Orthopaedic Emergencies Part IV

In our final blog post regarding Orthopaedic Emergencies, we will review:

1. Transverse Atlantal Ligament Rupture
2. Bilateral Cervical Facet Dislocation
3. Spinal Cord Compression
4. Cauda Equina Syndrome

Transverse Atlantal Ligament Rupture

The normal Atlanto-Dental Interval is less than 3mm. An A.D.I measuring greater than 3mm will be translationally unstable in the sagittal plane due to transverse atlantal ligament rupture. This is usually apparent on x-rays or CT scan. If the condition is not diagnosed, it can result in spinal cord compression, respiratory arrest, and a catastrophic outcome. Treatment typically requires a posterior atlanto-axial arthrodesis.

Bilateral Cervical Facet Dislocation

Facet dislocations of the cervical spine:

1. Unilateral Facet Dislocation
   1. Displacement is less than 50% of the vertebral body width
   2. May need surgery
2. Bilateral Facet Dislocation
   1. Displacement greater than 50% of the vertebral body width
   2. Usually needs surgery
   3. Exclude disc herniation

Obtain a preoperative MRI to rule our disc herniation associated with facet dislocations.

 

Spinal Cord Compression

Spinal cord compression is more common with cervical spine injuries and thoracic spine injuries. Neurogenic shock resulting from spinal cord injury may complicate resuscitation of the patient and should be differentiated from hypovolemic shock. It is important to look for hypotension and bradycardia as well as thoracolumbar fractures which could be missed. Treatment consists of emergency management involving resuscitation and hemodynamic stabilization with concurrent neurologic examination. Protocol requires steroids given early. Definitive treatment consists of stabilization of unstable spinal injuries.

Cauda Equina Syndrome

Central disc herniation compressing the cauda equine. It results from injury to the lumbosacral nerve roots within the spinal canal. This syndrome presents with involvement of the bladder, bowel, and lower limbs and usually results from central disc herniation or fractures. Central disc herniation or bony fragments results in the compression of the nerve roots. Early diagnosis is imperative to find the cause of the compression on the nerve roots. Urgent decompression by the removal of the central disc herniation or stabilization of the fracture is necessary for treatment.