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Spine - Diego B. Nuñez, MD, MPH*

Initial assessment issues = "Clearance" in the Emergency Department 
   - The evaluation of low-risk patients 
   - The evaluation of high-risk patients (multitrauma) 
   - The evaluation in patients with neurologic deficits

Concept and Assessment of Instability
Concept: Mechanism of injury, radiographic patterns, normal variants, frequently associated injuries.

1. Cranio-cervical / C1-C2
       a. Occipital condyle fracture
       b. Atlanto-occipital dislocation / subluxation
       c. Jefferson burst fracture
       d. Atlanto-axial rotary fixation
       e. C1 - posterior arch
       f. Dens fracture
       g. Hangman's fracture

2. C3-T1
      a. Anterior subluxation / whiplash syndromes
      b. Hyperextension sprain / spinal cord injury without radiographic abnormalities (Case 1) (Case 2
      c. Wedge compression, spinous process fractures
      d. Burst compression
      e. Flexion tear drop fracture
      f. Bilateral facet dislocation
      g. Unilateral facet dislocation
      h. Articular mass and transverse process fractures (Case 1) (Case 2)
      i. Traumatic isolation of articular pillar / pedicolumnar separation
      j. Corner Avulsion Fracture (extension teardrop)
      k. Laminar fractures
      l. Facet dislocation with fracture
      m. Acute ligamentous injuries

3. Thoraco-lumbar spine trauma
      a. Compression fracture
      b. Burst Fracture
      c. Chance fracture
      d. Complex fracture-dislocation
      e. Pathological fracture

4. Traumatic injuries to intervertebral disks

5. Ostoemyelitis / discitis

6. Epidural abscess

7. Disk herniation

8. Other




*Fellow of the American Society of Emergency Radiology (FASER)

Suggested readings:

Young JWR: Cervical spine trauma. (In) Imaging in Trauma and Critical Care, Mirvis SE & Young JWR (eds); Williams & Wilkins; Baltimore, MD; 1992, pp 291-379.

Berquist TH: Spinal trauma. (In) Trauma Radiology, McCort JJ & Mindelzun RE (eds); Churchill Livingstone; New York; 1990, pp 31-63(74).

Spine, including soft tissues of the pharynx and neck. (In) The Radiology of Emergency Medicine. Harris JH, Harris WH, (eds); Williams & Wilkins, Baltimore; 1999, pp 137-298.

Harris JH: Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR 1994;162:881-886,887-892

Rogers LF: Fractures of the sacrum. (In) Radiology of Skeletal Trauma (2nd Ed), Rogers LF (ed); Churchill Livingstone, New York; 1992, pp 1019-1023


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