Spine Injuries

Dorn Spinal Therapy

Spine Healing Therapy

Get Instant Access

Fig. 22.9. llustration of the common types of flexion distraction injuries. These injuries are the result of flexion force vector acting around an anteriorly placed axis of rotation. This is seen when patients, while wearing seatbelts, as a result of the lower spine being fixed against the seat and the upper spine pivoting around an axis anterior to the spine, undergo a distraction injury to the middle and posterior spine elements. When only the osseous elements fail at a single vertebral body, this is classified as a type A injury, or commonly called a Chance fracture. Involvement of the ligaments at the intervertebral space is called a type B injury. In a type C injury, there is failure of the two bodies and it includes the bony middle column. In the type D injury, there is also failure of the two bodies but it includes the ligament structures.

Fig. 22.9. llustration of the common types of flexion distraction injuries. These injuries are the result of flexion force vector acting around an anteriorly placed axis of rotation. This is seen when patients, while wearing seatbelts, as a result of the lower spine being fixed against the seat and the upper spine pivoting around an axis anterior to the spine, undergo a distraction injury to the middle and posterior spine elements. When only the osseous elements fail at a single vertebral body, this is classified as a type A injury, or commonly called a Chance fracture. Involvement of the ligaments at the intervertebral space is called a type B injury. In a type C injury, there is failure of the two bodies and it includes the bony middle column. In the type D injury, there is also failure of the two bodies but it includes the ligament structures.

rotation, and extension, shear forces or tension, with a resulting displacement of one vertebral body with respect to the other (Fig. 22.10) [31]. These account for approximately 20% of all spinal injuries and are also associated with the highest incidence of spinal cord injury. Neurological deficits are seen in over 75% of fracture dislocations and approximately 50% of these are complete lesions [32].

The type A fracture-dislocation is due to a flexion-rotation injury and is seen usually the result of a fall or a motor vehicle accident. In CT with reconstructions, rotation of the superior and inferior vertebral bodies can be appreciated on the axial views. Also, disruption of the facets as well as narrowing of the canal can be seen.

The type B injury, which occurs as a result of shear vectors directed from the posterior to the anterior portion of the spine, results in anterolisthesis of the superior body and retrolis-thesis of the inferior body, although the opposite can also occur. These are unstable injuries, since they affect all three columns and spinal cord injury is frequently seen.

A third type of injury pattern, characterized by bilateral facet dislocation, is known as the type C injury. The flexion-distraction force injures the anterior column, disrupting the anterior annulus and stripping the anterior longitudinal ligament.

Fracture dislocations are uniformly unstable. This is the reason why most of these injuries necessitate surgical intervention. The surgical procedures performed for these injuries depend on the clinical status of the patient as well as the nature of the injury. Most of these injuries are treated with posterior fixation and fusion, as well as decompression, if needed. Some studies support non-surgical management, with the patient in bed rest for 6-10 weeks [33]. However, patients treated surgically can be mobilized more quickly and have a shorter hospital stay. The purpose of the operation is to realign the spine, repair dural tears if present and to decompress the spinal canal.

Complications, such as overdistraction, overcompression, inadvertent canal compromise due to instrumentation and loss of reduction,

Was this article helpful?

0 0
Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

Get My Free Ebook


Post a comment