Spine

and Fracture of Spine

 It has a uniquely shaped form that support
the axial musculature and protect the spinal
cord and nerve roots.
 Vertebrae has :
 Body, has articular cartilage on both
superior and inferior surface
 Arch, made up of pedicel and lamina
 Processes, spinosus as ligament attachment
side; and transverse as rib (T-spine) and
ligament attachment
 Foramina, vertebra (spinal cord / cauda
equina) and neural (nerve root).
 The vertebral column is consists of 33
vertebrae, which is :
◦ 7 cervical;
◦ 12 thoracic;
◦ 5 lumbal;
◦ 5 fused sacral;
◦ and 4 fused coccygeal
 The vertebral column has four distinct curves:
◦ Cervical lordosis
◦ Thoracic kyphosis
◦ Lumbal lordosis
◦ and sacral kyphosis

◦ The primary curves are those of kyphotic thoracic

and sacral region.
 Intervertebral disks are located between the
vertebral body of C2-C3 through L5-S1.
 The disks are located between the vertebral
end plates, covered with hyaline cartilage and
support by subcondral bone.
 The nucleus pulposus is the inner portion of
the disk is predominantly made of type II
collagen, act as cushion to axial loads.
 The anulus fibrosus ios the outer portion, is
multilayer of fibrocartilaginous structure and
predominantly made of type I collagen
1. Anterior longitudinal ligament
2. Posterior longitudinal ligament
3. Ligamentum flavum
4. Interspinous ligaments
5. Supraspinous ligament
6. Intertransverse ligaments
 Muscles of the vertebral column is divided in to :
 Posterior : -intrinsic (superficial, intermediate, deep
layers)
- extrinsic

 Anterior
 The arterial blood suplly of the spine is
predominantly from segmental vessels that
originate from the vertebral arteries, aorta
and iliac vessels.
 There are 31 pairs of spinal nerves :
◦ 8 cervical;
◦ 12 thoracic;
◦ 5 lumbal;
◦ 5 sacral and;
◦ 1 coccygeal

 The spinal cord is shorter than vertebral column, it

usually end at level L1 or L2, and continue more
distally in the cauda equina.
 The spinal cord has cervical and lumbal
enlargements because the nerves branch out
to the upper and lower extremity as brachial
plexus and lumbal plexus.
 The dorsal and ventral rootlets coalesce to
form the dorsal and ventral roots.The dorsal
root has the cell bodies of the entering
sensory neurons medial to its union with the
motor neurons of the ventral roots.
 The spinal cord is covered by three layers of
menings : duramater, arachnoid mater and
pia mater.
 There are approximately 11.000 new spinal cord
injuries that requiring treatment each year. The
ratio of male to female patients sustaining
vertebral fractures is 4 : 1
 In older patients (>75 % years of age ), 60 % cases
cause by a fall.
 For patients with a spinal cord injuries, the overall
mortality during the initial hospitalization is 17 %.
 Approximately 2% to 6% of trauma pateints is
sustain a cervical spine fracture. (handbook of fractures, 3rd edition)
 High-Speed Crash
 Unconscious patient

 Multiple injuries

 Neurologic deficit

 Spinal pain / tenderness

 ≥ 5% of Patients worsen neurologically at
hospital
 Protection — priority; detection— secondary

 Spinal evaluation complicated by brain

injury
 Remove spine board as soon as possible
 Complete : No motor or sensory
function↓ below injury level
 Incomplete :

•Any motor or sensory preservation ↓

injury level
•Sacral sparing may be only residual
function
 Cervical Thoracic Lumbosacral
C-5 Deltoid T-4 Nipple L-4 Medial Leg
C-6 Thumb T-8 Xiphoid L-5 1st/2nd toes
C-7 Middle T-10 Umbilicus S-1 Lateral foot
finger T-12 S-4 Perianal
C-8 Little finger Symphysis
 Cervical / Thoracic Lumbosacral
C-5 Shoulder abduction L-2 Hip flexion
C-6 Wrist Extension L-3 Knee extension
C-7 Elbow extension L-4 Ankle dorsiflexion
C-8 Middle finger flexion L-5 Big toe extension
T-1 Little finger S-1 Big toe / ankle
abduction plantar flexion
 The Spinal injuries can be divided into several
categories based upon their biomechanical
and anatomy caharasteristic and the patient’s
neurogical status.
 Type of spinal injuries are :
◦ Comression fractures
◦ Burst fracture
◦ Distraction-flexion injury
◦ Fracture dislocation
◦ Distraction-extension injury
 The three column theory of spinal instability
by Denis is commonly used to define
vertebral column injury
 Adequacy
 Alignment
 Bony abnormality
 Base of skull
 Cartilage , Contours
 Disc space
 Soft tissue
 Ensure adequate ventilation
especially for high level (c-4)
quardriplegic
 Maintain blood pressure

 Atropine as needed for

bradycardia
 Methylprednisolone
Intravenous Fluids
 Treat hypovolemia first

 Consider neurogenic shock

 Insert urinary catheter

Steroids
 IV Methylprednisolone
 Proven spinal cord injury
 Stars within 1 st 8 hours from injury only
 30 mg/kg over 15 minutes
 5.4 mg/kg over next 23 hours
Proven in blunt trauma only
Transfer
 Unstable fractures

 Neurologic deficit

Avoid delay
 Properly Immobilized

 Respiratory support as needed