summary Subaxial Cervical Vertebral Body Fractures are a subset of cervical spine injuries that consist of compression fractures, burst fractures, flexion teardrop fractures, and extension teardrop avulsion fractures. Diagnosis is made with radiographs of the cervical spine. CT scan can be helpful for fracture characterization and surgical planning. Treatment can be nonoperative or surgical stabilization depending on fracture pattern, mechanical stability, and the presence of neurological deficits. Etiology Types compression fracture characterized by compressive failure of anterior vertebral body without disruption of posterior body cortex and without retropulsion into canal often associated with posterior ligamentous injury burst fracture characterized by fracture extension through posterior cortex with retropulsion into the spinal canal often associated with posterior ligamentous injury prognosis often associated with complete and incompete spinal cord injury treatment unstable and usually requires surgery flexion teardrop fracture characterized by anterior column failure in flexion/compression posterior portion of vertebra retropulsed posteriorly posterior column failure in tension larger anterior lip fragments may be called 'quadrangular fractures' prognosis associated with SCI treatment unstable and usually requires surgery extension teardrop avulsion fracture characterized by small fleck of bone is avulsed of anterior endplate usually occur at C2 must differentiate from a true teardrop fracture mechanism extension prognosis stable injury pattern and not associated with SCI treatment cervical collar 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 Presentation Symtoms incomplete vs. complete cord injury Imaging Must determine if there is a posterior ligamentous injury so MRI often important 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 early decompression (< 24 hours) has been shown to improve neurologic outcomes compared with delayed (>/ 24 hours) decompression posterior decompression, & fusion with instrumentation indications significant injury to posterior elements anterior decompression not required
QUESTIONS 1 of 3 1 2 3 Previous Next (SBQ18SP.12) A 22-year-old male arrives in the trauma bay 3 hours following a diving injury. He is conscious but endorsing severe neck pain. Secondary survey reveals no additional injuries besides the findings shown in Figures A and B. He is evaluated by the orthopaedic resident, who determines he is an ASIA C. Which of the following scenarios will result in the best chance of neurologic recovery? QID: 211234 FIGURES: A B Type & Select Correct Answer 1 Methylprednisolone bolus 30mg/kg over 15 minutes with maintenance infusion of 5.4 mg/kg per hour infused for 23 hours 3% (74/2261) 2 Delaying surgical decompression at least 5 days to avoid a "second hit" by operating in the acute inflammatory window 2% (37/2261) 3 Administration of methylprednisolone and urgent (< 24 hours) decompression 14% (317/2261) 4 Urgent surgical decompression (< 24 hours) 78% (1768/2261) 5 Observation in a hard collar and early mobilization 2% (51/2261) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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C7 Burst Fracture in 20M (C101838) Craig Forsthoefel Spine - Subaxial Cervical Vertebral Body Fractures C 10/31/2021 368 0 0