as a free fragment on MRI (whether attached or not!)

Q:

Wedge / Compression #

A:

75% of thoracic & lumbar vertebra #

• Anterior compression #

• Axial compression, lateral flexion or hyperflexion

• Middle column remains intact acting as a hinge

• Posterior column normal or distraction

• Pathological #?

Osteoporosis

- Metastatic deposits

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