spine fractures

The spine consists of thirty-three stacked vertebra that articulate anteriorly via intervertebral discs and posteriorly through facet joints.

The spinal canal runs within the osseous structures, and nerves exit the spinal canal bilaterally through the neural foramina.

The vertebral column can be divided into three vertical columns based on biomechanical stability, and instability occurs when injuries affect two contiguous columns, i.e., the anterior and m-middle column or the middle and posterior columns.

And then obviously, a three-column injury is also unstable.

The anterior column consists of the anterior longitudinal ligament, the anterior two-thirds of the vertebral body, and the anterior two-thirds of the intervertebral disc.

The middle column consists of the posterior one-third of the vertebral body, the posterior one-third of the intervertebral disc, and the posterior longitudinal ligament.

And then the posterior column includes everything posterior to the posterior longitudinal ligament, which are the pedicles, the facet joints, and articular processes, the ligamentum flavum, and the vertebral arch and interconnecting ligaments.

The cervical spine is divided functionally into the axial, which is C zero to C two, and the subaxial spine, which is C three to C seven, and C zero would just be the skull base.

The C zero to C one segment is mainly responsible for flexion and extension of the head, whereas the C one-C two segment enables head rotation.

Isolated bony fractures are more common in older patients, and ligamentous involvement is common in younger patients, typically after a motor vehicle crash.

However, studies on aging populations show high incidences of injured elderly patients with significant comorbidities being injured due to low-impact trauma.

And neurological impairment is more frequently observed in patients with subaxial injuries.

The thoracic spine is the most rigid area of the spine due to the kyphotic form and the additional anterior stabilizing effects from the chest wall.

The thoracolumbar junction allows, due to its specific angulation of facet joints and large-sized intervertebral discs, profound force distribution and transfer while handling extensive flexion and extension bending forces as well.

The thoracolumbar junction is defined as the area between the eleventh thoracic vertebral body and the second lumbar vertebral body.

This area is an important junctional area, as is the cervicothoracic junction, because it connects rigid thoracic with flexible lumbar regions.

Consequently, most fractures occur in this junctional area.

Seventy percent of fractures are in the thoracolumbar junction versus thirty percent are lumbar or thoracic.

Remember that insufficiency fractures, which is related to bone fragility, can lead to complaints in patients without a clear history of falls, and the sacrum is often involved following low-impact trauma in geriatric patients.

And in pathologic fractures, it's important to identify underlying causes such as osteoporosis, malignancy, which is typically metastasis, or infection.

Now let's review concurrent injury patterns in patients with spine fractures.

First, there's concurrent spine injuries.

For occipital condyle injuries, the concurrent injuries are an additional C-spine injury and atlanto-occipital dislocation.

With an atlas fracture, concurrent injuries are odontoid, hangman's fracture, C two teardrop, and cervical burst fracture.

And then for an odontoid fracture, the concurrent associated injury is also an atlanto-occipital dislocation.

The spine consists of thirty-three stacked vertebra that articulate anteriorly via intervertebral discs and posteriorly through facet joints.

The spinal canal runs within the osseous structures, and nerves exit the spinal canal bilaterally through the neural foramina.

The vertebral column can be divided into three vertical columns based on biomechanical stability, and instability occurs when injuries affect two contiguous columns, i.e., the anterior and m-middle column or the middle and posterior columns.

And then obviously, a three-column injury is also unstable.

The anterior column consists of the anterior longitudinal ligament, the anterior two-thirds of the vertebral body, and the anterior two-thirds of the intervertebral disc.

The middle column consists of the posterior one-third of the vertebral body, the posterior one-third of the intervertebral disc, and the posterior longitudinal ligament.

And then the posterior column includes everything posterior to the posterior longitudinal ligament, which are the pedicles, the facet joints, and articular processes, the ligamentum flavum, and the vertebral arch and interconnecting ligaments.

The cervical spine is divided functionally into the axial, which is C zero to C two, and the subaxial spine, which is C three to C seven, and C zero would just be the skull base.

The C zero to C one segment is mainly responsible for flexion and extension of the head, whereas the C one-C two segment enables head rotation.

Isolated bony fractures are more common in older patients, and ligamentous involvement is common in younger patients, typically after a motor vehicle crash.

However, studies on aging populations show high incidences of injured elderly patients with significant comorbidities being injured due to low-impact trauma.

And neurological impairment is more frequently observed in patients with subaxial injuries.

The thoracic spine is the most rigid area of the spine due to the kyphotic form and the additional anterior stabilizing effects from the chest wall.

The thoracolumbar junction allows, due to its specific angulation of facet joints and large-sized intervertebral discs, profound force distribution and transfer while handling extensive flexion and extension bending forces as well.

The thoracolumbar junction is defined as the area between the eleventh thoracic vertebral body and the second lumbar vertebral body.

This area is an important junctional area, as is the cervicothoracic junction, because it connects rigid thoracic with flexible lumbar regions.

Consequently, most fractures occur in this junctional area.

Seventy percent of fractures are in the thoracolumbar junction versus thirty percent are lumbar or thoracic.

Remember that insufficiency fractures, which is related to bone fragility, can lead to complaints in patients without a clear history of falls, and the sacrum is often involved following low-impact trauma in geriatric patients.

And in pathologic fractures, it's important to identify underlying causes such as osteoporosis, malignancy, which is typically metastasis, or infection.

Now let's review concurrent injury patterns in patients with spine fractures.

First, there's concurrent spine injuries.

For occipital condyle injuries, the concurrent injuries are an additional C-spine injury and atlanto-occipital dislocation.

With an atlas fracture, concurrent injuries are odontoid, hangman's fracture, C two teardrop, and cervical burst fracture.

And then for an odontoid fracture, the concurrent associated injury is also an atlanto-occipital dislocation.