Spine Trauma

Alexander R. Vaccaro, M.D., F.A.C.S.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Laurence N. Fitzhenry, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Zoe Brown, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Alexander R. Vaccaro III, MD, is professor of orthopedic surgery at Jefferson Medical College, where Laurence N. Fitzhenry is an orthopedic research fellow. Here, they discuss the classification, pathophysiology and management of spinal trauma; cervical and thoracolumbar trauma, operative and nonoperative treatment, and rehabilitation. Zoe Brown, MD, is a Spine Research Fellow in Orthopaedics at the Rothman Institute, Jefferson University Hospital, Philadelphia, PA. She received her medical degree from Jefferson Medical College in Philadelphia and completed a surgical residency at Boston University Medical Center in Boston, MA. Dr. Brown has published a number of articles on a variety of topics within Orthopedics.

The authors detail the incidence and causes of spinal cord injuries, and note that most are preventable. They discuss the primary and secondary phases of pathophysiology, evaluation and treatment using the Advanced Trauma Life Support (ATLS) principles in spine trauma. They define a "complete" spinal injury and the four types of incomplete injuries – anterior, posterior, central, and Brown-Sequard injuries in spine trauma, and discuss the five-point American Spinal Injury Association Scale of injuries according to level of impairment.

Pharmacologic treatment is mainly by high-dose methylprednisolone and the authors describe the indications for plain x-rays, MRI, or CT scan.

Using effective illustrations the authors go into considerable detail about the several types of spine trauma. These include classifications of Atlanto-occipal dislocation, Atlas fractures, atlantoaxial rotatory subluxation, odontoid fractures, traumatic spondylolisthesis of the axis ... and the Allen and Ferguson stages of compression-flexion injuries, distraction-flexion fractures, and compression extension injuries. They also describe the Denis system for classifying vertebral column injuries.

The lecture concludes with a discussion of potential complications ... including atelectasis, pneumonia, decubitus ulcers following spine trauma, and of the several phases in – and improvements to – the rehabilitation process in spinal cord injury.