Spinal Fractures: NEET PG Essentials
1. Classification & Stability (Denis Criteria)
The spine is divided into three columns. An injury is considered unstable if two or more columns are involved.
- Anterior Column: Anterior 2/3 of the vertebral body, anterior longitudinal ligament.
- Middle Column: Posterior 1/3 of the vertebral body, posterior longitudinal ligament.
- Posterior Column: Pedicles, laminae, spinous processes, and posterior ligamentous complex.
2. High-Yield Fractures
| Fracture | High-Yield Clinical Pearl |
|---|---|
| Jefferson Fracture | Burst fracture of C1 (Atlas). Caused by axial loading. |
| Hangman’s Fracture | Bilateral pars interarticularis fracture of C2 (Axis). Caused by hyperextension. |
| Chance Fracture | Flexion-distraction injury of the thoracolumbar junction (T12-L2). Associated with seatbelt injury. |
3. Examination Pearls
- Spinal Shock: Immediate, temporary loss of all reflex activity below the level of injury. Not a true physiological “shock.”
- Neurogenic Shock: True hemodynamic instability (hypotension, bradycardia) due to loss of sympathetic tone (common in T6 or higher injuries).
- Burst Fracture: Often involves the middle column; high risk of retropulsion of bone fragments into the spinal canal.
- Cervical Clearance: NEXUS criteria or Canadian C-Spine Rule are used to determine if radiographic imaging is necessary in a trauma setting.