Advertisement

Problems in Spinal Fractures

  • S. Y. Lee

Abstract

Several major goals should be attained in the ideal treatment of any spinal injury. Spinal alignment must be restored by appropriate means of reduction to retain normal spinal biomechanics. This allows early painless mobility, prevents or minimizes neurological deficits, provides stability at the injured site, and prevents progressive late-occurring spinal deformity, pain and possible neural compromise. The treatment should also aim to provide the neural structures with the optimal environment for function, healing and regeneration and minimize non-spinal complications such as deep vein thrombosis, pulmonary embolism, decubitus ulcers, and chest and urinary tract infections.

Keywords

Spinal Cord Injury Spinal Fracture Burst Fracture Odontoid Fracture Anterior Longitudinal Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Whitesides TE (1977) Traumatic kyphosis of the thoracolumbar spine. Clin Orthop 128:78–92PubMedGoogle Scholar
  2. 2.
    White AA, Panjabi MM (1978) Clinical biomechanics of the spine. Lippincott, PhiladelphiaGoogle Scholar
  3. 3.
    Denis F (1983) The three column spine and its significance in the classification of acute thoraco-lumbar spinal injuries. Spine 8:817–831PubMedCrossRefGoogle Scholar
  4. 4.
    Denis F (1984) Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop 189:65–76PubMedGoogle Scholar
  5. 5.
    Holdsworth F (1970) Fractures, dislocations and fracture-dislocations of the spine. J Bone Joint Surg [Am] 52:1534–1551Google Scholar
  6. 6.
    Kobrine AI, Bernstein JJ (1985) Experimental spinal cord injury. In: Wilkins RH, Rengachary SS (eds) Neurosurgery, vol 2. McGraw-Hill, New York, pp 1694–1700Google Scholar
  7. 7.
    Bricolo A, Dalle Ore G et al. (1976) Local cooling in spinal cord injury. Surg Neurol 6:101–106PubMedGoogle Scholar
  8. 8.
    Abraham J, Paterson A et al. (1987) Omento-myelo-synangiosis in the management of chronic traumatic parapledia. Paraplegia 25:44–49PubMedCrossRefGoogle Scholar
  9. 9.
    Yashon D (1988) Surgical management of trauma to the spine. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques, 2nd edn. Grune and Stratton, New York, pp 1449–1469Google Scholar
  10. 10.
    Sherrington CS (1947) The integrative action of the nervous system, 2nd edn. Yale University Press, New HavenGoogle Scholar
  11. 11.
    Schneider RC (1955) Syndrome of acute anterior spinal cord injury. J Neurosurg 12:95–122PubMedCrossRefGoogle Scholar
  12. 12.
    Pang D, Wilberger JE Jr (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57:114–119PubMedCrossRefGoogle Scholar
  13. 13.
    Pollack IF, Pang D et al. (1988) Recurrent spinal cord injury without radiographic abnormalities in children. J Neurosurg 69:177–182PubMedCrossRefGoogle Scholar
  14. 14.
    Hadley MN, Zabramski JM et al. (1988) Paediatric spinal trauma: review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68:18–24PubMedCrossRefGoogle Scholar
  15. 15.
    Foo D, Rossier AB (1982) Post-traumatic spinal epidural hematoma. Neurosurgery 11:25–32PubMedCrossRefGoogle Scholar
  16. 16.
    Berquist TH (1986) Imaging of orthopaedic trauma and surgery. Saunders, PhiladelphiaGoogle Scholar
  17. 17.
    Bools JC, Rose BS (1986) Traumatic atlanto-occipital dislocation: two cases with survival. AJNR 7:901–904PubMedGoogle Scholar
  18. 18.
    Bohlman H, Ducker T, Lucas J (1982) Spine and spinal cord injuries. In: Rothman R, Simeone F (eds) The spine, 2nd edn. Saunders, Philadelphia, pp 661–756Google Scholar
  19. 19.
    Powers B, Miller MD et al. (1979) Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4:12–17PubMedCrossRefGoogle Scholar
  20. 20.
    Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg [Am] 56:1663–1674Google Scholar
  21. 21.
    Clark C, White A (1985) Fractures of the dens. J Bone Joint Surg [Am] 67:1340–1348Google Scholar
  22. 22.
    Southwick W (1980) Management of fractures of the dens. J Bone Joint Surg [Am] 62:482–486Google Scholar
  23. 23.
    Daffner RH (1977) Pseudo fracture of the dens: Mach bands. Am J Radiol 128:607–612Google Scholar
  24. 24.
    Cancelmo JJ (1972) Clay shoveler’s fracture: a helpful diagnostic sign. Am J Radiol 115:540–543Google Scholar
  25. 25.
    Kim KS, Chen HH et al. (1989) Flexion teardrop fracture of the cervical spine: radiographic characteristics. Am J Radiol 152:319–326Google Scholar
  26. 26.
    Harris JH (1978) Acute injuries of the spine. Semin Roentgenol 13:53–68PubMedCrossRefGoogle Scholar
  27. 27.
    Lee C, Kim KS, Rogers LF (1982) Triangular cervical vertebral body fractures: diagnostic significance. Am J Radiol 138:1123–1132Google Scholar
  28. 28.
    Martinez S, Morgan CL et al. (1979) Unusual fractures and dislocations of the axis vertebra. Skeletal Radiol 3:206–212CrossRefGoogle Scholar
  29. 29.
    Lee C, Rogers LF et al. (1984) Fractures of the cranio-vertebral junction associated with other fractures of the spine: overlooked entity? AJNR 5:775–781PubMedGoogle Scholar
  30. 30.
    Mirvis S, Young J et al. (1987) Hangman’s fracture: radiologic assessment in 27 cases. Radiology 163:713–717PubMedGoogle Scholar
  31. 31.
    Peppin J, Hawkins R (1981) Traumatic spondylolisthesis of the axis: hangman’s fracture. Clin Orthop 157:133–138Google Scholar
  32. 32.
    Effendi B, Roy D et al. (1981) Fractures of the ring of the axis: a classification based on the analysis of 131 cases. J Bone Joint Surg [Br] 63:319–327Google Scholar
  33. 33.
    Elliott JM, Rogers LF et al. (1972) The hangman’s fracture: fractures of the neural arch of the axis. Radiology 104:303–307PubMedGoogle Scholar
  34. 34.
    Seljeskog EL, Chou SH (1976) Spectrum of the hangman’s fracture. J Neurosurg 45:3–8PubMedCrossRefGoogle Scholar
  35. 35.
    Miller MD, Gehweiler JA et al. (1978) Significant new observations on cervical spine traumas. Am J Radiol 130:659–663Google Scholar
  36. 36.
    Ballinger PW (ed) (1986) Merrill’s atlas of radiographic positions and radiographic procedures, vol 1, 6th edn. Mosby, St LauisGoogle Scholar
  37. 37.
    Koch RA, Nickel VL (1978) The halo-vest: an evaluation of motion and forces across the neck. Spine 3:103–107PubMedCrossRefGoogle Scholar
  38. 38.
    Han SY, Witten DM, Mussleman JP (1976) Jefferson fracture of the atlas. J Neurosurg 44:368–371PubMedCrossRefGoogle Scholar
  39. 39.
    Sherk HH, Nicholson JT (1970) Fractures of the atlas. J Bone Joint Surg [Am] 52:1017–1024Google Scholar
  40. 40.
    Spence K, Decker S, Sell K (1970) Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg [Am] 52:543–546Google Scholar
  41. 41.
    Zielinski C, Gunther S, Deeb Z (1982) Cranial nerve palsies complicating Jefferson fractures. J Bone Joint Surg [Am] 64:1382–1384Google Scholar
  42. 42.
    Segal LS, Grimm JO, Stauffer ES (1987) Non-union of fractures of the atlas. J Bone Joint Surg [Am] 69:1423–1434Google Scholar
  43. 43.
    Perry J, Nickel VL (1959) Total cervical spine fusion for neck paralysis. J Bone Joint Surg [Am] 41:37–59Google Scholar
  44. 44.
    Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg [Am] 56:1663–1674Google Scholar
  45. 45.
    Chan RC, Schweigel JF, Thompson GB (1983) Halo-thoracic brace immobilization in 188 patients with acute cervical spine injuries. J Neurosurg 58:508–515PubMedCrossRefGoogle Scholar
  46. 46.
    Cooper PR, Maravilla KR et al. (1979) Halo immobilization of cervical spine fractures. Indications and results. J Neurosurg 50:603–610PubMedCrossRefGoogle Scholar
  47. 47.
    Koch RA, Nickel VL (1978) The halo vest. Spine 3:103–107CrossRefGoogle Scholar
  48. 48.
    Kostuik JP (1981) Indications for the use of halo immobilization. Clin Orthop 154:46–50PubMedGoogle Scholar
  49. 49.
    Schweigel JF (1979) Halo-thoracic brace management of odontoid fractures. Spine 4:192–194PubMedCrossRefGoogle Scholar
  50. 50.
    Seljeskig EL (1978) Non-operative management of acute upper cervical injuries. Acta Neurochir (Wien) 41:87–100CrossRefGoogle Scholar
  51. 51.
    Zwerling MT, Riggins RS (1974) Use of the halo apparatus in acute injuries of the cervical spine. Surg Gynecol Obstet 138:189–193PubMedGoogle Scholar
  52. 52.
    Zimmerman E, Grant J et al. (1976) Treatment of Jefferson fracture with a halo apparatus. Report of two cases. J Neurosurg 44:372–375PubMedCrossRefGoogle Scholar
  53. 53.
    Garfin SR, Botte MJ et al. (1986) Complications in the use of the halo fixation device. J Bone Joint Surg [Am] 68:320–325Google Scholar
  54. 54.
    Goodman ML, Nelson PB (1987) Brain abscess complicating the use of a halo orthosis. Neurosurgery 20(1):27–30PubMedCrossRefGoogle Scholar
  55. 55.
    Humbyrd DE, Latimer FR et al. (1981) Brain abscess as a complication of halo traction. Spine 6:365–368PubMedCrossRefGoogle Scholar
  56. 56.
    Victor DI, Bresnan MJ, Kellar RB (1973) Brain abscess complicating the use of halo traction. J Bone Joint Surg [Am] 55:635–639Google Scholar
  57. 57.
    Botte MJ, Byrne T, Garfin SR (1987) Application of the halo cervical immobilizer utilizing an increased torque pressure. J Bone Joint Surg [Am] 69:750–753Google Scholar
  58. 58.
    Andriacchi TP, Schultz AB et al. (1974) A model for studies of mechanical interactions between the human spine and rib cage. J Biomech 7:497PubMedCrossRefGoogle Scholar
  59. 59.
    Markolf KL (1972) Deformation of the thoraco-lumbar intervertebral joints in response to external loads: a biomechanical study using autopsy material. J Bone Joint Surg [Am] 54:511–533Google Scholar
  60. 60.
    White AA, Hirsch C (1971) The significance of the vertebral posterior elements in the mechanics of the thoracic spine. Clin Orthop 81:2–14PubMedCrossRefGoogle Scholar
  61. 61.
    Dommisse GF (1974) The blood supply of the spinal cord. A critical vascular zone in spinal surgery. J Bone Joint Surg [Br] 56:225–235Google Scholar
  62. 62.
    Ferguson RL, Allen BL (1984) A mechanistic classification of thoraco-lumbar spine fractures. Clin Orthop 189:77–88PubMedGoogle Scholar
  63. 63.
    McAfee PC, Yuan HA et al. (1983) The value of computed tomography in thoraco-lumbar fractures: an analysis of 100 consecutive cases and a new classification. J Bone Joint Surg [Am] 65:461–473Google Scholar
  64. 64.
    Bohlman HH (1985) Current concepts review: treatment of fractures and dislocations of the thoracic and lumbar spine. J Bone Joint Surg [Am] 67:165–169Google Scholar
  65. 65.
    McAfee PC, Yuan HA, Lasda NA (1982) The unstable burst fracture. Spine 7:365–373PubMedCrossRefGoogle Scholar
  66. 66.
    McAfee PC, Bohlman HH, Yuan HA (1985) Anterior decompression of traumatic thoraco-lumbar fractures with incomplete neurological deficit using a retroperitoneal approach. J Bone Joint Surg [Am] 67:89–104Google Scholar
  67. 67.
    Kaneda K, Abumi K, Fujiya M (1984) Burst fractures with neurologic deficits of the thoracolumbar spine. Results of anterior decompression and stabilization with anterior instrumentation. Spine 9:788–795PubMedCrossRefGoogle Scholar
  68. 68.
    Kostuik JP (1984) Anterior fixation for fractures of the thoracic and lumbar spine with or without neurologic involvement. Clin Orthop 189:103PubMedGoogle Scholar
  69. 69.
    Edwards CC, Levine AM (1986) Early rod sleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am 17:122–145Google Scholar
  70. 70.
    Chance GQ (1948) Note on a type of flexion fracture of the spine. Br J Radiol 21:452–453PubMedCrossRefGoogle Scholar
  71. 71.
    Kaufer H, Hayes JT (1966) Lumbar fracture-dislocation - a study of twenty-one cases. J Bone Joint Surg [Am] 48:712–730Google Scholar
  72. 72.
    Morgan TH, Wharton GW, Austin GN (1970) The results of laminectomy in patients with incomplete spinal cord injuries. J Bone Joint Surg [Am] 52:822Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • S. Y. Lee

There are no affiliations available

Personalised recommendations