Definition
• Injury to the bony/ligamentous structure TLS spine
Approach
• Maintain logroll precautions
• Palpation: Spinal tenderness, step-offs, neurologic deficits
Anterior Wedge/Compression Fracture
Definition
• Stable compression fracture of the vertebral body (wedge → only anterosuperior vertebral body endplate)
History
• Flexion
Physical Findings
• Focal tenderness, no neurologic deficits
Evaluation
• CT scan
Treatment
• Spine consult
Disposition
• D/c if pain controlled
Burst Fracture
Definition
• Stable compression fracture of anterior & posterior vertebral body (may be complicated by retropulsed bony fragments → cord injury)
History
• Axial load/vertical compression
Physical Findings
• Focal tenderness, ± neurologic deficit
Evaluation
• CT scan
Treatment
• Spine consult, bracing/orthosis
Disposition
• Likely admit
Chance Fracture
Definition
• Often stable fracture through the vertebra, can also include body/pedicles/laminae
History
• Back pain after head-on MVC when wearing only a lap belt from flexion injury
Physical Findings
• Focal tenderness, rare neurologic deficit
Evaluation
• CT scan
Treatment
• Spine consult, orthosis
Disposition
• Admit
Sacral Fracture
Definition
• Fractures of the sacrum (may be a/w pelvic fractures in above S4)
History
• Buttock/perirectal/posterior thigh pain after direct trauma to sacrum (fall or force from behind)
Physical Findings
• Focal tenderness, neurologic deficits (above S4), careful eval for cauda equina
Evaluation
• CT scan
Treatment
• Spine consult
Disposition
• D/c if isolated & stable
Anterior Cord Syndrome
Definition
• Injury to the anterior cord from blunt or ischemic injury
History
• Flexion/axial load (major trauma), minor trauma (arthritis/spinal stenosis/OA/spinal cord pathology)
Physical Findings
• Bilateral loss of motor/pain/temperature sensation, dorsal column intact (proprioception/vibratory sense) (See Sensory & Motor deficit tables)
Evaluation
• MRI
Treatment
• Spine consult
Disposition
• Admit
Central Cord Syndrome
Definition
• Trauma to central cord → injury of corticospinal motor tracts of UE > tracts of LE (buckling of ligamentum flavum)
History
• Hyperextension of neck, h/o elderly, arthritis, OA, spinal stenosis
Physical Findings
• Loss of motor function in UE >LE, variable sensory loss (See Sensory & Motor deficit tables), loss of pain & temperature if nontraumatic
Evaluation
• MRI
Treatment
• Spine consult
Disposition
• Admit
Brown-Sequard Syndrome (Lateral Cord Syndrome)
Definition
• Hemicord transection from penetrating trauma
History
• Penetrating trauma
Physical Findings
• Ipsilateral motor/proprioception/vibration loss, contralateral pain/temperature sensation loss, deficits occur 2 levels below lesion
Evaluation
• MRI
Treatment
• Spine consult
Disposition
• Admit
Spinal Shock
Definition
• Loss of vascular tone caused by cord trauma lasting 24–48 h, rarely can last several weeks
History
• Spinal cord trauma
Physical Findings
• Hypotension, bradycardia, flaccid paralysis, hyporeflexia
Treatment
• Phenylephrine (Neosynephrine peripheral alpha agonist) for BP support
Disposition
• Admit
Pearls
• There is NO evidence to support the administration of steroids in spinal trauma
• SCIWORA (spinal cord injury without radiologic abnormality): In pediatric pts, if focal tenderness/neurologic deficits → treat as cord injury regardless of imaging