VERTEBRAE FRACTURE

MAULANA SAPUTRA
WIRASASMITA PARIPIH
MAULIDA ANGRAINI

INTRODUCTION
Incidence 30-40/ 1,000,000 person
The mortality rate 40-50%
Most common in the thoracolumbal
region 64%
The peak incidence in the young age
group (15-25 year-old)
Motor vehicle accidents acounts for
50% followed by falls (25%), athletic
accidents (15%), and penetraing
injuries (10%)

The Vertebral Column

> central bony pillar of the body
> provides a base of support for the
head and internal organs; a stable
base for the attachments of
ligaments, bones, and muscles of the
UE, rib cage, pelvis,
> a link between the UE and LE
> protects the spinal cord

Structure
33 short bones
called vertebrae
and 23 IV disks
5 regions
> cervical (7)
> thoracic ( 12)
> lumbar ( 5)
> sacral ( 5)
> coccygeal ( 4)

Primary and Seconday

Curves
Primary curves ( thoracic and sacral)
posterior convexity, anterior
concavity
( kyphotic curves)
Secondary curves (cervical and lumbar)
posterior concavity, anterior
convexity
( lordotic curves)

General characteristics of
vertebra

7 processes
4 articular and 3 nonarticular
NONARTICULAR
A. (1) spinous process or spine (directed
posteriorly )
B. (2) transverse processes ( directed
laterally)
> arise from the junction of pedicles and
laminae
> serves as levers
> receives attachments of muscles and
ligaments

7 processes

ARTICULAR ( vertically arranged)

A. (2) superior articular
B. (2) inferior articular
2 superior articular processes of one arch
articulate with the 2 inferior articular
processes of the arch above forming two
synovial joints
IV foramen formed by superior notch of
one vertebra and inferior notch of an
adjacent vertebra; transmits the spinal
nerves and blood vessels

Characteristics of a typical
cervical vertebra
Transverse processes has a foramen
transversarium for passage of vertebral
artery and veins
Spines are small and bifid
Body is small and broad from side to side
Vertebral foramen is large and triangular
Superior articular processes have facets that
face backward and upward; inferior have
facets that face downward and forward

Typical cervical vertebra

Characteristics of the atypical

cervical vertebrae
( C1, C2, and C7)

C1 atlas ( supports the globe of the

head)
> s body and spinous process
> has anterior and posterior arch
> has a lateral mass on each side with
articular surfaces on its upper surface
for articulation with the occipital
condyles(atlanto-occipital joints)

Characteristics of the atypical

cervical vertebrae
( C1, C2, and C7).
C2 axis ( epistropheus)
> has peglike odontoid process
C7 (vertebra prominens)
> has the longest spinous process and
not bifid
> transverse process is large
> foramen transversarium is small and
transmits the vertebral vein or veins.

Atypical vertebrae

Characteristics of a Typical
Thoracic Vertebra

Body is medium size and heart shaped

Vertebral foramen is small and circular
Spines are long and inclined downward
Costal facets are present on the sides of
the bodies for articulation with the head of
the ribs
Costal facets are present on the
transverse processes for articulation with
the tubercles of the ribs( T11 and 12 have
no facets on the transverse processes)
Superior articular processes facets
backward and laterally
Inferior articular processes facets
forward and medially

Typical thoracic vertebra

Characteristics of a Typical
Lumbar Vertebra

Body is large and kidney shaped

Pedicles are strong and directed backward
Laminae are thick
Vertebral foramina are triangular
Transverse processes are long and slender
Spinous processes are short, flat, and
quadrangular and project backward
Articular surfaces of the superior articular
process face medially
Inferior articular processes face laterally

comparison

Sacrum
5 vertebrae fused together to form
wedge-shaped bone
Concave anteriorly
Upper border articulates with L5
Inferior border articulates with
coccyx
Lateral border articulates with 2 iliac
bones ( sacroiliac joints)

Structure and Function of the IV Disk

The Annulus Fibrosus

fibrocartilage and collagen
provides tensile strength
restrain various spinal motion
fibers of the inner layer blend with the
nucleus pulposus
firmly attached to the adjacent vertebra
and to one another
Supported by ligaments

Structure and Function of the IV Disk

The Nucleus Pulposus
gelatinous mass with loosely aligned fibers.
high concentration of proteoglycans
Fluid Mechanics In the Spine
evenly distribute pressure
transport for nutrients
normally: NP does not move in a healthy disk

The Cartilaginous End-Plates

encircled by the apophyseal ring of the
respective vertebral body
nutrition diffuses from marros of the vertebral
bodies to the disk via the endplates

Ligaments

Intervertebral disk

OTHER FACTORS THAT INFLUENCE

MOVEMENT
Slant and Shape of Spinous Process
Relative size of IV and Body
Ribs in the thoracic Region
Muscles

Spinal Column Injury

Atlanto-occipital dislocation

Powers ratio=BC/OA<

Atlanto-occipital
dislocation (AOD) is
a devastating
condition that
frequently results in
prehospital
cardiorespiratory
arrest
accounts for 1% of
spinal trauma.
AOD occurs 3 times
more commonly in
children than adults,
hyperextension.
Unstable

Spinal Column Injury

Atlanto-Axial dislocation
Lower mortality than
Atlanto-occipital
dislocation
1/3 of patients have
deficit
Transverse ligament
injury
AAD occurs more
commonly in children
than adults
Non-traumatic in downs
syndrome and
Rheumatoid arthritis
Unstable

ADI> 5mm

Spinal Column Injury

Atlas (C1) fractures
Described as Jefferson
#
Axial load
Usually no neurological
deficit
1/3 have C2 #
Usually stable

Spinal Column Injury

Axis (C2) #
Includes Hangmans #
and Odontoid process
#

HANGMANS #
Bilateral # of the
isthmus of the pedicles
of C2 with anterior
sublaxation of C2-C3
Hyperextention and
axial loading
Usually stable

Spinal Column Injury

Axis (C2) #
Includes
Hangmans # and
Odontoid process
#
Odontoid #
Flexion injury
15% of all cervical
injuries
II unstable,I & III
stable

II

III

Spinal Column Injury

Subaxial (C3-C7) #
Whiplash injury:
Traumatic injury to the
soft tissue in the
cervical region
Hyperflexion,
hyperextention
No fractures or
dislocations
Most common
automobile injury
Recover 3-6 months

Spinal Column Injury

Subaxial (C3-C7) #
Vertical compression
injury:
Loss of normal cervical
lordosis
Burst #
Compression of spinal
cord
Unstable
Requires
decompression and
fusion

Spinal Column Injury

Subaxial (C3-C7) #
Compression flexion
injury (teardrop #)
Classical diving injury
Posterior elements
involved in >50%
Displacement of
inferior margin of the
body
Unstable
Requires stabilization

Spinal Column Injury

Subaxial (C3-C7) #
flexion distraction
injury (locked
facet)
>50% displacement
Unstable
Requires reduction
and stabilization

Spinal Column Injury

Subaxial (C3-C7) #
extention injury (#
posterior elements)
# lamina, pedicles or
spinous process
With or without
ligamentous injury
Usually stable

Spinal Column Injury

Thoracic and lumbar #
Stability (three
column model of
Denis)
Injury affecting two or
more column is
unstable

Spinal Column Injury

Thoracic and lumbar #
Compression #
Burst #
Chance # (seat
belt)
Flexion distraction
Fracture dislocation

General Management
Guidelines

Strict spine precautions (immobilization)

Emergency resuscitation (ABC..)
Comprehensive approach
Neurological and Radiological assesment.
Always expect multiple trauma
(neuroexam, chest,
abdomin,muskuloskeletal)
Differentiate hggic from neurogenic
shock

General Management
Guidelines
External vs Internal
stabilization