ISSN 2398-2969      

Spine: fracture / luxation

icanis

Synonym(s): Spinal trauma


Introduction

  • Cause: trauma such as a fall or a road traffic accident (RTA).
  • Signs: neurological, orthopedic, other serious injuries likely.
  • Diagnosis: neurological examination, survey radiographs of spine, CT and MRI of spine.
  • Treatment: cage rest, methylprednisolone, external support or surgical stabilization and/or decompression.
  • Prognosis: poor if deep pain sensation (nociception) absent.

Pathogenesis

Etiology

  • Vehicular collision.
  • Fall from a considerable height.
  • Gunshot injury.
  • Dog running into obstacle at high speed.
  • Falling object.

Specific

  • Fracture or dislocation/luxation.

Pathophysiology

  • Because the spinal cord is encircled by a rigid, inelastic bony encasement (vertebrae), and because of the relatively soft texture of spinal parenchyma, any change in canal diameter results in spinal cord injury.
  • Mechanical injury to nervous tissue (especially axons), results in physiologic or morphologic disruption of nervous impulses.
  • Contusive injury to the spinal cord causes primary mechanical injury to the parenchyma and vasculature, and secondary damage that is responsible for an expanding zone of necrosis.
  • The majority of the secondary damage occurs in the 24-48 hour period after the initial injury, but ongoing apoptotic cell death can be detected months and even years later.
  • Numerous pathophysiological consequences may evolve including ischemia, hemorrhage, alterations in spinal cord blood flow and edema.
  • These secondary events lead to a self-perpetuating process of damage to the spinal cord that often is equally, if not more, detrimental to the spinal cord than the initial mechanical injury (second injury phenomenon).
  • Putative mediators of this self-perpetuating process include excitatory neurotransmitters, endorphins, catecholamines and free radicals released after the intitial insult.
  • The different injuries resulting from trauma include vertebral fractures, subluxations and luxations, flexion/extension injuries and traumatic disk herniations.
  • Several different types of vertebral fracture and luxation can occur dependent on the combination of loading forces applied and the location along the spine.
  • Forces can be divided into axial loading, flexion and extension, and rotational with each producing a different type of vertebral column injury.
  • Flexion injuries→ damage to the ventral compartment.
  • Extension injuries→ damage to the dorsal compartment.
  • Fracture is more common at the junctions of rigid and more mobile parts of the spine, eg thoracolumbar and lumbosacral junctions.
  • Ongoing instability can result in repeated contusive injuries, additional laceration of the cord and increasing severity of compression.
Schiff-Sherrington Syndrome
  • This results from a lesion between T2 to L3 spinal segments that interrupts the ascending inhibitory impulses from the Border cells in the lumbar spinal cord grey matter.
  • These cells are present in the dorsolateral part of the ventral grey matter from L1 to L7 with a maximal population from L2 to L4.
  • Axons from these cells cross to ascend in the contralateral fasciculus proprius of the lateral funiculus to terminate in the cervical intumescence.
  • This loss of ascending inhibition to the thoracic limbs results in extensor rigidity of the thoracic limbs.
  • The thoracic limbs, however, are otherwise neurologically normal in terms of gait and postural reactions.
  • While Schiff-Sherrington posture is usually seen with acute and severe spinal cord injuries, this posture alone does not indicate that the spinal lesion is irreversible.

Timecourse

  • Acute onset, neurological deterioration in first few hours/days after trauma.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Tatton B, Jeffery N, Holmes M (2009) Predicting recovery of urination control in cats after sacrocaudal injury: a prospective study. JSAP 50 (11), 593-596 PubMed.
  • Bruce C W, Brisson B A, Gyselinck K (2008) Spinal fracture and luxation in dogs and cats: a retrospective evaluation of 95 cases. Vet Comp Orthop Traumatol 21 (3), 280-284 PubMed.
  • Laverty P H et al (2004) A preliminary study of intravenous surfactants in paraplegic dogs: polymer therapy in canine related SCI. J Neruotrauma 21 (12), 1767-77 PubMed.
  • Olby N J, Levine J, Harris T, Muñana K, Sheen T & Sharp N J H (2003) Long term functional outcome of dogs with severe thoracolumbar spinal cord injuries. JAVMA 222 (6), 762-769 PubMed.
  • Bagley R S et al (1999) Exogenous Spinal Trauma - clinical assessment and initial mangement. Comp Contin Educ Pract Vet 21 (12), 1138-1144 VetMedResource.
  • Hawthrone J C, Blevins W E, Wallace L J et al (1999) Cervical vertebral fractures in 56 dogs - A retrospective study. JAAHA 35 (2), 135-46 PubMed.
  • Anderson A, Coughlan A R (1997) Sacral fractures in dogs and cats - a classification scheme and review of 51 cases. JSAP 38 (9), 404-409 PubMed.
  • Bruecker K A (1996) Principles of vertebral fracture management. Semin Vet Med Surg (Small Anim) 11 (4), 259-272 PubMed.
  • Quencer R M & Bunge R P (1996) The injured spinal cord - Imaging, histopathologic, clinical correlates, and basic science approaches to enhancing neural function after spinal injury. Spine 21 (18), 2064-6 PubMed.
  • Coates J R, Sorjonen D C, Simpson S T, Cox N R et al (1995) Clinicopathologic effects of a 21-aminosteroid compound (U74389G) and high-dose methylprednisolone on spinal cord function after simulated spinal cord trauma. Vet Surg 24 (2), 128-39 PubMed.
  • Ferguson J F (1995) What is your diagnosis? Spinal fractures. JSAP 36 (9), 381/406 PubMed.
  • Kuntz C A et al (1995) Sacral fractures in dogs - a review of 32 cases. JAAHA 31 (2), 142-150 PubMed.
  • Nicoll S A & Remedios A M (1995) Recumbency in small animals - Pathophysiology and management. Comp Contin Ed 17 (11), 1367-74 VetMedResource.
  • Bruecker K A, Seim H B 3rd (1992) Principles of spinal fracture management. Semin Vet Med Surg (Small Anim) (1), 71-84 PubMed.
  • Patterson R H & Smith G K (1992) Backsplinting for treatment of thoracic and lumbar fracture/luxation in the dog - Principles of application and case series. VCOT 5 (4), 179-87 VetMedResource.
  • Shores A (1992) Spinal trauma. Pathophysiology and management of traumatic spinal injuries. Vet Clin North Am 22 (4), 859-88 PubMed.
  • Shores A (1992) Fractures and luxations of the vertebral column. Vet Clin North Am Small Anim Pract 22 (1), 171-180 PubMed.
  • Taylor R A (1992) Post-surgical physical therapy - The missing link. Comp Contin Ed 14 (2), 1583-94 AGRIS FAO.
  • Janssens L A A (1991) Mechanical and pathophysiological aspects of acute spinal cord trauma. JSAP 32 (11), 572-8 VetMedResource.
  • Selcer R R, Bubb W J, Walker T L (1991) Management of vertebral column fractures in dogs and cats - 211 cases (1977-1985). JAVMA 198 (11), 1965-1968 PubMed.
  • Braund K G, Shores A & Brawner W R Jr. (1990) The etiology, pathology and pathophysiology of acute spinal trauma. Vet Med 85 (7), 684-91 VetMedResource.
  • Brawner W R Jr, Braund K G & Shores A (1990) Radiographic evaluation of dogs and cats with acute spinal cord trauma. Vet Med 85 (7), 703-23 VetMedResource.
  • Rucker N C (1990) Management of spinal cord trauma. Prog Vet Neurol 1 (4), 397-412 VetMedResource.
  • Carberry C A, Flanders J A, Dietz A E et al (1989) Nonsurgical management of thoracic and lumbar spinal fractures and fracture/luxations in the dog and cat - a review of 17 cases. JAAHA 25 (1), 43-54 VetMedResource.
  • Turner W D (1987) Fractures and fracture-luxations of the lumbar spine - A retrospective study in the dog. JAAHA 23 (4), 459-64 VetMedResource.
  • Berg R J & Rucker N C (1985) Pathophysiology and medical management of acute spinal cord injury. Comp Contin Ed 7 (8), 646-52 VetMedResource.
  • Hoerlein B F, Redding R W, Hoff J & McGuire J A (1985) Evaluation of Naloxone, Crocetin, Thyrotropin releasing hormone, methylprednisolone, partial myelotomy, and hemilaminectomy in the treatment of acute spinal cord trauma. JAAHA 21 (1), 67-77 VetMedResource.
  • Matthiesen D T (1983) Thoracolumbar spinal fracture/luxations: Surgical management. Comp Contin Ed Pract Vet 5 (10), 867-78 VetMedResource.
  • Feeney D A & Oliver J E (1980) Blunt spinal trauma in the dog and cat - Insight into radiographic lesions. JAAHA 16 (6), 885-90 VetMedResource.
  • Stone E A, Betts C W & Chambers J N (1979) Cervical fractures in the dog - A literature and case review. JAAHA 14 (4), 463-71 VetMedResource.
  • Slocum B & Rudy R L (1975) Fractures of the seventh lumbar vertebra in the dog. JAAHA 11 (2), 167-74 VetMedResource.

Other sources of information

  • Sharp N J H, Wheeler S J (2005)Spinal trauma.In:Small Animal Surgical Disorders, Diagnosis and Surgery.2nd edn. Chapter 13, pp 281-318. Elsevier Mosby.
  • Bruecker A & Seim III H B (1993)Spinal fractures and luxations.In:Texbook of Small Animal Surgery, 2nd edn. Ed D Slatter. Philadelphia: W B Saunders Co. pp 1110-1121.

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