Dr. Ebraheim’s educational animated illustrates spine concepts associated the cervical spine - trauma. Transverse ligament: - It provides the C1-C2 stability - It is behind the odontoid and it anchors the odontoid to the ring of C1 so it prevents an abnormal movement between C1 and C2. - A.D.I. in adults is 3.5 mm. - Of the transverse ligament is injured, C1 and C2 will be free to move & there will be an increase in the A.D.I. - Isolated traumatic injury to the transverse ligament is probably rare. - Jefferson fracture Three types: - Type II: fracture at the base of the odontoid process, most common, troublesome fracture. - Nonunion rate is 20-80% due to interruption of the blood supply. - High nonunion rate in: - More than 5 mm of displacement. - Patients older than 50 years of age. - Other risk factors: - Delay in treatment - Posterior displacement of the fracture - Diabetes - Do not use halo in early patients, risk of death from pneumonia - Treatment of young patients: • Halo: halo traction may be needed initially to reduce fracture, halo for up to 3 months, 30% non-union rate in halo. • When do you do surgery? Displaced fracture in older patients, risk factors for no-union. • Odontoid screw is preferred in the young patient. • Need to preserve C1-C2 motion. • Do not do fusion in young patients. • Can use C1- C2 fusion in older patients. • For older patients: - Orthosis or Fusion of C1- C2 if there is an indication for surgery and if there is a clearance for surgery. Type III: - Fracture through the body of C2. - Treatment: • Cervical orthosis • Halo: if displaced • Hangman’s fracture is a bilateral fracture of the pars interarticularis • The spinal canal is wider and there will be a low risk for spinal cord injury. Levine and Edwards classification: - Type I: stable fracture with less than 3 mm displacement, no angulation, treatment: cervical orthosis. - Type II: most common type, significant translation and some angulation, unstable fracture, treatment: cervical traction and extension to improve the displacement, immobilization in halo vest for about 3 months. - Type IIa: severe angulation and slight translation seen in flexion distraction injuries with tearing of the posterior longitudinal ligament, the fracture is unstable, treatment: do not use traction when there is severe angulation of the fracture. - Type III: surgical type, C2-C3 facet dislocation, rare fracture of the pedicles in addition to the anterior facet dislocation, it has some neurological deficit association, treatment: surgery for reduction of the facet dislocation and stabilization of the injury, open reduction and posterior spine fusion. • Facet dislocations: the association of disk herniation and facet involvement is very high, so watch out for a herniated disc in addition to the bony injury. - Unilateral facet dislocation will usually have less than 50% translation on x-ray and it may affect a nerve root. - Bilateral facet dislocation will have more than 50% translation and probably a spinal cord injury. - Treatment: immediate closed reduction, get an MRI, then do surgery, if the patient has a change in mental status, then get the MRI first, and immediately followed by open reduction and surgical fixation. - When do you go anteriorly? - Go anteriorly if there is a disc herniation, incidence is about 10%-30% in cervical facet dislocation. - If you try to do reduction, the disc fragment may stay in the canal causing spinal cord injury. - When do you do posterior? - If reduction of the dislocation failed and there was no disc herniation. - When do you combined anterior and posterior procedures? - Need to go anteriorly to remove the disc - Need to go posteriorly because the dislocation cannot be reduced by a closed method or by an open anterior technique. • Important points: 1- Get the MRI before surgery: make sure there is not a disc herniation. 2- Ligament injuries do not heal: will need fusion surgery. 3- Know the arrangement of the facets: superior and inferior facets in normal, subluxed, and dislocated positions. Know the “naked facet” or the “empty facet”. Train yourself to know this, especially for exam questions. Naked Facet. Cervical Spine MRI Facet Fracture Ligamentous Injury OF THE Cervical Spine Burst Fracture of Lower Cervical Spine Tear Drop Fracture Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundation/home/Give_Online.aspx?sig=29
Watch the latest Video, moderated by Alexander Vaccaro, MD. The AOSpine Knowledge Forum Trauma was given the task to develop and validate a new classification system. The AOSpine Thoracolumbar and Subaxial Classification systems are the result of a systematic assessment and revision of the Magerl classification. The AOSpine Classification Group reached a consensus on a classification that incorporates both fracture morphology and clinical factors relevant for clinical decision making. After the endorsement of the classification by the International Board, the Knowledge Forum Trauma finalized the validation studies.
Dr. Ebraheim’s educational animated video describes Hangman's fractures. Hangman's Fracture is a bilateral fracture of the pars interarticularis. The spinal canal is widened and there is a low risk for spinal cord injury. The fracture usually occurs more due to motor vehicle accidents. Anatomy •Spinous process •Body •Axis •Pars interarticularis Mechanism of injury Hyperextension will fracture the pars interarticularis with secondary flexion injury the disc and posterior ligament. The patient may have other associated spine fractures (up to 30%). Levine and Edwards classification Type I •Stable fracture with less than 3 mm displacement •No angulation •Treatment: cervical orthosis Type II •Most common type •Significant translation and some angulation •Unstable fracture •Treatment: cervical traction to improve the displacement and immobilization in halo vest. Typer IIa •Slight translation but severe angulation seen in flexion-distraction injuries with tearing of the posterior longitudinal ligament and the disc. The fracture is unstable. •Treatment: reduction in extension and compression in a Halo. Do not use traction when there is severe angulation of the fracture. Type III C2-C3 facet dislocation •Rare fracture that results from initial anterior facet dislocation of C2 on C3 followed by extension injury fracturing the neural arch. Results in translation with unilateral or bilateral facet dislocation of C2-C3 unstable fracture. •Treatment : Surgery for reduction of the facet dislocation and stabilization of the injury Typical and atypical fractures •A typical hangman’s fracture displaces the vertebral body anteriorly and its posterior element posteriorly. This creates increased space for the spinal cord. •An atypical hangman’s fracture line leaves the canal circumferentially intact, which puts the spinal cord at risk of injury if displacement occurs. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
In this episode of eOrthopodTV, Orthopaedic Surgeon Randale C. Sechrest, MD narrates this animated video describing the basics of the anatomy of the cervical spine.
This video “Spinal Trauma: Cervical Trauma Protocol, Common Spinal Fractures” is part of the Lecturio course “Radiology” ► WATCH the complete course on http://lectur.io/spinaltrauma ► LEARN ABOUT: - Cervical trauma protocol - Common mechanism of spine trauma - Common spinal fractures - Burst fracture - Chance fracture - Jefferson fracture - Hangman's fracture ► THE PROF: Hetal Verma has extensive experience practicing in the field of radiology. She is currently a Clinical Instructor at Harvard Medical School. Hetal has been in practice for over 10 years and has been teaching medical students and residents throughout that time. She has also been invited as a speaker at multiple teaching conferences for other physicians, technologists and the community. ► LECTURIO is your single-point resource for medical school: Study for your classes, USMLE Step 1, USMLE Step 2, MCAT or MBBS with video lectures by world-class professors, recall & USMLE-style questions and textbook articles. Create your free account now: http://lectur.io/spinaltrauma ► INSTALL our free Lecturio app iTunes Store: https://app.adjust.com/z21zrf Play Store: https://app.adjust.com/b01fak ► READ TEXTBOOK ARTICLES related to this video: http://lectur.io/spinaltraumamagazine ► SUBSCRIBE to our YouTube channel: http://lectur.io/subscribe ► WATCH MORE ON YOUTUBE: http://lectur.io/playlists ► LET’S CONNECT: • Facebook: https://www.facebook.com/lecturio.medical.education.videos • Instagram: https://www.instagram.com/lecturio_medical_videos • Twitter: https://twitter.com/LecturioMed
Dr. Ebraheim’s educational animated video describes the condition of tear drop fracture. Cervical spine. 1-Flexion tear drop fracture: interspinous ligament tear. Most severe unstable fracture of the cervical spine. Typically occurs from flexion and compression. 2-Extension teardrop fracture: usually occurs at C2. Disruption of the anterior longitudinal ligament. Stable avulsion fracture from attachment of the anterior longitudinal ligament to the inferior corner of the vertebral body. Both fractures involve the anterior-inferior aspect of the vertebral body. Flexion teardrop fractures typically affect C5-C6 extension tear drop usually occurs at C2. Flexion teardrop fractures are severe flexion injuries of the cervical spine along with axial loading (compression). This injury may occur for example in diving headfirst into shallow water. A flexion teardrop fracture is usually associated with spinal cord injury. There will be displacement of the posterior part of the vertebral body into the spinal canal. Separation of the spinous process will be seen due to disruption of the posterior ligaments. The fracture is unstable and will require surgery. A flexion teardrop fracture is best seen in the lateral view x-ray. Extension teardrop fractures are stable fractures with no widening of the posterior elements or no posterior vertebral body displacement. No spinal cord injury. Surgery is not needed. This fracture occurs due to sudden pull of the anterior longitudinal ligament on the anterior inferior aspect of the vertebral body. Extension tear drop fractures occur in extreme hyperextension of the neck and usually involve C2. The fracture is usually seen on lateral view x-rays. The rest of the vertebrae architecture will be normal except for some prevertebral soft tissue swelling. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step
Cervical Spine Trauma Author: Robyn Kalke, MSK Fellow; Adnan Sheikh, MSK Radiologist; Kwan Rakhra, MSK Radiologist
Dr. Ebraheim’s educational animated video describes the Anatomy of the Cervical Spine. C1 is a ring. At the upper cervical region, the spinal canal is 2.5 times larger than the cord size. 50% flexion-extension is between occiput & C1. 50% of neck rotation is between C1 and C2. C5-C6 is more prone to disc degeneration due to anatomical and mechanical forces centered at this level. There are 8 cervical nerve roots. These nerves exit on or above each vertebra C8 exits above T1. Disc prolapse occurs due to rupture of the annulus fibrosus and protrusion of the nucleus pulposus which compresses the nerve root. The most common type of disc prolapse is posterolateral disc prolapse. C2 ganglion may be vulnerable to compression/entrapments due to: •Cervical arthritis causing repeated mechanical damage or compression •Post traumatic hyperextension injuries (whiplash injury) •C2 Ganglion entrapment/ compression causes cervicogenic headache The incidence of vertebral artery increases if the fracture extends into the foramen transversum. This may manifest as impaired consciousness, drowsiness, syncope, ataxia, brain-stem and cerebellar ischemia/infarction, dysarthia, headache, vertigo, visual impairment, and ptosis. Bilateral or dominant vertebral artery injury can cause fatal ischemic damage to the brain stem and cerebellum. Delayed cortical blindness and recurrent quadriparesis can also occur from occult vertebral artery injury after cervical trauma. The great majority of vertebral artery injuries are clinically silent. The majority of patients with vertebral artery injuries had flexion-distraction or flexion-compression types of spinal injuries. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC