SlideShare una empresa de Scribd logo
1 de 43
Descargar para leer sin conexión
Trauma -Classification
• Functions ->
• 1) Improves communication between health care providers.
• 2) Can guide medical decision making.
• 3) Can determine injury prognosis.
• 4) Allows for valid and reliable research using a standard, universal language.
• An ideal classification system  both descriptive and prognostic information.
• (1)The descriptive component relays information about the traumatic
condition, organized by injury severity, based upon consistent radiographic and
clinical parameters, in an easily understood, reproducible language.
• (2)The prognostic component  affects clinical decision making by accounting
for natural history and known injury outcomes to guide treatment.
• Lastly, this system must be reproducible, incorporate commonly used clinical
parameters and be readily implemented into regular clinical practice.
Calenoff classification
• Patients with severe trauma may simultaneously sustain more than one level of
spinal injury. Often, the second or third levels of Injury are not recognized early
enough to prevent clinically signIficant extension of the neurologic deficit, pain
pattern, spinal instabilfty, and/or deformity. Of the secondary lesions, 40%
occurred above and 60% below the primary lesion.
Three major patterns of
multiple level injury.
Pattern A, Primary lesion
at C5-C7 with secondary
lesion at T12 or lumbar
spine.
Pattern B, Primary lesion at
T2-T4 with secondary
lesion in cervical spine.
Pattern C, Primary lesion
in thoracolumbar junction
with secondary lesion at
L4-L5. O
• Six main classification systems for acute subaxial cervical trauma->
• (1)Holdsworth's classification-> classified the injuries into 5 distinct groups:
– Pure flexion injuries
– Flexion-rotation injuries
– Extension injuries
– Compression injuries
– Shearing injuries
• (2)Allen's classification-> opt for a mechanistic classification and within
each group they classify each injury into a subgroup (stage) based on radiographic
pathology.
– Compressive flexion (5 stages)
– Vertical compression (3 stages)
– Distractive flexion (4 stages)
– Compressive extension (5 stages)
– Distractive extension (2 stages)
– Lateral flexion (2 stages)
  cervical Trauma  classification
  cervical Trauma  classification
  cervical Trauma  classification
compressive flexion (CF) phylogeny
Stage 1 (A) is associated with blunting of the antero-superior end plate of the vertebral body.
Stage 2 (B) there is a “beak-shape” deformity of the vertebral body without translation.
Stage 3 (C) there is a “broken beak” of the vertebral body without translation.
Stage 4 (D) indicates a broken beak with up to 3 mm translation
Stage 5 (E) we have a broken vertebral body with more than 3 mm translation.
Stages 4 and 5 are very much reminiscent of “teardrop” fracture
vertical compression (VC) fracture.
stage 2 (A) there is cupping of superior and inferior end plates of C6 vertebral body
stage 3 (B) there is significant compression fracture of the vertebral body with
protrusion of bone fragments into the spinal canal.
Stage 3 is an example of a burst fracture
Distractive flexion (DF)
stage 2 (A), there is unilateral
locked facets.
stage 3 (B) facets are
bilaterally locked with partial
translation of the rostral
vertebral body
stage 4 (C) there is significant
translation of the rostral
vertebral body in conjunction
with bilateral locked facets
(CE) stage 1 (A), a typical floating lateral mass of C5
vertebral body compatible with compressive extension
(CE) stage 4 (B) reformatted sagittal computed
tomography views of cervical spine indicating fracture
of the superior articulating processes of C7 bilaterally
The findings on imaging studies
and the history were compatible
with a compressive extension
injury phylogeny Stage 5 of Allen
Classification
Sagittal reformatted views of cervical spine indicating distractive extension
stage 2 of Allen Classification.
• (3)Harris Classification-> Major vector forces were flexion, extension, rotation,
vertical compression, and lateral bending. A combination of vector forces such as
flexion-rotation, extension-rotation, and lateral bending may produce added
varieties of injuries.
• White and Panjabi Clinical Checklist ->in 1990, White and Punjabi
described a formula for evaluating fracture stability. The amount of displacement
at this time was 3.5 mm of translation and 11 degrees of greater angulation
than adjacent levels
• Stability and neurologic status are the most important factors when treating
patients with cervical spine trauma .
• (4)Cervical Spine Injury Severity Score->
• CSISS is based on independent analysis of four columns (anterior, posterior, right
column, and left lateral column) .
• The anterior column includes the body, disc including the annulus, anterior and
posterior longitudinal ligaments.
• Each lateral column is scored separately and includes the facet projections, lateral
mass, pedicles, and facet joint capsules.
• The posterior column includes the lamina, spinous process, ligamentum flavum,
and nuchal ligaments.
• Each column is scored using a 0-5 analog scale.
•
• Each column is scored independently and summed, giving the CSISS ranging 0-20.
A nondisplaced fracture is valued at “1,” while increasing scores
are given proportionally to the amount of displacement.
A “5” is given for the worst injury to a given column that is
possible.
• (5)Subaxial Cervical Spine Injury Classification->2007 by Vaccaro and the
STSG
• SLIC evaluates fracture morphology, the discoligamentous complex, and neurologic
function, creating a comprehensive system to aid treatment decision
making,
• Disruption of the DLC may be represented by abnormal facet alignment (articular
apposition 50% or diastasis 2 mm through the facet joint), abnormal widening of the
anterior disc space either on neutral or extension radiographs, translation or rotation
of the vertebral bodies, or kyphotic alignment of the cervical spine. Indeterminate
injury may exist when radiographic disruption of the DLC is not otherwise obvious on
radiographic or CT imaging but a hyperintense signal is found through the posterior
ligamentous regions on T2-weighted MRI images, suggesting edema and injury.
• (6)AO Subaxial cervical spine classification-> Based on four criteria:
• (A) morphology of the injury,
• (B) facet injury,
• (C) neurologic status, and
• (D) any case-specific modifiers.
• (A) Morphology:-> Three basic categories (Types) were used in a similar manner
to the AO thoracolumbar fracture
• ‘‘Type A’’ injuries are fractures that result in compression of the vertebra with
intact tension band.
• ‘‘Type B’’ injuries include failure of the posterior or anterior tension band through
distraction with physical separation of the subaxial spinal elements while
maintaining continuity of the alignment of the spinal axis without translation or
dislocation.
• ‘‘Type C’’ includes those injuries with displacement or translation of one vertebral
body relative to another in any direction; anterior, posterior, lateral translation, or
vertical distraction
  cervical Trauma  classification
  cervical Trauma  classification
  cervical Trauma  classification
  cervical Trauma  classification
  cervical Trauma  classification
  cervical Trauma  classification
• (B) Facet injury:->
• If there are multiple injuries to the same facet (for example, a small fracture
and dislocation), only the highest level of injury is classified (dislocation).
• If both facets on the same vertebrae are injured, the right-sided facet injury is
listed before the left sided injury if the injuries are of different subcategories.
• The ‘‘Bilateral’’ (BL) modifier is used if both facets have the same type of injury.
  cervical Trauma  classification
  cervical Trauma  classification
  cervical Trauma  classification
• (C) Neurology:
• It is graded according to a six-part system similar to the system described with
the TL classification:
• N0—neurologically intact
• N1—transient neurologic deficit that has completely resolved by the time of
clinical examination (usually within 24 h from the time of injury)
• N2—radiculopathy
• N3—incomplete spinal cord injury
• N4—complete spinal cord injury
• NX—neurology undetermined—used to designate patients who cannot be
examined due to head injury or another condition which limits their ability to
complete a neurological examination such as intoxication, multiple trauma, or
intubation/sedation
• (D) Case-specific modifiers: additional modifiers created to describe unique
conditions relevant to clinical decision makingare as follows:
• M1—posterior capsulo-ligamentous complex injury without complete disruption:
This modifier designates injuries, which may appear stable from a bony stand
point , but there is some evidence of injury to the posterior ligamentous
structures without complete disruption. This is often identified on MRI imaging
and associated with very localized posterior tenderness on clinical examination.
• M2—Critical disk herniation defined by tissue signal intensity that is consistent
with nucleus pulposus protruding posteriorly to a vertical line drawn along the
posterior border of the inferior vertebral body at the injured level .
• M3—Stiffening/metabolic bone disease [i.e., Diffuse Idiopathic Skeletal
Hyperostosis (DISH), Ankylosing Spondylitis (AS), Ossification of the Posterior
Longitudinal Ligament (OPLL) or Ossification of the LigamentumFlavum (OLF)].
This modifier describes conditions that may argue either for or against surgery for
those patients.
• M4—Signs of vertebral artery injury
Flowchart of cervical classification.
• Anterior Column Injuries->
• easily recognizable on plain radiographs or CT.
• usually hyperflexion mechanism and a search for a concomitant injury to the
posterior ligamentous complex should ensue. The notable exception is the disc-
distraction injury resulting from opposite forces ( extension and posterior shear).
• (1) Anterior Compression Fractures->
• Mechanism of Injury-> Due to hyperflexion and/or axial loading forces, it leads
to , failure of the endplate(sup.) and creating wedging of the vertebral body.
During hyperflexion the posterior ligaments ->disruption. This injury pattern has
been termed “hidden flexion injury” and often fails nonoperative treatment.
• Radiographic Characteristics-> wedging of the anterior body and fractures of the
superior endplate is seen. The posterior wall is intact. Widening of the space
between spinous processes or perching of the facets is pathognomonic of PLC
injury. In some cases associated fractures of the lamina or spinous processes are
present.
• Assessment-> Isolated compression fractures without posterior or lateral mass
involvement almost always score low.
• (2)Burst Fractures
• Mechanism of Injury-> Rapid increase in intradiscal pressure resulting in
failure of the superior endplate, which is driven along with the disc into the
vertebral body,eventual failure of the body with radial displacement of bone
fragments. In addition, the pedicles are pushed outward, fragment from the
body displaces posteriorly into the spinal canal.
• Often flexion is present, causing posterior ligamentous complex disruption
and/or facet subluxation, fracture, or dislocation.
• Radiographic Assessment -> most commonly at C6 and C7 .
• Both anterior and posterior vertebral body heights are shortened and a small
fragment from the posterior superior body is rotated into the spinal canal.
Interspinous widening or facet perching or subluxation, when present, indicate
posterior ligamentous injury.
• Clinical Assessment -> isolated to the anterior column have low score, but if
associated with posterior ligamentous complex disruption have significantly
higher score.
• (3)Flexion Axial Loading Injury (tear drop fractures)
• Mechanism of Injury ->devastating injuries due to the propensity for neurologic
injury and often are the result of diving or other sports-related activities.
• The injury occurs from a compression force oblique applied in a downward and
posterior direction. Forces are concentrated in the anterior inferior corner of the
vertebral body, which is sheared off, giving the injury its name The remaining
part of the vertebral body shears through the disc space and rotates posteriorly
into the spinal canal, crushing the spinal cord . Varying amounts of flexion strain
occur in the posterior ligamentous complex, which accounts for a wide
presentation of stability with this injury.
• Radiographic Assessment-> confused with burst fractures.
• In this the vertebral body is displaced posteriorly and not a fracture fragment as
in the latter. Displacement of the main fragment in the flexion/axial loading
injury occurs by shearing through the posterior half of the disc space. Further, a
small triangular fragment (teardrop) is located in its normal position at the
anterior inferior vertebral body margin.
• Assessment-> without posterior ligamentous disruption, CSISS scores range from
3 to 5 because of anterior displacement with minimal injury to lateral masses or
posterior ligamentous complex. The SLIC score is 3 for a distraction injury with
increasing scores being based on neurologic involvement. When associated with
posterior ligamentous complex injury or facet fractures/subluxation, high scores
on both CSISS and SLIC are present.
• (4)Transverse Process Fractures-> quite common. not involved with spinal
stability and therefore are not significant in treatment decision making for the
spine. fractures at C6 and above may warn of possible vertebral artery injury
• (5)Disc-Distraction Injury
• Mechanism of Injury -> Impacting the head or face in a fall or forward striking a
windshield creates hyperextension, compression, and posterior shear. ALL and
disc annulus can fail from tension, may avulse a small fragment, which can be
confused with the teardrop fragment. Excessive compressive loading of the
lateral masses and impaction of the spinous process .In transiently narrow the
spinal canal, causing spinal cord injury, typical of the central cord type.
• Radiographic Analysis-> MRI -> Classic findings are increased signal in anterior
soft tissues both rostral and caudal to the injured disc. Increased signal intensity
across the disc space transversing the anterior annulus and anterior longitudinal
ligament is pathognomonic . Posterior increased signal in the facet joints and
ligamentum flavum are indicative of more extensive injury and greater instability.
• Assessment
• Disc-distraction injuries are difficult to diagnose and MRI is essential if these
lesions are suspected. Isolated disc distraction injuries of the anterior column
usually have small amounts of subluxation or hyperlordosis, thus scoring low.
• more severe injury ranging from 3 to 6 with higher scores when spinal cord injury
has occurred .
• Treatment of Anterior Column Injuries ->
• Anterior column injuries with low SLIC or CSISS scores can be treated non-
operatively . Less significant injuries can be treated with a cervical collar, while
burst fractures and flexion/axial loading injuries can be treated with a cervical
thoracic orthosis (CTO) or halo vest.
• Surgical indications for anterior column injuries are those with evidence of
disruption of the posterior ligamentous complex as demonstrated by high CSISS
and SLIC scores,
• In the case of compression fractures-> recommends posterior fusion because a
single-level anterior fusion may fail in the face of a vertebral fracture at the
location of caudal screw fixation. Burst fractures and flexion/axial loading injuries
can be reduced or significantly improved with tong traction. Although both
anterior and posterior approaches may be used, the authors recommend
addressing pathology at its major location(ant).
• Surgical indications for disc distraction injuries are cases with any significant
displacement, ongoing neurologic symptoms, or chronic pain. Anterior
discectomy and fusion are indicated in neurologically intact patients and those
with radiculopathy.
• Posterior Column Injuries->
• Isolated injuries to the posterior column are less common. Isolated injuries
include spinous process and lamina fractures and disruption of the posterior
ligamentous complex without facet subluxation .
• Spinous Process and Lamina Fractures->
• Mechanism of Injury->forced hyperextension or hyperflexion.Paraspinal muscle
contractions can also result in spinous process fractures termed clay shoveler’s
fracture. Lamina fractures also occur from similar mechanisms, although these
herald a more significant injury and should prompt a search for other injuries.
• Radiographic Analysis
• Spinous process fractures are easily visualized except at C6 and C7, which may
require CT. They are usually displaced due to muscle tension, and kyphosis may
be present. Multilevel injuries are not uncommon. Lamina fractures occur
bilaterally except when combined with a lateral mass fracture, where they may
be unilateral. In some cases the lamina may be displaced, compressing the dorsal
side of the spinal cord.
• Assessment
• Isolated spinous process and lamina fractures score low (0 to 2) on both CSISS
and SLIC.
• Posterior Ligamentous Injury without Subluxation ->
• Mechanism of Injury ->from hyperflexion and are worsened with any rotation.
• Radiographic Analysis -> suspected when interspinous process spreading is
present but without vertebral or facet subluxation. MRI with T2 fat-suppression
techniques is useful in confirming ligamentous injury.
• Assessment -> Posterior ligamentous injuries without subluxation score slightly
higher,.
• Treatment of Posterior Column Injuries-> Isolated posterior ligamentous injuries
without subluxation have a worse prognosis , Initial management of these
injuries unless there is MRI evidence of complete disruption is nonoperative in a
collar or CTO. If upright radiographs demonstrate increasing deformity or
excessive motion after 8 to 10 weeks of immobilization, surgery is
recommended.
• Lateral Column Injuries->
• Anatomically the lateral column consists of the lateral masses with their superior
and inferior articular process projections.
• Lateral column injuries include a wide variety of fracture types including isolated
facet fractures without subluxation, lateral mass fractures, and unilateral and
bilateral dislocation with and without fractures.
• 1)Isolated Facet Fractures->
• Mechanism of Injury ->Isolated facet fractures occur from forced impaction
against the neighboring facet, usually with a component of anterior shear.
• Radiographic Characteristics-> CT is sensitive for these injuries, and they are
best evaluated on sagittal reconstructions through the plane of the lateral mass.
• Assessment-> Isolated facet fractures without subluxation have low CSISS (0-3)
and SLIC (1) scores and are deemed stable.
• (2)Lateral Mass Fractures->
• Mechanism of Injury-> result from lateral compression or hyperextension where
facets impact each other. Transiently this may narrow the neuroforamina with
resultant root injury.
• Radiographic Characteristics->Kotani->
• Type I-> is a fracture separation, creating a free floating lateral mass , can rotate
forward, which allows for anterior subluxation at both cranial and caudal
articulations, rendering two motion segments unstable.
• Type II-> lateral mass fractures are highly comminuted also with a similar
potential as type I for instability.
• Type III-> is a vertical fracture in the coronal plane with invagination of the
superior facet into the cranial lateral mass.
• Type IV=> fractures are traumatic spondylolisthesis, which usually occurs at C7 or
T1. This is caused by bilateral fractures of the pedicles or pars interarticularis and
vertebral subluxation., spinal cord injury may be absent or minimal as the spinal
canal opens due to separation of the anterior and posterior components.
• Assessment->Type I and type II lateral mass fractures have moderate CSISS
scores, depending on the amount of translation ,The type III split fractures are
more stable. The type IV traumatic spondylolisthesis fractures are highly
unstable, having more score.
• (3)Unilateral Facet Dislocations->
• Mechanism of Injury-> Head rotation or rotation associated with flexion cause
forward and upward translation of the opposite facet.
• Radiographic Analysis-> On lateral views, unilateral facet dislocations result in
10% to 25% vertebral body rotation. CT will show better way. Facet fractures are
common. Interspinous widening or increased posterior signal heralds disruption
of the posterior ligamentous complex. Disc disruption is seen in the majority of
cases and frank herniation in a small percent.
• Assessment-> Unilateral facet dislocations are graded according to amount of
displacement. However, stability ultimately depends on the severity of injury to
the posterior ligamentous complex. The CSISS ranges from 5 to 13 and SLIC
ranges from 4 to 20.
• (4)Bilateral Facet Dislocation->devastating injuries resulting in quadriplegia.
• Mechanism of Injury-> from hyperflexion with or without rotation. There will
always be associated disruption of the posterior ligamentous complex. Another
potential mechanism has been shown to be cranial impaction with the head
slightly flexed, which transmits flexion loads causing facet dislocation.
• Radiographic Analysis->
• Bilateral facet dislocations result in a minimum of 50% vertebral body translation.
Fractures of the facets, lamina, and spinous processes are common. Posterior
interspinous widening is usually present. The disc may be inappropriately
narrowed, suggesting posterior herniation. The spinal canal is significantly
narrowed, accounting for the high incidence of quadriplegia. Disc disruption is
almost always present, and nuclear herniation may be present in up to 65% of
cases.3
• Assessment ->
• Bilateral facet dislocations should be considered unstable and have the highest
CSISS (15 to 20) and SLIC (6 to 10) scores.
• Treatment of Lateral Column Injuries->

Más contenido relacionado

La actualidad más candente

FRACTURES of CALCANEUS AND TALUS
FRACTURES of CALCANEUS AND TALUSFRACTURES of CALCANEUS AND TALUS
FRACTURES of CALCANEUS AND TALUSAjit Rampure
 
Terrible triad - elbow
Terrible triad - elbow Terrible triad - elbow
Terrible triad - elbow jatinder12345
 
Ilizarov External fixator
Ilizarov External fixatorIlizarov External fixator
Ilizarov External fixatorAbdullah Mamun
 
High Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAVHigh Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAVUtsav Agrawal
 
Knee Portal Placement & Diagnostic arthroscopy
Knee Portal Placement & Diagnostic arthroscopyKnee Portal Placement & Diagnostic arthroscopy
Knee Portal Placement & Diagnostic arthroscopyAsish Rajak
 
Principles of lock plate fixation AO
Principles of lock plate fixation AOPrinciples of lock plate fixation AO
Principles of lock plate fixation AOAhmad Sulong
 
Evolution of Intramedullary Nails
Evolution of Intramedullary NailsEvolution of Intramedullary Nails
Evolution of Intramedullary NailsPrateek Goel
 
Vertebrolasty plus Kyphoplasty
Vertebrolasty plus KyphoplastyVertebrolasty plus Kyphoplasty
Vertebrolasty plus KyphoplastyAlexander Bardis
 
Principles of lock plates
Principles of lock platesPrinciples of lock plates
Principles of lock platesAhmad Sulong
 
Fractures and dislocations of hand
Fractures and dislocations of handFractures and dislocations of hand
Fractures and dislocations of handAftab Alam
 
Soft Tissue Balancing in Primary Total Knee Arthroplasty
Soft Tissue Balancing in Primary Total Knee ArthroplastySoft Tissue Balancing in Primary Total Knee Arthroplasty
Soft Tissue Balancing in Primary Total Knee ArthroplastyIhab El-Desouky
 
Principles of external fixation
Principles of external fixationPrinciples of external fixation
Principles of external fixationSiddhartha Sinha
 
Posterior Cruciate Ligament Injury
Posterior Cruciate Ligament InjuryPosterior Cruciate Ligament Injury
Posterior Cruciate Ligament InjuryArslan Luqman
 

La actualidad más candente (20)

Pelvic fractures
Pelvic fracturesPelvic fractures
Pelvic fractures
 
FRACTURES of CALCANEUS AND TALUS
FRACTURES of CALCANEUS AND TALUSFRACTURES of CALCANEUS AND TALUS
FRACTURES of CALCANEUS AND TALUS
 
Osteotomies around the hip
Osteotomies around the hipOsteotomies around the hip
Osteotomies around the hip
 
Terrible triad - elbow
Terrible triad - elbow Terrible triad - elbow
Terrible triad - elbow
 
Hip Resurfacing
Hip ResurfacingHip Resurfacing
Hip Resurfacing
 
Ilizarov External fixator
Ilizarov External fixatorIlizarov External fixator
Ilizarov External fixator
 
Pelvic ext
Pelvic extPelvic ext
Pelvic ext
 
High Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAVHigh Tibial Osteotomy_UTSAV
High Tibial Osteotomy_UTSAV
 
Protrusio acetabuli
Protrusio acetabuliProtrusio acetabuli
Protrusio acetabuli
 
Knee Portal Placement & Diagnostic arthroscopy
Knee Portal Placement & Diagnostic arthroscopyKnee Portal Placement & Diagnostic arthroscopy
Knee Portal Placement & Diagnostic arthroscopy
 
Principles of lock plate fixation AO
Principles of lock plate fixation AOPrinciples of lock plate fixation AO
Principles of lock plate fixation AO
 
Evolution of Intramedullary Nails
Evolution of Intramedullary NailsEvolution of Intramedullary Nails
Evolution of Intramedullary Nails
 
Vertebrolasty plus Kyphoplasty
Vertebrolasty plus KyphoplastyVertebrolasty plus Kyphoplasty
Vertebrolasty plus Kyphoplasty
 
Chance fracture
Chance fractureChance fracture
Chance fracture
 
Acl reconstruction
Acl reconstructionAcl reconstruction
Acl reconstruction
 
Principles of lock plates
Principles of lock platesPrinciples of lock plates
Principles of lock plates
 
Fractures and dislocations of hand
Fractures and dislocations of handFractures and dislocations of hand
Fractures and dislocations of hand
 
Soft Tissue Balancing in Primary Total Knee Arthroplasty
Soft Tissue Balancing in Primary Total Knee ArthroplastySoft Tissue Balancing in Primary Total Knee Arthroplasty
Soft Tissue Balancing in Primary Total Knee Arthroplasty
 
Principles of external fixation
Principles of external fixationPrinciples of external fixation
Principles of external fixation
 
Posterior Cruciate Ligament Injury
Posterior Cruciate Ligament InjuryPosterior Cruciate Ligament Injury
Posterior Cruciate Ligament Injury
 

Similar a cervical Trauma classification

Imaging of thoracic spine Trauma
Imaging of thoracic spine TraumaImaging of thoracic spine Trauma
Imaging of thoracic spine TraumaSunil Jeph MD
 
Imaging of thoracic spine Trauma
Imaging of thoracic spine TraumaImaging of thoracic spine Trauma
Imaging of thoracic spine TraumaSunil Jeph MD
 
THORACOLUMBAR SPINE INJURIES
THORACOLUMBAR SPINE INJURIESTHORACOLUMBAR SPINE INJURIES
THORACOLUMBAR SPINE INJURIESSuman Subedi
 
subaxial cervical fx VI.pptx
subaxial cervical fx VI.pptxsubaxial cervical fx VI.pptx
subaxial cervical fx VI.pptxwilliamvicky174
 
Thoracolumbar fractures classification
Thoracolumbar fractures classificationThoracolumbar fractures classification
Thoracolumbar fractures classificationAmr Mansour Hassan
 
Thoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.pptThoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.pptyiminli12
 
Thoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.pptThoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.pptDR KHALID FIYAZ M
 
Ct spine fractures ppt
Ct spine fractures pptCt spine fractures ppt
Ct spine fractures pptBipulBorthakur
 
Spine injury -halim.pptx
Spine injury -halim.pptxSpine injury -halim.pptx
Spine injury -halim.pptxezrys54ety5
 
Injury of Spinal cord
Injury of Spinal cordInjury of Spinal cord
Injury of Spinal cordEneutron
 
Cervical spine trauma asif.pptx
Cervical spine trauma asif.pptxCervical spine trauma asif.pptx
Cervical spine trauma asif.pptxAsifAliJatoi2
 
Pelvic Fracture
Pelvic FracturePelvic Fracture
Pelvic Fractureahmad214
 

Similar a cervical Trauma classification (20)

Imaging of thoracic spine Trauma
Imaging of thoracic spine TraumaImaging of thoracic spine Trauma
Imaging of thoracic spine Trauma
 
Imaging of thoracic spine Trauma
Imaging of thoracic spine TraumaImaging of thoracic spine Trauma
Imaging of thoracic spine Trauma
 
THORACOLUMBAR SPINE INJURIES
THORACOLUMBAR SPINE INJURIESTHORACOLUMBAR SPINE INJURIES
THORACOLUMBAR SPINE INJURIES
 
subaxial cervical fx VI.pptx
subaxial cervical fx VI.pptxsubaxial cervical fx VI.pptx
subaxial cervical fx VI.pptx
 
SPINE FRACTURES.pptx
SPINE FRACTURES.pptxSPINE FRACTURES.pptx
SPINE FRACTURES.pptx
 
CME Orthopedic.pptx
CME Orthopedic.pptxCME Orthopedic.pptx
CME Orthopedic.pptx
 
Thoracolumbar fractures classification
Thoracolumbar fractures classificationThoracolumbar fractures classification
Thoracolumbar fractures classification
 
Thoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.pptThoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.ppt
 
Thoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.pptThoracolumbar-spine-fracture-.ppt
Thoracolumbar-spine-fracture-.ppt
 
Slic System
Slic SystemSlic System
Slic System
 
Ct spine fractures ppt
Ct spine fractures pptCt spine fractures ppt
Ct spine fractures ppt
 
Spine injury -halim.pptx
Spine injury -halim.pptxSpine injury -halim.pptx
Spine injury -halim.pptx
 
Spinal cord trauma
Spinal cord traumaSpinal cord trauma
Spinal cord trauma
 
Spinetrauma 2
Spinetrauma 2Spinetrauma 2
Spinetrauma 2
 
319 thoracolumbar trauma
319 thoracolumbar trauma319 thoracolumbar trauma
319 thoracolumbar trauma
 
Injury of Spinal cord
Injury of Spinal cordInjury of Spinal cord
Injury of Spinal cord
 
Cervical spine trauma asif.pptx
Cervical spine trauma asif.pptxCervical spine trauma asif.pptx
Cervical spine trauma asif.pptx
 
Pelvic Fracture
Pelvic FracturePelvic Fracture
Pelvic Fracture
 
Pelvis fracture dislocation
Pelvis fracture dislocationPelvis fracture dislocation
Pelvis fracture dislocation
 
Cervical spine trauma
Cervical spine traumaCervical spine trauma
Cervical spine trauma
 

Más de spine spine

Injection in spine
Injection in spine Injection in spine
Injection in spine spine spine
 
Transfacet screw fixation
Transfacet screw fixationTransfacet screw fixation
Transfacet screw fixationspine spine
 
General anatomy of the vertebral artery
General anatomy of the vertebral arteryGeneral anatomy of the vertebral artery
General anatomy of the vertebral arteryspine spine
 
Spinal cord blood supply
Spinal cord blood supplySpinal cord blood supply
Spinal cord blood supplyspine spine
 
Intraoperative neurophysiologic monitoring of the spine
Intraoperative neurophysiologic monitoring of the spineIntraoperative neurophysiologic monitoring of the spine
Intraoperative neurophysiologic monitoring of the spinespine spine
 

Más de spine spine (6)

Injection in spine
Injection in spine Injection in spine
Injection in spine
 
Transfacet screw fixation
Transfacet screw fixationTransfacet screw fixation
Transfacet screw fixation
 
General anatomy of the vertebral artery
General anatomy of the vertebral arteryGeneral anatomy of the vertebral artery
General anatomy of the vertebral artery
 
Facet reduction
Facet reductionFacet reduction
Facet reduction
 
Spinal cord blood supply
Spinal cord blood supplySpinal cord blood supply
Spinal cord blood supply
 
Intraoperative neurophysiologic monitoring of the spine
Intraoperative neurophysiologic monitoring of the spineIntraoperative neurophysiologic monitoring of the spine
Intraoperative neurophysiologic monitoring of the spine
 

Último

AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 

Último (20)

AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 

cervical Trauma classification

  • 1. Trauma -Classification • Functions -> • 1) Improves communication between health care providers. • 2) Can guide medical decision making. • 3) Can determine injury prognosis. • 4) Allows for valid and reliable research using a standard, universal language. • An ideal classification system  both descriptive and prognostic information. • (1)The descriptive component relays information about the traumatic condition, organized by injury severity, based upon consistent radiographic and clinical parameters, in an easily understood, reproducible language. • (2)The prognostic component  affects clinical decision making by accounting for natural history and known injury outcomes to guide treatment. • Lastly, this system must be reproducible, incorporate commonly used clinical parameters and be readily implemented into regular clinical practice.
  • 2. Calenoff classification • Patients with severe trauma may simultaneously sustain more than one level of spinal injury. Often, the second or third levels of Injury are not recognized early enough to prevent clinically signIficant extension of the neurologic deficit, pain pattern, spinal instabilfty, and/or deformity. Of the secondary lesions, 40% occurred above and 60% below the primary lesion. Three major patterns of multiple level injury. Pattern A, Primary lesion at C5-C7 with secondary lesion at T12 or lumbar spine. Pattern B, Primary lesion at T2-T4 with secondary lesion in cervical spine. Pattern C, Primary lesion in thoracolumbar junction with secondary lesion at L4-L5. O
  • 3. • Six main classification systems for acute subaxial cervical trauma-> • (1)Holdsworth's classification-> classified the injuries into 5 distinct groups: – Pure flexion injuries – Flexion-rotation injuries – Extension injuries – Compression injuries – Shearing injuries • (2)Allen's classification-> opt for a mechanistic classification and within each group they classify each injury into a subgroup (stage) based on radiographic pathology. – Compressive flexion (5 stages) – Vertical compression (3 stages) – Distractive flexion (4 stages) – Compressive extension (5 stages) – Distractive extension (2 stages) – Lateral flexion (2 stages)
  • 7. compressive flexion (CF) phylogeny Stage 1 (A) is associated with blunting of the antero-superior end plate of the vertebral body. Stage 2 (B) there is a “beak-shape” deformity of the vertebral body without translation. Stage 3 (C) there is a “broken beak” of the vertebral body without translation. Stage 4 (D) indicates a broken beak with up to 3 mm translation Stage 5 (E) we have a broken vertebral body with more than 3 mm translation. Stages 4 and 5 are very much reminiscent of “teardrop” fracture
  • 8. vertical compression (VC) fracture. stage 2 (A) there is cupping of superior and inferior end plates of C6 vertebral body stage 3 (B) there is significant compression fracture of the vertebral body with protrusion of bone fragments into the spinal canal. Stage 3 is an example of a burst fracture
  • 9. Distractive flexion (DF) stage 2 (A), there is unilateral locked facets. stage 3 (B) facets are bilaterally locked with partial translation of the rostral vertebral body stage 4 (C) there is significant translation of the rostral vertebral body in conjunction with bilateral locked facets
  • 10. (CE) stage 1 (A), a typical floating lateral mass of C5 vertebral body compatible with compressive extension (CE) stage 4 (B) reformatted sagittal computed tomography views of cervical spine indicating fracture of the superior articulating processes of C7 bilaterally The findings on imaging studies and the history were compatible with a compressive extension injury phylogeny Stage 5 of Allen Classification
  • 11. Sagittal reformatted views of cervical spine indicating distractive extension stage 2 of Allen Classification.
  • 12. • (3)Harris Classification-> Major vector forces were flexion, extension, rotation, vertical compression, and lateral bending. A combination of vector forces such as flexion-rotation, extension-rotation, and lateral bending may produce added varieties of injuries. • White and Panjabi Clinical Checklist ->in 1990, White and Punjabi described a formula for evaluating fracture stability. The amount of displacement at this time was 3.5 mm of translation and 11 degrees of greater angulation than adjacent levels • Stability and neurologic status are the most important factors when treating patients with cervical spine trauma .
  • 13. • (4)Cervical Spine Injury Severity Score-> • CSISS is based on independent analysis of four columns (anterior, posterior, right column, and left lateral column) . • The anterior column includes the body, disc including the annulus, anterior and posterior longitudinal ligaments. • Each lateral column is scored separately and includes the facet projections, lateral mass, pedicles, and facet joint capsules. • The posterior column includes the lamina, spinous process, ligamentum flavum, and nuchal ligaments. • Each column is scored using a 0-5 analog scale. • • Each column is scored independently and summed, giving the CSISS ranging 0-20.
  • 14. A nondisplaced fracture is valued at “1,” while increasing scores are given proportionally to the amount of displacement. A “5” is given for the worst injury to a given column that is possible.
  • 15. • (5)Subaxial Cervical Spine Injury Classification->2007 by Vaccaro and the STSG • SLIC evaluates fracture morphology, the discoligamentous complex, and neurologic function, creating a comprehensive system to aid treatment decision making, • Disruption of the DLC may be represented by abnormal facet alignment (articular apposition 50% or diastasis 2 mm through the facet joint), abnormal widening of the anterior disc space either on neutral or extension radiographs, translation or rotation of the vertebral bodies, or kyphotic alignment of the cervical spine. Indeterminate injury may exist when radiographic disruption of the DLC is not otherwise obvious on radiographic or CT imaging but a hyperintense signal is found through the posterior ligamentous regions on T2-weighted MRI images, suggesting edema and injury.
  • 16. • (6)AO Subaxial cervical spine classification-> Based on four criteria: • (A) morphology of the injury, • (B) facet injury, • (C) neurologic status, and • (D) any case-specific modifiers. • (A) Morphology:-> Three basic categories (Types) were used in a similar manner to the AO thoracolumbar fracture • ‘‘Type A’’ injuries are fractures that result in compression of the vertebra with intact tension band. • ‘‘Type B’’ injuries include failure of the posterior or anterior tension band through distraction with physical separation of the subaxial spinal elements while maintaining continuity of the alignment of the spinal axis without translation or dislocation. • ‘‘Type C’’ includes those injuries with displacement or translation of one vertebral body relative to another in any direction; anterior, posterior, lateral translation, or vertical distraction
  • 23. • (B) Facet injury:-> • If there are multiple injuries to the same facet (for example, a small fracture and dislocation), only the highest level of injury is classified (dislocation). • If both facets on the same vertebrae are injured, the right-sided facet injury is listed before the left sided injury if the injuries are of different subcategories. • The ‘‘Bilateral’’ (BL) modifier is used if both facets have the same type of injury.
  • 27. • (C) Neurology: • It is graded according to a six-part system similar to the system described with the TL classification: • N0—neurologically intact • N1—transient neurologic deficit that has completely resolved by the time of clinical examination (usually within 24 h from the time of injury) • N2—radiculopathy • N3—incomplete spinal cord injury • N4—complete spinal cord injury • NX—neurology undetermined—used to designate patients who cannot be examined due to head injury or another condition which limits their ability to complete a neurological examination such as intoxication, multiple trauma, or intubation/sedation
  • 28. • (D) Case-specific modifiers: additional modifiers created to describe unique conditions relevant to clinical decision makingare as follows: • M1—posterior capsulo-ligamentous complex injury without complete disruption: This modifier designates injuries, which may appear stable from a bony stand point , but there is some evidence of injury to the posterior ligamentous structures without complete disruption. This is often identified on MRI imaging and associated with very localized posterior tenderness on clinical examination. • M2—Critical disk herniation defined by tissue signal intensity that is consistent with nucleus pulposus protruding posteriorly to a vertical line drawn along the posterior border of the inferior vertebral body at the injured level . • M3—Stiffening/metabolic bone disease [i.e., Diffuse Idiopathic Skeletal Hyperostosis (DISH), Ankylosing Spondylitis (AS), Ossification of the Posterior Longitudinal Ligament (OPLL) or Ossification of the LigamentumFlavum (OLF)]. This modifier describes conditions that may argue either for or against surgery for those patients. • M4—Signs of vertebral artery injury
  • 29. Flowchart of cervical classification.
  • 30. • Anterior Column Injuries-> • easily recognizable on plain radiographs or CT. • usually hyperflexion mechanism and a search for a concomitant injury to the posterior ligamentous complex should ensue. The notable exception is the disc- distraction injury resulting from opposite forces ( extension and posterior shear). • (1) Anterior Compression Fractures-> • Mechanism of Injury-> Due to hyperflexion and/or axial loading forces, it leads to , failure of the endplate(sup.) and creating wedging of the vertebral body. During hyperflexion the posterior ligaments ->disruption. This injury pattern has been termed “hidden flexion injury” and often fails nonoperative treatment. • Radiographic Characteristics-> wedging of the anterior body and fractures of the superior endplate is seen. The posterior wall is intact. Widening of the space between spinous processes or perching of the facets is pathognomonic of PLC injury. In some cases associated fractures of the lamina or spinous processes are present. • Assessment-> Isolated compression fractures without posterior or lateral mass involvement almost always score low.
  • 31. • (2)Burst Fractures • Mechanism of Injury-> Rapid increase in intradiscal pressure resulting in failure of the superior endplate, which is driven along with the disc into the vertebral body,eventual failure of the body with radial displacement of bone fragments. In addition, the pedicles are pushed outward, fragment from the body displaces posteriorly into the spinal canal. • Often flexion is present, causing posterior ligamentous complex disruption and/or facet subluxation, fracture, or dislocation. • Radiographic Assessment -> most commonly at C6 and C7 . • Both anterior and posterior vertebral body heights are shortened and a small fragment from the posterior superior body is rotated into the spinal canal. Interspinous widening or facet perching or subluxation, when present, indicate posterior ligamentous injury. • Clinical Assessment -> isolated to the anterior column have low score, but if associated with posterior ligamentous complex disruption have significantly higher score.
  • 32. • (3)Flexion Axial Loading Injury (tear drop fractures) • Mechanism of Injury ->devastating injuries due to the propensity for neurologic injury and often are the result of diving or other sports-related activities. • The injury occurs from a compression force oblique applied in a downward and posterior direction. Forces are concentrated in the anterior inferior corner of the vertebral body, which is sheared off, giving the injury its name The remaining part of the vertebral body shears through the disc space and rotates posteriorly into the spinal canal, crushing the spinal cord . Varying amounts of flexion strain occur in the posterior ligamentous complex, which accounts for a wide presentation of stability with this injury.
  • 33. • Radiographic Assessment-> confused with burst fractures. • In this the vertebral body is displaced posteriorly and not a fracture fragment as in the latter. Displacement of the main fragment in the flexion/axial loading injury occurs by shearing through the posterior half of the disc space. Further, a small triangular fragment (teardrop) is located in its normal position at the anterior inferior vertebral body margin. • Assessment-> without posterior ligamentous disruption, CSISS scores range from 3 to 5 because of anterior displacement with minimal injury to lateral masses or posterior ligamentous complex. The SLIC score is 3 for a distraction injury with increasing scores being based on neurologic involvement. When associated with posterior ligamentous complex injury or facet fractures/subluxation, high scores on both CSISS and SLIC are present. • (4)Transverse Process Fractures-> quite common. not involved with spinal stability and therefore are not significant in treatment decision making for the spine. fractures at C6 and above may warn of possible vertebral artery injury
  • 34. • (5)Disc-Distraction Injury • Mechanism of Injury -> Impacting the head or face in a fall or forward striking a windshield creates hyperextension, compression, and posterior shear. ALL and disc annulus can fail from tension, may avulse a small fragment, which can be confused with the teardrop fragment. Excessive compressive loading of the lateral masses and impaction of the spinous process .In transiently narrow the spinal canal, causing spinal cord injury, typical of the central cord type. • Radiographic Analysis-> MRI -> Classic findings are increased signal in anterior soft tissues both rostral and caudal to the injured disc. Increased signal intensity across the disc space transversing the anterior annulus and anterior longitudinal ligament is pathognomonic . Posterior increased signal in the facet joints and ligamentum flavum are indicative of more extensive injury and greater instability. • Assessment • Disc-distraction injuries are difficult to diagnose and MRI is essential if these lesions are suspected. Isolated disc distraction injuries of the anterior column usually have small amounts of subluxation or hyperlordosis, thus scoring low. • more severe injury ranging from 3 to 6 with higher scores when spinal cord injury has occurred .
  • 35. • Treatment of Anterior Column Injuries -> • Anterior column injuries with low SLIC or CSISS scores can be treated non- operatively . Less significant injuries can be treated with a cervical collar, while burst fractures and flexion/axial loading injuries can be treated with a cervical thoracic orthosis (CTO) or halo vest. • Surgical indications for anterior column injuries are those with evidence of disruption of the posterior ligamentous complex as demonstrated by high CSISS and SLIC scores, • In the case of compression fractures-> recommends posterior fusion because a single-level anterior fusion may fail in the face of a vertebral fracture at the location of caudal screw fixation. Burst fractures and flexion/axial loading injuries can be reduced or significantly improved with tong traction. Although both anterior and posterior approaches may be used, the authors recommend addressing pathology at its major location(ant).
  • 36. • Surgical indications for disc distraction injuries are cases with any significant displacement, ongoing neurologic symptoms, or chronic pain. Anterior discectomy and fusion are indicated in neurologically intact patients and those with radiculopathy.
  • 37. • Posterior Column Injuries-> • Isolated injuries to the posterior column are less common. Isolated injuries include spinous process and lamina fractures and disruption of the posterior ligamentous complex without facet subluxation . • Spinous Process and Lamina Fractures-> • Mechanism of Injury->forced hyperextension or hyperflexion.Paraspinal muscle contractions can also result in spinous process fractures termed clay shoveler’s fracture. Lamina fractures also occur from similar mechanisms, although these herald a more significant injury and should prompt a search for other injuries. • Radiographic Analysis • Spinous process fractures are easily visualized except at C6 and C7, which may require CT. They are usually displaced due to muscle tension, and kyphosis may be present. Multilevel injuries are not uncommon. Lamina fractures occur bilaterally except when combined with a lateral mass fracture, where they may be unilateral. In some cases the lamina may be displaced, compressing the dorsal side of the spinal cord. • Assessment • Isolated spinous process and lamina fractures score low (0 to 2) on both CSISS and SLIC.
  • 38. • Posterior Ligamentous Injury without Subluxation -> • Mechanism of Injury ->from hyperflexion and are worsened with any rotation. • Radiographic Analysis -> suspected when interspinous process spreading is present but without vertebral or facet subluxation. MRI with T2 fat-suppression techniques is useful in confirming ligamentous injury. • Assessment -> Posterior ligamentous injuries without subluxation score slightly higher,. • Treatment of Posterior Column Injuries-> Isolated posterior ligamentous injuries without subluxation have a worse prognosis , Initial management of these injuries unless there is MRI evidence of complete disruption is nonoperative in a collar or CTO. If upright radiographs demonstrate increasing deformity or excessive motion after 8 to 10 weeks of immobilization, surgery is recommended.
  • 39. • Lateral Column Injuries-> • Anatomically the lateral column consists of the lateral masses with their superior and inferior articular process projections. • Lateral column injuries include a wide variety of fracture types including isolated facet fractures without subluxation, lateral mass fractures, and unilateral and bilateral dislocation with and without fractures. • 1)Isolated Facet Fractures-> • Mechanism of Injury ->Isolated facet fractures occur from forced impaction against the neighboring facet, usually with a component of anterior shear. • Radiographic Characteristics-> CT is sensitive for these injuries, and they are best evaluated on sagittal reconstructions through the plane of the lateral mass. • Assessment-> Isolated facet fractures without subluxation have low CSISS (0-3) and SLIC (1) scores and are deemed stable. • (2)Lateral Mass Fractures-> • Mechanism of Injury-> result from lateral compression or hyperextension where facets impact each other. Transiently this may narrow the neuroforamina with resultant root injury.
  • 40. • Radiographic Characteristics->Kotani-> • Type I-> is a fracture separation, creating a free floating lateral mass , can rotate forward, which allows for anterior subluxation at both cranial and caudal articulations, rendering two motion segments unstable. • Type II-> lateral mass fractures are highly comminuted also with a similar potential as type I for instability. • Type III-> is a vertical fracture in the coronal plane with invagination of the superior facet into the cranial lateral mass. • Type IV=> fractures are traumatic spondylolisthesis, which usually occurs at C7 or T1. This is caused by bilateral fractures of the pedicles or pars interarticularis and vertebral subluxation., spinal cord injury may be absent or minimal as the spinal canal opens due to separation of the anterior and posterior components.
  • 41. • Assessment->Type I and type II lateral mass fractures have moderate CSISS scores, depending on the amount of translation ,The type III split fractures are more stable. The type IV traumatic spondylolisthesis fractures are highly unstable, having more score. • (3)Unilateral Facet Dislocations-> • Mechanism of Injury-> Head rotation or rotation associated with flexion cause forward and upward translation of the opposite facet. • Radiographic Analysis-> On lateral views, unilateral facet dislocations result in 10% to 25% vertebral body rotation. CT will show better way. Facet fractures are common. Interspinous widening or increased posterior signal heralds disruption of the posterior ligamentous complex. Disc disruption is seen in the majority of cases and frank herniation in a small percent. • Assessment-> Unilateral facet dislocations are graded according to amount of displacement. However, stability ultimately depends on the severity of injury to the posterior ligamentous complex. The CSISS ranges from 5 to 13 and SLIC ranges from 4 to 20.
  • 42. • (4)Bilateral Facet Dislocation->devastating injuries resulting in quadriplegia. • Mechanism of Injury-> from hyperflexion with or without rotation. There will always be associated disruption of the posterior ligamentous complex. Another potential mechanism has been shown to be cranial impaction with the head slightly flexed, which transmits flexion loads causing facet dislocation. • Radiographic Analysis-> • Bilateral facet dislocations result in a minimum of 50% vertebral body translation. Fractures of the facets, lamina, and spinous processes are common. Posterior interspinous widening is usually present. The disc may be inappropriately narrowed, suggesting posterior herniation. The spinal canal is significantly narrowed, accounting for the high incidence of quadriplegia. Disc disruption is almost always present, and nuclear herniation may be present in up to 65% of cases.3 • Assessment -> • Bilateral facet dislocations should be considered unstable and have the highest CSISS (15 to 20) and SLIC (6 to 10) scores.
  • 43. • Treatment of Lateral Column Injuries->