- Source: Spinal fracture
- Spinal fracture
- Cervical fracture
- Vertebral compression fracture
- Hangman's fracture
- Burst fracture
- Spinal fusion
- Bone fracture
- Spinal precautions
- Basilar skull fracture
- Spinal stenosis
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A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury (or worsening of an already injured spine) if the fracture is unstable, that is, likely to change alignment without internal or external fixation.
Types
Cervical fracture
Fracture of C1, including Jefferson fracture
Fracture of C2, including Hangman's fracture
Flexion teardrop fracture – a fracture of the anteroinferior aspect of a cervical vertebra
Clay-shoveler fracture – fracture through the spinous process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae
Burst fracture – in which a vertebra breaks from a high-energy axial load
Compression fracture – a collapse of a vertebra, often resulting in the form of a wedge-shape due to larger compression anteriorly
Chance fracture – compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements
Holdsworth fracture – an unstable fracture dislocation of the thoracolumbar junction of the spine
Distraction is where there is a pulling apart of the vertebrae. Distraction injuries generally cause breaks in osseous and ligamentous supporting structures, and are therefore generally unstable. A distraction injury on the posterior side of a vertebra can lead to a compression fracture on its anterior side.
Cervical fracture
A medical history and physical examination can be sufficient in clearing the cervical spine. Notable clinical prediction rules to determine which patients need medical imaging are Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS).
The AO Foundation has developed a descriptive system for cervical fractures, the AOSpine subaxial cervical spine fracture classification system.
The indication to surgically stabilize a cervical fracture can be estimated from the Subaxial Injury Classification (SLIC).
Thoracolumbar fracture
Vertebral fractures of the thoracic vertebrae, lumbar vertebrae or sacrum are usually associated with major trauma and can cause spinal cord injury that results in a neurological deficit.
= Thoracolumbar injury classification and severity score
=The thoracolumbar injury classification and severity score (TLICS) is a scoring system to determine the need to surgically treat a spinal fracture of thoracic or lumbar vertebrae. The score is the sum of three values, each being the score of the most fitting alternative in three categories:
Injury type
Compression fracture - 1 point
Burst fracture - 2 points
Translational rotational injury - 3 points
Distraction injury - 4 points
Posterior ligamentous complex
Intact - 0 points
Suspected injury or indeterminate - 2 points
Injured - 3 points
Neurology
Intact - 0 points
Spinal nerve root injury - 2 points
Incomplete injury of cord/conus medullaris - 3 points
Complete injury of cord/conus medullaris (complete) - 2 points
Cauda equina syndrome - 3 points
A TLICS score of less than 4 indicates non-operative treatment, a score of 4 indicates that the injury may be treated operatively or non-operatively, while a score of more than 4 means that the injury is usually considered for operative management.
= AOSpine Thoracolumbar Injury Classification System
=AOSpine Thoracolumbar Injury Classification System (ATLICS) is the most recent classification scheme for thoracolumbar injuries. ATLICS is broadly based on the TLICS system and has sufficient reliability irrespective of the experience of the observer. ATLICS is primarily focused on fracture morphology, and has two additional sections addressing the neurological grading and clinical modifiers:
Fracture morphology
Type A: Compression injuries (sub-types A0-A4)
Type B: Distraction injuries (sub-types B1-B3)
Type C: Translation injuries
Neurological status
N0: neurologically intact
N1: transient deficit
N2: radiculopathy
N3: "incomplete spinal cord injury or cauda equina injury"
N4: "complete spinal cord injury"
NX: unknown neurological status
Modifiers
M1: unknown tension band injury status
M2: comorbidities
Osteoporotic vertebral compression fracture
Osteoporosis is a condition causing weakening of the bone due to loss of bone substance. Women are about four times more likely to be affected by osteoporosis than men. Osteoporosis may occur after the menopause or as a result of malnutrition, hyperthyroidism, alcoholism, kidney disease. Osteoporosis may occur after treatment with antiepileptic drugs, proton pump inhibitors, antidepressants, corticosteroids or chemotherapy. Osteoporotic vertebral body compression fractures might occur even after minor trauma or while twisting, bending or coughing.
Sacral fracture
References
External links
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