| Introduction |
 High risk of SCI- Fracture patterns include
- compression fracture
- compressive failure of anterior vertebral body without disruption of posterior body cortex and without retropulsion into canal
- look carefully for signs of posterior ligament injury
- burst fracture
- fracture extension through posterior cortex with retropulsion into the spinal canal
- look carefully for signs of posterior ligament injury
- often associated with complete and incompete spinal cord injury
- flexion teardrop fracture
- characterized by fracture of anterior inferior portion of vertebra
- poserior-inferior corner of body breaks off and is retropulsed posteriorly
- often associated with posterior ligamentous injury
- associated with SCI
- unstable and usually requires surgery
- extension teardrop avulsion fracture
- must differentiate from a true teardrop fracture
- caused by mild extension injury
- small fleck of bone is avulsed of anterior endplate
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| Subaxial Spine Injury Classification |
- Allen and Ferguson classification (of subaxial spine injuries)
- typically used for research and not in clinical setting
- based solely on static radiographs appearance and mechanisms of injury
- six groups represent a spectrum of anatomic disruption and include
- flexion-compression
- vertical compression
- flexion-distraction
- extension-compression
- extension-distraction
- lateral flexion
- Radiographic description classification (of subaxial spine injuries)
- more commonly used in clinical setting
- includes
- compression fracture
- burst fraction
- flexion-distraction injury
- facet dislocation (unilateral or bilateral)
- facet fracture
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| Presentation |
- Symtoms
- incomplete vs. complete cord injury
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| Imaging |
- Must determine if there is a posterior ligamentous injury so MRI often important
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| Treatment |
- Nonoperative
- collar immobilization for 6 to 12 weeks
- indications
- stable mild compression fractures (intact posterior ligaments & no significant kyphosis)
- anterior teardrop avulsion fracture
- external halo immobilization
- indications
- only if stable fracture pattern (intact posterior ligaments & no significant kyphosis)
- Operative
- anterior decompression, corpectomy, strut graft, & fusion with instrumentation
- indications
- compression fracture with 11 degrees of angulation or 25% loss of vertebral body height
- unstable burst fracture with cord compression
- unstable tear-drop fracture with cord compression
- minimal injury to posterior elements
- posterior decompression, & fusion with instrumentation
- indications
- significant injury to posterior elements
- anterior decompression not required
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