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
C2 visualized -

C3 the
shoulders
C4 must be
lowered
Dislocation C5 even more
of C5 on C6
C6
 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

‫‪5‬‬ ‫גופי החוליות‬
 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 )C2-
T1(
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 open-
mouth odontoid view
FRACTURE OF C1 -
Jefferson’s fracture

‫שבר של הלסת‬
‫תחתונה‬
 DENS FRACTURE
10 % of all cervical #

Hyperflexion injury

Most common-
through 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

Spino-
laminar
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

‫שבר דו”צ של החלק בין מפ‬ ‫מפרק פצטלי‬

‫‪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
Thank you