If the transverse atlantal ligament ruptures, you can see
that the spine becomes translationally unstable in the sagittal plane, and the
odontoid will be displaced posteriorly. The ADI will increase more than 3mm,
and the spinal cord area will be narrowed, and you may get spinal cord
compromise as the odontoid process moves posteriorly towards the spinal cord.
This rupture of the transverse ligament is usually apparent on the x-rays or CT
scan as the odontoid moves posteriorly, and the ADI increases, compromising the
spinal cord. If the condition is not diagnosed properly, it can result in
spinal cord compression, respiratory arrest and a catastrophic outcome. This
condition usually requires surgery because ligaments do not heal (they need to
be fused), so it will probably require posterior atlanto-axial arthrodesis.
Facet dislocations of the cervical spine include unilateral
facet dislocation and bilateral facet dislocation. In unilateral facet
dislocation, displacement of the vertebrae is less than 50% of the cervical
body width and may need surgery. Bilateral facet dislocation is more serious;
the displacement is greater than 50% of the vertebral body width. Obtain a
preoperative MRI to rule out disc herniation associated with facet
dislocations.
Spinal cord compression is more common with cervical spine
injuries and thoracic spine injuries. Bone within the canal increases the risk
of spinal cord compression and injury. Neurogenic shock resulting from spinal
cord injury may complicate resuscitation of the patient and should be
differentiated from hypovolemic shock. Look for hypotension and bradycardia in
neurogenic shock. Emergency management involves resuscitation and hemodynamic
stabilization of the patient with a concurrent, adequate and frequent
neurologic examination. Definitive treatment is usually stabilization of the
unstable spinal injuries.
Cauda equina syndrome results from injury to the lumbosacral
nerve roots within the spinal canal. It presents with involvement of the
bladder, bowel, and lower limbs and usually results from fractures or central
disc herniation. Central disc herniation or bony fragments result in
compression of the nerve roots. Early diagnosis of the condition is important
for eventual improvement on the outcome. Treatment is urgent decompression by
the removal of the central disc herniation or decompression and stabilization
of the fracture.
