SPINE TRAUMA

3 Column Theory
3 Column Theory
• Denis three column system clinical relevance
• only moderately reliable in determining clinical degree of stability
• definitions
• anterior column
• anterior longitudinal ligament (ALL)
• anterior 2/3 of vertebral body and annulus
• middle column
• posterior longitudinal ligament (PLL)
• posterior 1/3 of vertebral body and annulus
• posterior column
• pedicles
• facets
• ligamentum flavum
• spinous process
• posterior ligament complex (PLC)
• instability defined by
• injury to middle column
• as evidenced by widening of interpedicular distance on AP radiograph
• loss of height of posterior cortex of vertebral body
• disruption of posterior ligament complex combined with anterior and middle column involvement
Let’s start
Cervical Spine Trauma Evaluation
• All trauma patients have a cervical spine injury until proven otherwise
• Cervical spine clearance defined as confirming the absence of cervical spine injury
• important to clear cervical spine and remove collar in an efficient manner
• delayed clearance associated with increased complication rate

• cervical clearance can be performed with

• physical exam
• radiographically
• Missed cervical spine injuries
• may lead to permanent disability
• careful clinical and radiographic evaluation is paramount
• high rate of missed cervical spine injuries due to
• inadequate imaging of affected level
• loss of consciousness
• multisystem trauma
• cervical spine injury necessitates careful examination of entire spine
• noncontiguous spinal column injuries reported in 10-15% of patients
History
• Details of accident
• energy of accident
• higher level of concern when there is a history of high energy trauma as indicated by
• MVA at > 35 MPH
• fall from > 10 feet
• closed head injuries
• neurologic deficits referable to cervical spine
• pelvis and extremity fractures
• mechanism of accident
• e.g., elderly person falls and hits forehead (hyperextension injury)
• e.g., patient rear-ended at high speed (hyperextension injury)
• condition of patient at scene of accident
• general condition
• degree of consciousness
• presence or absence of neurologic deficits
• Identify associated conditions and comorbidities
• ankylosing spondylitis (AS)
• diffuse idiopathic skeletal hyperostosis (DISH)
• previous cervical spine fusion (congenital or acquired)