Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 7 n Spine and Spinal Cord Trauma
A B C
n FIGURE 7-6 Hangman’s Fracture (arrows). Demonstrated in CT reconstructions: A. axial; B. sagittal paramedian; and C. sagittal midline.
Note the anterior angulation and excessive distance between the spinous processes of C1 and C2 (double arrows).
body rarely is more than 25% shorter than the posterior
body. Due to the rigidity of the rib cage, most of these
fractures are stable.
Burst injury is caused by vertical-axial compression.
Chance fractures are transverse fractures through
the vertebral body (n FIGURE 7-7). They are caused by
flexion about an axis anterior to the vertebral column
and are most frequently seen following motor vehicle
crashes in which the patient was restrained by only
an improperly placed lap belt. Chance fractures can
be associated with retroperitoneal and abdominal
visceral injuries.
Due to the orientation of the facet joints, fracturedislocations
are relatively uncommon in the
thoracic and lumbar spine. These injuries nearly
always result from extreme flexion or severe blunt
trauma to the spine, which causes disruption of the
posterior elements (pedicles, facets, and lamina) of
the vertebra. The thoracic spinal canal is narrow in
relation to the spinal cord, so fracture subluxations in
the thoracic spine commonly result in complete
neurological deficits.
Simple compression fractures are usually stable
and often treated with a rigid brace. Burst fractures,
Chance fractures, and fracture-dislocations are
extremely unstable and nearly always require
internal fixation.
Thoracolumbar Junction Fractures
(T11 through L1)
Fractures at the level of the thoracolumbar junction are
due to the immobility of the thoracic spine compared
with the lumbar spine. Because these fractures most
often result from a combination of acute hyperflexion
and rotation, they are usually unstable. People who
fall from a height and restrained drivers who sustain
severe flexion with high kinetic energy transfer are at
particular risk for this type of injury.
The spinal cord terminates as the conus medullaris
at approximately the level of L1, and injury to this
part of the cord commonly results in bladder and
bowel dysfunction, as well as decreased sensation
and strength in the lower extremities. Patients with
thoracolumbar fractures are particularly vulnerable
to rotational movement, so be extremely careful
when logrolling them. (See Logroll video on MyATLS
mobile app.)
Lumbar Fractures
n FIGURE 7-7 Chance Fracture. Radiograph showing a Chance
fracture, which is a transverse fracture through the vertebral body.
The radiographic signs associated with a lumbar fracture
are similar to those of thoracic and thoracolumbar
fractures. However, because only the cauda equina is
involved, the probability of a complete neurological
deficit is much lower with these injuries.
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