Spinal Trauma: Cervical Trauma Protocol, Common Spinal Fractures – Radiology | Lecturio

Summary

This lecture focuses on the diagnosis and management of spinal trauma, emphasizing the role of imaging in identifying fractures that may lead to long-term complications like paralysis. Key types of spinal fractures discussed include compression fractures, burst fractures, chance fractures, Jefferson fractures, and hangman's fractures. The lecture also covers common mechanisms of injury, such as flexion, extension, rotation, and shearing, as well as the importance of trauma protocols and imaging techniques like radiographs and CT scans to detect and assess these injuries. Timely recognition of spinal fractures is crucial to prevent neurological deficits.

Takeaways

• 😀 **Imaging is crucial in diagnosing spinal trauma**, especially when there's suspicion of cervical spine fractures. Proper imaging helps prevent long-term complications like paralysis.
• 😀 **The initial step in trauma assessment is to immobilize the neck** to prevent further spinal cord damage, especially in cases of suspected cervical fractures.
• 😀 **A cross-table lateral radiograph** is typically used as the first step in the trauma protocol for cervical spine injuries to identify fractures or subluxations before manipulating the neck.
• 😀 **Common mechanisms of spinal injury include flexion, extension, rotational, and shearing forces**, which can all lead to different types of spinal fractures.
• 😀 **Compression fractures** are the most common type of spinal fracture, usually caused by axial loading forces, leading to collapse of the vertebral body.
• 😀 **Burst fractures** occur due to axial loading and involve a comminuted fracture of the vertebral body, often with retropulsion of bone fragments into the spinal canal, potentially causing neurological deficits.
• 😀 **Chance fractures**, also known as 'seatbelt fractures,' are often caused by motor vehicle accidents and involve fractures through the vertebral body, pedicles, and spinous processes. They are unstable and may be associated with abdominal injuries.
• 😀 **Jefferson fractures** are caused by axial loading injuries and involve fractures of C1, with displacement of the lateral masses. These fractures are often not associated with neurological deficits but still require careful management.
• 😀 **Hangman's fractures** result from hyperextension injuries, commonly in unrestrained passengers during car accidents, and typically show fractures in the posterior elements of C2 with displacement. These fractures usually don't cause immediate neurological deficits.
• 😀 **Imaging techniques like open-mouth radiographs and CT scans** are essential for diagnosing fractures involving C1 and C2 (e.g., Jefferson and Hangman's fractures), as they provide detailed visualization of bony displacement and structural abnormalities.

Q & A

What role does imaging play in spinal trauma diagnosis?

Imaging is crucial in spinal trauma diagnosis as it helps exclude abnormalities that could lead to long-term complications like paralysis. It allows healthcare providers to assess the severity of the injury and determine the appropriate course of treatment.

Why should a patient's neck not be moved if there's suspicion of a spinal fracture?

A patient's neck should not be moved if there's suspicion of a spinal fracture because an unstable fracture could compromise spinal cord integrity, potentially leading to neurological damage or paralysis.

What does a trauma protocol for cervical spine trauma typically involve?

A trauma protocol typically involves obtaining a cross-table lateral radiograph of the neck to ensure that there's no fracture or subluxation of the cervical spine before proceeding with further imaging, which may require neck manipulation.

What are some common mechanisms of spine trauma?

Common mechanisms of spine trauma include flexion injuries, extension injuries, rotational injuries, and shearing abnormalities.

What is a burst fracture, and how does it occur?

A burst fracture occurs due to axial loading injuries, where the disk above the vertebra is pushed into the vertebral body below. This results in a comminuted fracture of the vertebral body, often associated with displacement of bony fragments into the spinal canal, which can lead to neurological deficits.

What is a Chance fracture, and how is it commonly caused?

A Chance fracture, also called a 'seatbelt fracture,' is a type of flexion-distraction injury caused by a lap belt during a motor vehicle accident. It involves fractures through the vertebral body, pedicles, and spinous processes, and can lead to increased interspinous distance and separation of facet joints.

What are the typical imaging findings for a Chance fracture?

Imaging findings for a Chance fracture include fractures through the vertebral body, pedicles, and spinous processes, as well as separation of the facet joints. CT scans may show associated injuries such as an epidural hematoma or cord contusion.

What is a Jefferson fracture, and how is it typically diagnosed?

A Jefferson fracture is an axial loading injury that involves the offset of the lateral masses of C1 with respect to C2. It is diagnosed through an open-mouth radiograph, which shows lateral displacement of the C1 lateral masses. A CT scan confirms fractures of the anterior and posterior arches of C1.

What are the characteristics of a Hangman's fracture, and how does it occur?

A Hangman's fracture is caused by hyperextension and compression injuries, often occurring when a person hits their forehead on a windshield during a motor vehicle accident. It typically involves fractures of the posterior elements of C2 and results in anterior displacement of C2 on C3.

How is a Hangman's fracture identified on a radiograph?

A Hangman's fracture can be identified on a lateral cervical radiograph by observing posterior displacement of the spinolaminar line and anterior displacement of the C2 vertebral body. There is also a fracture of the posterior elements of C2.

What is the significance of recognizing spinal fractures in trauma patients?

Recognizing spinal fractures in trauma patients is critical because these injuries can lead to chronic neurological deficits. Prompt diagnosis and treatment can help prevent long-term complications such as paralysis.