5 types
Types of spinal fractures
Compression (wedge) fracture
Axial bust fracture
Flexion/distraction (chance) fracture
Transverse process fracture
Fracture-dislocation fracture
When is a fracture stable?
Only the anterior column (not middle or posterior are affected)
Where is most common for spinal fractures to occur?
50% occur between T11 and L2
Where ridgid thoracic spine meets more flexible lumbar spine
How can a stable fracture be conservitively managed?
minimum 6-12 weeks bracing with gradual increase in activity
Compression (wedge) fracture
- Anterior fractures and loses height
- Middle and posterior columns typically unaffected
- Typically stable and therefore not associated with SCI
- Usually mid-thoracic or thoracolumbar spine
- Most often in patients with bones weakened by disease (e.g. osteoporosis, bone cancer)
Axial bust fracture
- Vertebral body fracture with fragments in all directions (as vertebra is crushed)
- Can be from landing on feet from high fall
- Unstable and usually not suitable for conservative management
- Can cause SCI
Flexion distraction (chance) fracture
- Vertebra pulled apart
- Can occur from head-on car collision (pelvis stabilised while trunk flung forward)
- Unstable but excellent healing potential
- Commonly L1-3
Transverse process fracture
- From extreme lateral bending
- Only transverse process affected so does not usually affect stability
- Treatment gradual increase in movement ± bracing
Fracture-dislocation fracture
- Vertebra moves off adjacent vertebra
- Most unstable spinal fracture
- Highest risk of SCI and neurological impairment
- Typically from major trauma across the back
Spondylolisthesis
- Vertebra body slips forward from the one below it
- Different types dependant on cause (pathological, congenital, etc)
5 grades
Grades of spondylolisthesis
1: < 25% slip
2: 25-50% slip
3: 50-75% slip
4: > 75% slip
5: 100% slip
Osteoporosis
- Progressive disease where bone density and quality educes
- ↓ bone matrix and minerals (calcium and phosphate)]
- Remodelling = bone reabsorption and osteoid formation
- In osteoporosis bone resorption < formation
What population is most at risk of osteoporosis?
Post menopausal women
(35%F, 20%M > 50 will have a fracture due to osteoporosis)
What bones do osteoporotic fractures most commonly occur in?
- Hip
- Wrist
- Spine
Spondylosis
- Arthritis of the spine
- Degenerative process affecting vertebral disc and facet joints
- Facet joints enlarge → bone spur formation
- Can cause spinal canal to narrow (possible compression of spinal cord)
- Chronic compression of spinal cord can result in numbness, weakness, pain, difficulty walking
Low back pain
- Most common location of chronic pain
- 80% will have back pain at some point, 85% will recur
- LBP is a symptom not a disease
- Usually resolves on its own with gental exercise
- Lumbar disc herniation is common cause of LBP in adults
Who is most at risk of a prolapsed intervertebral disc?
Men (3x more common than in women)
Where do most prolapsed discs occur?
95% at L4/5 or L5/S1
4 stages
Stages of disc prolapse
- Disc degeneration
* Nucleus pulposus dries with age
* Symptoms: back pain only - Prolapse
* bulge begins to form (may press on spinal cord or column)
* Symptoms: back pain and leg pain - Extrusion
* Nucleus pulposus breaks form annulus fibrosus
* Symptoms: back pain, leg pain. neuro findings - Sequestration
* nucleus populsus breaks into spinal canal
* mainly leg pain
Sciatica
- Symptom not a pathology
- Pain, weakness, or tingling through lower back, buttock and leg
- Compression of 1 or more nerve root L4-S3
- May be symptom of: herniated disc, spinal stenosis,spondylolisthesis, traums
Spinal stenosis
- Narrowing of the spinal canal
- Often due to degeneration of the facet joints and bone spur growth
- Severity dependant on size of spinal canal and degree of nerve encroachment
- May present without any symptoms
Pectus carinatum
Pigeon chest
- Breast bone is pushed out and more pronounced
- Other areas of the ribs may be depressed
- Symmetrical or asymmetrical presentation
- Unknown cause (may be genetic, some association with connective tissue disorders)
- Treated with compression brace 23 hrs/day for up to 2 years
- Improvement usually seen within a few months
What tests are used in scoliosis?
Cobb angle
Adams forward bend test
Risser sign (or wrist x-ray)
vertebral rotation
Types of scoliosis
- Congenital
- Neuromuscular
- Idiopathic
- Infantile (<3)
- Juvinile (4-10)
- Adolecent (10-16)
