Spine injuries

Cervical Spine

In a classic Jefferson fracture, the transverse ligament is intact and no instability is present and because displacement of the bony fragments occurs in a centripetal pattern during axial loading, cord damage is uncommon. In one large series, no patient presented with neurologic symptoms.

Extension teardrop

This fracture is an avulsion fracture that arises from the anteroinferior corner of the vertebral body caused by a hyperextension injury. Retrolisthesis is often present but of minimal degree and only about 9% of patients present with neurologic symptoms.

Hangman

Bilateral fracture of the C2 pars interarticularis typically results from hyperextension. Death from judicial hanging resulted from delayed extension/distraction. Most cases today are secondary to motor vehicle accidents with transient hyperextension and no distraction. There is usually anterior subluxation of C2 on C3. Although unstable by nature, neurologic deficits are uncommon. Without significant distraction, the cord is typically spared because the acquired pars fracture allows for canal widening at a level where the cord already has abundant room.

Flexion teardrop

The flexion teardrop fracture is the most severe flexion injury characterized by complete disruption of all ligaments, intervertebral disc and facet joints at the level of injury and a large triangular fracture fragment consisting of the anterior, inferior aspect of the involved vertebral body. There is neither ligamentous or skeletal stability. This completely unstable fracture is associated with severe neurologic symptoms in 87% of patients including complete quadriplegia, paraplegia, Brown-Sequard syndrome, or anterior cord syndrome. It is caused by combined flexion and axial loading and classically affects C5.

Dens fracture

Clay-shoveler fractures are fractures of the spinous process of a lower cervical vertebra (usually C7), and are usually a stress fracture.

Scoliosis

abnormal curvature of the spine when viewed in the coronal plane

also generally associated with a rotational deformity

Causes:

idiopathic --  infantile, juvenile, adolescent and adult according to age of onset

Dx

Forward bending, or the Adams test, is the best way to screen

Radiographs - gold standard