Spinal Dislocations Workup
- Author: J Allan Goodrich, MD; Chief Editor: Jeffrey A Goldstein, MD more...
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.
Imaging for spinal dislocation begins with high-quality plain radiographs taken in the AP and lateral views. 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.
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.
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.
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.
Currently, the AO classification has many advocates.
Magerl basically divided thoracolumbar fractures into 3 groups :
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%.
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