Spinal Injuries - Principles
Complications of spinal injury
Stable injuries
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Vertebral components won't be displaced by normal movement.
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An undamaged spinal cord is not in danger
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There is no development of incapacitating deformity or pain
Unstable injuries
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Further displacement of the injury may occur
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Loss of 50% of vertebral height
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Angulation of thoracolumbar junction of > 20 degrees
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Failure of at least 2 of Denis's 3 columns
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Compression # of three sequential vertebrae can lead to posttraumatic kyphosis
Anatomical considerations
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The upper thoracic spine (T1-T10) is protected by the ribs, sternum and the facet joint orientation
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At the thoracolumbar junction there is a fulcrum of increased motion, so there is increased risk of injury
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The middle thoracic spine is a vascular 'watershed', vascular insult can cause cord ischaemia
(Artery of Adamkiewitz)
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Cauda equina begins at L1-L2. Lesions below L1 have a better prognosis as nerve roots, not cord are affected
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