Spinal Trauma

by Cassar-pullicino, Victor; Imhof, Herwig

• ISBN13: 9781588903488
• ISBN10: 1588903486
• Format: Hardcover
• Copyright: 2006-04-01
• Publisher: Thieme Medical Pub

Summary

The diagnosis of trauma to the spine -- where the slightest oversight may have catastrophic results -- requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the beautifully illustrated pathology of cervical trauma. Acute trauma topics include: Optimization of imaging modalities Malalignment -- signs and significance Vertebral fractures -- detection and implications Classification of thoraco-lumbar fractures -- rationale and relevance Neurovascular injury Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: The pediatric spine Sports injuries The rigid spine Trauma in the elderly Vertebral collapse, benign and malignant Spinal trauma therapy Vertebral fractures and osteoporosis Neuropathic spine All throughout the book, the focus is on understanding the injury, and its implications and complications, through "an imaging approach." Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma -- with its broad scope, practical imaging approach, and current focus -- is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels.

Table of Contents

Clinical Perspectives on Spinal Injuries	1	(14)
W. S. El Masry
A. E. Osman
Introduction	1	(1)
Effects of Spinal Cord Injury	1	(1)
Clinical and Radiological Assessment in the Acute Stage	2	(3)
Missed Spinal injuries	2	(1)
Clinical Diagnosis of SCI in the Conscious Patient	2	(1)
Clinical Diagnosis in the Semiconscious or Unconscious Patient	3	(1)
Associated Injuries	3	(1)
Radiological Assessment	4	(1)
The Subacute Stage and Long Term	5	(2)
Assessment of the Cardiovascular System	5	(1)
Assessment of the Respiratory System	5	(1)
Assessment of the Abdomen	6	(1)
Bladder and Urinary System	6	(1)
Assessment of Level of Consciousness	7	(1)
Psycho-Social Assessment of Cognitive Functions	7	(1)
Electrophysiological Assessment	7	(1)
Standards for Neurological Examination and Documentation	7	(2)
Frankel's Classification	8	(1)
The ASIA/IMSOP Classification	8	(1)
Management of the Spinal Injury	9	(2)
The Secondary Injury	9	(1)
Biomechanical Instability of Injuries to the Spinal Column	9	(1)
Unstable Injuries Without Neurological Damage	9	(1)
Physiological Instability of the Spinal Cord	10	(1)
Stable and Unstable Injuries with Neurological Damage	10	(1)
Canal Encroachment	10	(1)
Cord Compression	10	(1)
Natural History of Complete Spinal Cord Injuries	11	(1)
Natural History of Incomplete Cord Injuries	11	(1)
The Role of Surgery	11	(1)
Conclusion	12	(3)
References	12	(3)
Understanding Cervical Spinal Trauma: Biomechanics and Pathophysiology	15	(40)
K.-S. Saternus
G. Kernbach-Wighton
Introduction	15	(1)
Atlanto-Occipital and Atlanto-Axial Joints	15	(3)
Condylar Fracture	15	(1)
Alar Ligaments	16	(1)
Cruciform Ligament, Apical Ligament, Anterior Atlanto-Occipital Membrane, and Anterior Longitudinal Ligament	17	(1)
Atlas Fracture	18	(4)
Anterior Arch	18	(1)
Jefferson Fracture	19	(1)
Lateral Mass	20	(1)
Posterior Arch	21	(1)
Axis Fracture	22	(2)
Odontoid Fracture	22	(1)
Hangman's Fracture	23	(1)
Injuries to the Intervertebral Disk and Major Longitudinal Ligaments	24	(4)
Traumatology	24	(1)
Biomechanics	24	(4)
Vertebral Injury	28	(4)
Compression Fracture	28	(2)
Avulsion Fracture of the Margin of the Vertebra	30	(1)
Injuries to the Facet Joints and Intervertebral Foramina	30	(2)
Spinous Process Fractures	32	(1)
Conclusion	32	(4)
References	34	(2)
Optimizing the Imaging Options
B. Tins
V. N. Cassar-Pullicino
Introduction	36	(2)
Imaging Modalities	38	(7)
Pros and Cons	40	(5)
Imaging Approaches and Dilemmas	45	(2)
Specific Scenarios and Technical Considerations	47	(3)
An Approach to Imaging of Spinal Injuries	50	(1)
Conclusion	51	(4)
References	51	(4)
Classification: Rationale and Relevance	55	(11)
F. C. Oner
Why Classify?	55	(1)
Classification of Thoracolumbar Spine Fractures	55	(5)
The Three-Column CT Era	56	(1)
The Load-Sharing Classification	57	(1)
The AO (Comprehensive) Classification	58	(2)
Influence of Imaging Modality	60	(1)
Problems of Reproducibility	61	(1)
The Concept of Stability	62	(1)
Do We Need Any Classification at All?	63	(3)
References	64	(2)
Malalignment: Signs and Significance	66	(15)
J. H. Harris, Jr
Introduction	66	(1)
Normal Alignment	67	(2)
Cervicocranium (Occiput-C2-C3 Interspace)	67	(1)
Lower Cervical Spine (C3-C7)	68	(1)
Malalignment	69	(12)
Case 1	69	(1)
Case 2	70	(1)
Case 3	70	(1)
Case 4	71	(1)
Case 5	72	(1)
Case 6	72	(1)
Case 7	73	(1)
Case 8	74	(1)
Case 9	74	(1)
Case 10	75	(1)
Case 11	75	(1)
Case 12	76	(1)
Case 13	76	(1)
Case 14	77	(1)
Case 15	78	(1)
Case 16	79	(1)
Case 17	79	(1)
References	80	(1)
Vertebral Injuries: Detection and Implications	81	(19)
R. H. Daffner
S. D. Daffner
Introduction	81	(1)
Indicators of High Risk for Injury	82	(1)
Mechanisms of Injury and Their Imaging ``Fingerprints''	83	(10)
``Footprints'' of Vertebral Injury---the ABCS	93	(5)
Vertebral Stability Following Trauma	98	(1)
Implications	98	(2)
References	98	(2)
Neurovascular Injury	100	(13)
M. L. White
G. Y. El-Khoury
Introduction	100	(1)
MR Imaging/Histopathological Correlation of Acute Spinal Cord Injury	100	(1)
MRI Features of Spinal Cord Hemorrhage	101	(2)
Prognostic Role of MR Imaging in Neurological Outcome	103	(1)
Vascular Injury	104	(1)
Vertebral Artery Injury	104	(7)
Conclusion	111	(2)
References	111	(2)
Trauma to the Pediatric Spine	113	(24)
P. N. M. Tyrrell
V. N. Cassar-Pullicino
Introduction	113	(1)
Development of the Vertebral Column	113	(1)
Normal Variants	114	(3)
Birth Injury	117	(1)
Nonaccidental Injury (NAI)	118	(1)
Cervical Spine Injuries	118	(5)
Atlanto-Occipital Dissociation (AOD)	118	(1)
Fractures of C1	118	(1)
Injury of C2	119	(1)
Os Odontoideum	119	(2)
Atlanto-Axial Dislocation	121	(1)
Atlanto-Axial Rotatory Fixation	121	(2)
Thoracolumbar Spine Injury	123	(3)
Physeal Injury	126	(5)
SCIWORA	131	(2)
Slipped Vertebral Apophysis	133	(1)
Spondylolysis	133	(1)
Prognosis	133	(4)
References	133	(4)
Sports Injuries: Spondylolysis	137	(12)
F. Kainberger
Introduction	137	(1)
Indications for Imaging	138	(1)
Investigation Techniques	139	(4)
Radiography	139	(1)
Computed Tomography	139	(1)
Magnetic Resonance Imaging	139	(1)
Nuclear Medicine Studies	139	(1)
Ultrasound	139	(4)
Image Interpretation	143	(5)
Imaging Anatomy	143	(1)
Signs	144	(2)
Differential Diagnosis	146	(2)
Conclusion	148	(1)
References	148	(1)
Sports Injuries: Diskovertebral Overuse Injuries	149	(6)
J.J. Rankine
Introduction	149	(1)
Anatomy	149	(1)
Scheuermann's Disease	150	(2)
Disk Degeneration	152	(3)
References	153	(2)
The Rigid Spine	155	(11)
P. H. Lander
Introduction	155	(1)
Ankylosing Spondylitis	155	(1)
Disseminated Idiopathic Skeletal Hyperostosis (DISH)	155	(1)
Mechanisms and Imaging Techniques	155	(2)
Cervical Spine Injuries	157	(3)
Thoracolumbar Spine Injuries	160	(6)
References	165	(1)
Spinal Trauma in the Elderly	166	(9)
S. Ehara
Background	166	(1)
Cervical Spine	166	(4)
Biomechanical Characteristics	166	(1)
Clinical Features	166	(1)
Imaging Techniques	167	(1)
Radiological Features	167	(3)
Thoracolumbar Spine	170	(4)
Biomechanical Characteristics	170	(1)
Clinical Features	170	(1)
Imaging Techniques	171	(1)
Imaging Features	172	(2)
Conclusion	174	(1)
References	174	(1)
Therapy---Options and Outcomes	175	(13)
J. M. Trivedi
Introduction	175	(1)
Epidemiology of Spinal Trauma	175	(1)
Pathophysiology of Spinal Cord Injury	175	(1)
Anatomical Classification of Spinal Fractures	175	(1)
Patterns of Injury	176	(2)
Flexion Injury	176	(1)
Burst Fractures	176	(1)
Flexion Distraction Injury	176	(2)
Flexion Rotation	178	(1)
Management	178	(7)
Initial Management	178	(2)
Pharmacological Intervention	180	(1)
Nonsurgical Management of Spinal Fractures	180	(1)
Surgical Treatment of Spinal Fractures	181	(2)
Burst Fractures	183	(1)
Osteoporotic Vertebral Fractures	184	(1)
Conclusion	185	(3)
References	186	(2)
Imaging in Chronic Spinal Cord Injury: Indications and Benefits	188	(15)
R. Bodley
Abbreviations	188	(1)
Introduction	188	(1)
Neurological System	188	(8)
Cord Changes Post-SCI	189	(2)
Reported Series	191	(1)
Treatment	192	(1)
Imaging	192	(4)
Urological Investigations	196	(1)
Surveillance	196	(1)
Imaging in Specific Conditions	197	(2)
Deteriorating Neurology	197	(1)
Spinal Instability	197	(1)
The Acutely Unwell Patient	197	(1)
Deteriorating Renal Function and Renal Tract Complications	197	(1)
Pressure Sores	197	(2)
Ectopic Ossification	199	(1)
Pain	199	(1)
Muscular Spasms	199	(1)
Airway Problems	199	(1)
Elective Management of the Renal Tract	199	(1)
Conclusion	199	(4)
References	201	(2)
Vertebral Fractures and Osteoporosis	203	(10)
P. Peloschek
S. Grampp
Introduction	203	(1)
Definition	203	(1)
Osteoporosis	203	(1)
T-Score and Z-Score	203	(1)
Vertebral Fragility Fracture	204	(1)
Epidemiology and Outcome of Osteoporotic Spinal Fractures	204	(1)
The Radiologist's Role in Diagnosis	204	(4)
Screening during Routine Chest Radiography	204	(1)
Diagnosis of Osteoporosis on Lateral Radiographs of the Spine	205	(1)
Bone Densitometry	205	(1)
Dual X-ray Absorptiometry	206	(1)
Quantitative Computed Tomography	207	(1)
Quantitative Ultrasonography of Bone	207	(1)
Radiographic Absorptiometry	207	(1)
Single-Photon Absorptiometry	207	(1)
The Radiologist's Role in Therapy---Percutaneous Vertebroplasty	208	(1)
Conclusion	208	(1)
Ten Things to Remember	208	(1)
Case Study	209	(4)
References	211	(2)
Vertebral Collapse---Benign or Malignant	213	(10)
A. M. Herneth
Introduction	213	(1)
Clinical Evaluation	213	(7)
Age	213	(1)
History of Trauma	213	(1)
Imaging Findings	214	(4)
New Imaging Methods	218	(2)
Biopsy	220	(1)
Conclusion	220	(3)
References	221	(2)
Neuropathic Osteo-Arthropathy of the Spine	223	(8)
A. Chevrot
A. Feydy
C. Vallee
J. L. Drape
Introduction	223	(1)
Mechanism	223	(2)
Clinical Findings	225	(1)
Imaging Findings	225	(3)
Differential Diagnosis	228	(2)
Treatment	230	(1)
References	230	(1)
The Future: Trends and Developments in Spinal Cord Regeneration	231	(4)
A. E. Osman
D.J. Short
V. N. Cassar-Pullicino
H. Imhof
W.S. El Masry
Introduction	231	(1)
Spinal Cord Research	231	(2)
Neuroprotection	232	(1)
Regeneration	232	(1)
Transplantation	232	(1)
Rehabilitation	232	(1)
Future Trends---Role of Imaging	233	(1)
Conclusion	233	(2)
References	233	(2)
Index	235