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Spinal Dislocations Workup

  • Author: J Allan Goodrich, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
 
Updated: Sep 24, 2012
 

Laboratory Studies

The laboratory workup for spinal dislocation parallels that for any patient with complex traumatic injuries. The workup should include a complete blood count, comprehensive metabolic profile, and urinalysis. The workup frequently includes clotting studies (prothrombin time, activated partial thromboplastin time).

If the patient presents in shock, urgent type and crossmatch is necessary for blood administration. Since a dislocation fracture requires a significant insult, associated chest and abdominal injuries are not uncommon.

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Imaging Studies

Imaging for spinal dislocation begins with high-quality plain radiographs taken in the AP and lateral views.[11] These most often demonstrate the severity of the injury. A well-centered lateral view provides information on alignment and associated fractures, primarily of the anterior column. The AP view demonstrates associated injuries to the ribs and transverse processes, which are an indication of the violent nature of the injury. Associated pneumothorax may also be depicted from this view. See the radiographs below.

Flexion distraction injury with facet dislocation. Flexion distraction injury with facet dislocation.
Fracture dislocation. Fracture dislocation.

CT scan supplements the information gathered from the plain radiographs and provides pertinent data on the injuries to the posterior elements, including lamina and facet injuries. The empty facet sign is a complete dislocation of these joints and is a hallmark finding with these injuries as well as severe flexion-distraction–type traumas. These studies usually are obtained with 3-mm cuts and can be reformatted in the frontal and sagittal plains.[12]

MRI is infrequently required; plain radiographs and CT scans can provide most of the data needed to treat these injuries. If the neurologic examination findings do not correlate with the level of injury determined from plain films, then MRI may be indicated to provide additional information on adjacent levels of involvement. The neural elements and disk injuries are better depicted by MRI.[13, 12]

Ultrasound has been used in some centers intraoperatively to assess canal clearance. Specific expertise in its interpretation is required and is not always available.

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Staging

Classification systems for thoracolumbar fractures

Many classification systems for thoracolumbar fractures exist. None are universally accepted, but each has its own merits and limitations. Important factors in their application include simplicity, reproducibility, and the ability to assist in making management decisions.[14, 15, 16]

Historically, Holdsworth viewed the spine as a 2-column structure with the vertebrae representing the anterior, load-bearing column and the posterior elements (pedicles, laminae, spinous processes, and attaching ligaments) functioning primarily as a tension band resisting tensile loads. Involvement of either structure or both structures, according to Holdsworth, required potentially different modes of reconstruction.[17]

Currently, the AO classification has many advocates.

Magerl basically divided thoracolumbar fractures into 3 groups[18] :

  • Group A involves compression injuries.
  • Group B involves distraction mechanisms.
  • Group C involves torsional injuries.

Further subdivisions are based on morphology of the fracture and its associated ligamentous components. This system and others base their classification on plain radiographs and computer tomographic (CT) findings. While extremely inclusive and comprehensive, interobserver agreement approaches only 67%.[14]

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Contributor Information and Disclosures
Author

J Allan Goodrich, MD Staff Physician, Orthopaedic Spine Surgeon, Doctor's Hospital

J Allan Goodrich, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, North American Spine Society, Society of Lateral Access Surgery

Disclosure: Received consulting fee from Nuvasive for speaking and teaching; Received royalty from Globus for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, North American Spine Society, Scoliosis Research Society, Cervical Spine Research Society, International Society for the Study of the Lumbar Spine, AOSpine, Society of Lateral Access Surgery, International Society for the Advancement of Spine Surgery, Lumbar Spine Research Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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Flexion distraction injury with facet dislocation.
Fracture dislocation.
 
 
 
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