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Spine Fractures

Practical Management of Spinal Fractures

Andrew Lee

on 22 September 2016

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Transcript of Spine Fractures

Odontoid Fractures
Geriatric Odontoid Fractures
Poor union rate
High morbidity/mortality
Immobility is lethal
Treatment of Odontoid Fractures
Often not well tolerated by elderly patients
Some studies demonstrate high mortality rate in elderly in halo.
Union rate of fracture may not be superior to collar alone
Halo-thoracic Brace
Treatment of
Spine Fractures

Cervical Facet Fracture
Cervical Spine Facet Fracture
Fracture, subluxation, dislocation
Unilateral or bilateral
Disc disruption?
Treatment of Cervical Spine Fractures
56 years old woman
Tripped over a coffee table at home
Bilateral arm weakness, neck pain
Bilateral Facet Dislocation
Treatment of Cervical Facet Fracture
Tolerate brace?
Needs Decompression?
Vertebral Compression Fractures
Vertebral Compression Fractures
Anterior Column
Generally Stable
Usually heal with conservative management
Persisting pain after 4-6 months
Progressive kyphosis
Decreased bone density on testing
57 years old woman
Fall onto buttocks from standing
Back pain
Cement Vertebroplasty/Kyphoplasty
Methylmethacrylate injection into vertebral body
Improves hardness/stability
Thoracolumbar Fractures
Cement Kyphoplasty
Thoracolumbar Spine Fractures
Burst Fracture
Axial Load
Chance Fracture
Balloon Kyphoplasty
Cervical Spine Fractures
Young man. MVA
Some ankle weakness, numbness
Burst Fracture
Pedicle Screw Fixation
Chance Fracture
Young woman, MVA
Initial surgical procedure, nonunion
Revision surgery
3-Column Concept Spinal Stability
Odontoid Fractures
More rapid mobilization
Surgical risks vs. Immobility
Loss of ROM with posterior approach
Surgical Fixation
Spinal Stability
"The ability of the spine under physiologic loads to limit the pattern of dispalcement so as not to damage or irritate the spinal cord or nerve roots and, in addition, to prevent incapacitating deformity or pain caused by structural change" - Panjabi and White
The End
Dr. Andrew Lee

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