Introduction to Spine Injuries

Dr Yuhin Asadulhaq Bin Yusoff

Anatomy of the Spine
7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae
5 fused sacral vertebrae
3-4 small bones forming the coccyx

Cervical lordosis
Thoracic kyphosis
Lumbar lordosis

Allow flexion, extension, side bend and

rotation
Structure of Vertebrae
 Intervertebral disc is a joint between two consecutive vertebral body
and acts as shock absorber
Facet joints form intervertebral foramen through which pass the nerve
roots
 Anterior logitudinal ligament
Posterior logitudinal ligament
Ligamentum flavum
Interspinous ligament
Spinal Cord and Vertebrae
Mechanisms of Injury
Compression Extension
Vertebral body fracture Tearing of anterior longitudinal
ligament
Disc herniation
Epidural haematoma
Separation of vertebral bodies

Displacement of posterior wall of

Rupture of intervertebral disc
the vertebral body Avulsion of upper vertebral body
from disc
Flexion
Tearing of interspinous ligaments
Rotational
Disruption of capsular ligaments Associated with unilateral facet
around facet joints dislocation
Fracture of posterior elements
Disruption of posterior ligaments
Often unstable fracture
 7 cervical vertebrae
C1 (atlas) is a ring which articulates
with the occiput
C1 has no vertebral body and spinous
process
C2 (axis) so named because it is the
pivot on which the atlas turns to
rotate the head
Atlas has dens which articulates with
C1
Complete spinal cord injuries above C4
seldom survive as diphragmatic
function (innervated by C3-C5) is lost
Cervical Spine X-ray Evaluation

Need to see all 7 vertebrae including top of C1

Check the anterior alignment of the vertebral bodies
Check the posterior alignment of the vertebral bodies
Check the width of the spinal canal (between spinolaminar
line and posterior vertebral lines)
Check the alignment of the spinolaminar line
Check the first 3 points of the spinolaminar line for
straightness
Check the spinous processes for fracture
Check for soft tissue swelling
 Fracture of the atlas/C1 (Jefferson fracture)
Commonly fractured in four places
Axial loading
Usually stable and spinal cord damage is uncommon
Treatment with collar is usually adequate
Best seen on open mouth x-ray

Fracture of the axis/C2

Hangmans fracture
Hyperextension of the neck
Dens fracture
C2/C3 traumatic spondylolisthesis
Less severe forms can be treated conservatively while more
severe forms require discectomy and fusion

Subaxial injuries (C3-C7)

Assessing Stability: Denis Three Column Model

Anterior column
Formed by the anterior longitudinal ligament, the anterior annulus and the anterior
portion of vertebral body
Middle column
Formed by the posterior longitudinal ligament, the posterior annulus and the anterior
portion of vertebral body
Posterior column
Includes the pedicles, facet joints, spinous processes, neural arch and interconnecting
ligaments
Chance fracture: failure of all 3 columns
Compression fracture
Stable
Failure of anterior column without middle column
injury

Burst fracture
Unstable
Failure of both anterior column and middle column
Often a boney fragment projecting into spinal canal
Indications for Spine Surgery
Neurologic deterioration
Unstable fracture
Epidural haematomna
Spinal canal stenosis

Goals of Spine Surgery

Decompression of spinal canal
Stabilization of spine