Abstract
Spine fractures are complex injuries that occur as a result of minor or high-energy trauma. These injuries can result in significant morbidity and commonly cause chronic pain and decreased quality of life. In this chapter, we attempt to give a broad overview of the epidemiology and clinical presentations of patients presenting with cervical, thoracolumbar, and sacral spine trauma. We outline a systematic approach to appropriately evaluate and diagnose patients with suspected spine trauma. Treatment algorithms for spine injuries are nuanced and multifarious, taking into consideration a myriad of fracture-related elements such as the stability of the fracture pattern, potential for healing, fracture displacement, associated injuries, and the patient’s neurological status. Indications and treatment protocols, inclusive of both non-operative and operative treatment options, are discussed. The aim of this chapter is to provide a practical guide for practitioners, informing and aiding their approach across all treatment stages.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Cervical Spine Trauma and Injuries
Passias PG, Poorman GW, Segreto FA, Jalai CM, Horn SR, Bortz CA, Vasquez-Montes D, Diebo BG, Vira S, Bono OJ, De La Garza-Ramos R. Traumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013. World Neurosurg. 2018;1(110):e427–37.
Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR, NEXUS Group. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med. 2001;38(1):17–21.
Oliver M, Inaba K, Tang A, Branco BC, Barmparas G, SchnĂ¼riger B, Lustenberger T, Demetriades D. The changing epidemiology of spinal trauma: a 13-year review from a level I trauma centre. Injury. 2012;43(8):1296–300.
Robinson AL, Olerud C, Robinson Y. Epidemiology of C2 fractures in the 21st century: a national registry cohort study of 6,370 patients from 1997 to 2014. Adv Orthoped. 2017;1:2017.
Schiff DC, Parke WW. The arterial supply of the odontoid process. JBJS. 1973;55(7):1450–6.
Damadi AA, Saxe AW, Fath JJ, Apelgren KN. Cervical spine fractures in patients 65 years or older: a 3-year experience at a level I trauma center. J Trauma Acute Care Surg. 2008;64(3):745–8.
Levine AM, Edwards CC. Treatment of injuries in the C1-C2 complex. Orthop Clin North Am. 1986;17(1):31–44.
Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56(8):1663–74.
Hadley MN, Dickman CA, Browner CM, Sonntag VK. Acute axis fractures: a review of 229 cases. J Neurosurg. 1989;71(5):642–7.
Wang H, Coppola M, Robinson RD, Scribner JT, Vithalani V, de Moor CE, Gandhi RR, Burton M, Delaney KA. Geriatric trauma patients with cervical spine fractures due to ground level fall: five years experience in a level one trauma center. J Clin Med Res. 2013;5(2):75.
Spence KF, Decker S, Sell KW. Bursting atlantal fracture associated with rupture of the transverse ligament. JBJS. 1970;52(3):543–9.
Bohlman HH. Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. JBJS. 1979;61(8):1119–42.
Platzer P, Jaindl M, Thalhammer G, Dittrich S, Wieland T, Vecsei V, Gaebler C. Clearing the cervical spine in critically injured patients: a comprehensive C-spine protocol to avoid unnecessary delays in diagnosis. Eur Spine J. 2006;15(12):1801–10.
Harris JH Jr, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 1994;162(4):881–6.
Vaccaro AR, Kreidl KO, Pan W, Cotler JM, Schweitzer ME. Usefulness of MRI in isolated upper cervical spine fractures in adults. J Spinal Disord. 1998;11(4):289–93.
Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38(1):44–50.
Majercik S, Tashjian RZ, Biffl WL, Harrington DT, Cioffi WG. Halo vest immobilization in the elderly: a death sentence? J Trauma Acute Care Surg. 2005;59(2):350–7.
Thoracic and Lumbar Vertebral Fractures
Cooper C, Dunham CM, Rodriguez A. Falls and major injuries are risk factors for thoracolumbar fractures: cognitive impairment and multiple injuries impede the detection of back pain and tenderness. J Trauma Acute Care Surg. 1995;38(5):692–6.
Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine. 1992;17(5):528–40.
Keene JS. Radiographic evaluation of thoracolumbar fractures. Clin Orthop Relat Res. 1984;189:58–64.
Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine. 2005;30(20):2325–33.
Chance GQ. Note on a type of flexion fracture of the spine. Br J Radiol. 1948;21(249):452–3.
Hauser CJ, Visvikis G, Hinrichs C, Eber CD, Cho K, Lavery RF, Livingston DH. Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma Acute Care Surg. 2003;55(2):228–35.
Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine. 1993;18(8):971–6.
Mumford J, Weinstein JN, Spratt KF, Goel VK. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine. 1993;18(8):955–70.
Bailey CS, Urquhart JC, Dvorak MF, Nadeau M, Boyd MC, Thomas KC, Kwon BK, Gurr KR, Bailey SI, Fisher CG. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J. 2014;14(11):2557–64.
Shamji MF, Roffey DM, Young DK, Reindl R, Wai EK. A pilot evaluation of the role of bracing in stable thoracolumbar burst fractures without neurological deficit. Clin Spine Surg. 2014;27(7):370–5.
Spondylolysis and Spondylolisthesis
Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. JBJS. 1984;66(5):699–707.
Albanese M, Pizzutillo PD. Family study of spondylolysis and spondylolisthesis. J Pediatr Orthop. 1982;2(5):496–9.
Wynne-Davies R, Scott JH. Inheritance and spondylolisthesis: a radiographic family survey. J Bone Joint Surg Br. 1979;61(3):301–5.
Wiltse LL, Newman PH, Macnab IA. Classification of spondylosis and spondylolisthesis. Clin Orthop Relat Res. 1976–2007;117:23–9.
Hu SS, Tribus CB, Diab M, Ghanayem AJ. Spondylolisthesis and spondylolysis. JBJS. 2008;90(3):656–71.
Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371–7.
Steiner ME, Micheli LJ. Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace. Spine. 1985;10(10):937–43.
Blanda J, Bethem D, Moats W, Lew M. Defects of pars interarticularis in athletes: a protocol for nonoperative treatment. J Spinal Disord. 1993;6(5):406–11.
Selhorst M, Fischer A, Graft K, Ravindran R, Peters E, Rodenberg R, Welder E, MacDonald J. Timing of physical therapy referral in adolescent athletes with acute spondylolysis: a retrospective chart review. Clin J Sport Med. 2017;27(3):296–301.
Lee GW, Lee SM, Ahn MW, Kim HJ, Yeom JS. Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial. Spine J. 2015;15(7):1545–53.
Gramse RR, Sinaki M, Ilstrup DM. Lumbar spondylolisthesis: a rational approach to conservative treatment. Mayo Clin Proc. 1980;55(11):681–6.
Sinaki M, Lutness MP, Ilstrup DM, Chu CP, Gramse RR. Lumbar spondylolisthesis: retrospective comparison and three-year follow-up of two conservative treatment programs. Arch Phys Med Rehabil. 1989;70(8):594–8.
O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22(24):2959–67.
Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain: a prospective, randomized, controlled, double-blind study. JBJS. 2000;82(11):1589.
Johnson GV, Thompson AG. The Scott wiring technique for direct repair of lumbar spondylolysis. J Bone Joint Surg Bri. 1992;74(3):426–30.
Nicol RO, Scott JH. Lytic spondylolysis. Repair by wiring. Spine. 1986;11(10):1027–30.
Sacral/Coccyx Fractures
Santolini E, Kanakaris NK, Giannoudis PV. Sacral fractures: issues, challenges, solutions. EFORT Open Rev. 2020;5(5):299–311.
Bydon M, De la Garza-Ramos R, Macki M, Baker A, Gokaslan AK, Bydon A. Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Spinal Disord Tech. 2014;27:297–304.
Mehta S, Auerbach JD, Born CT, Chin KR. Sacral fractures. JAAOS J Am Acad Orthopaedic Surg. 2006;14(12):656–65.
Mahmood B, Pasternack J, Razi A, Saleh A. Safety and efficacy of percutaneous sacroplasty for treatment of sacral insufficiency fractures: a systematic review. J Spine Surg. 2019;5(3):365.
Buttaci CJ, Foye PM, Stitik TP. Poster board 56: Coccydynia successfully treated with ganglion impar blocks: a case series. Am J Phys Med Rehabil. 2005;84(3):218.
Perkins R, Schofferman J, Reynolds J. Coccygectomy for severe refractory sacrococcygeal joint pain. Clin Spine Surg. 2003;16(1):100–3.
Trollegaard AM, Aarby NS, Hellberg S. Coccygectomy: an effective treatment option for chronic coccydynia: retrospective results in 41 consecutive patients. J Bone Joint Surg Br. 2010;92(2):242–5.
Browner BD, editor. Skeletal trauma: basic science, management, and reconstruction. Elsevier Health Sciences; 2009.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hecht, A., Markowitz, J.S. (2022). Spine Dislocations and Fractures. In: Mostoufi, S.A., George, T.K., Tria Jr., A.J. (eds) Clinical Guide to Musculoskeletal Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-92042-5_13
Download citation
DOI: https://doi.org/10.1007/978-3-030-92042-5_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-92041-8
Online ISBN: 978-3-030-92042-5
eBook Packages: MedicineMedicine (R0)