FACTS & HINTS

High-Yield Facts

Clinical Points

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Types of Vertebral Fractures

Compression fractures

Vertebral bodycollapses

Caused byosteoporosis, trauma, or tumor

Usuallyoccur at C7 and T1

Moderate to severe pain, limitation of movement, kyphosis

Jefferson fracture

Four part fracture of the ring of C1

Caused bya fall on the vertex

Patients have upper neck pain but can be neurologicallyintact

Hangman fracture

Caused byhyperextension of the head on the neck

Bipedicle fracture of C2

Anterior displacement of C2 and C3

Results in quadriplegia or death

Cervical Hyperextension

Most common in young adults from trauma and sports injuries and the elderly, resulting in cord compression

Result of whiplash from car accidents

Results in soft tissue injury, fractures, dislocations, ligamentous tears, and disc disruption

Clinical Points

Spinal curvatures:The primarycurvatures of the vertebral column in the thoracic and sacral regions develop during the fetal period and are caused bydifferences in height between the anterior and posterior aspects of the vertebrae. The secondarycurvatures are mainlya result of anterior-posterior differences in IVdisc thickness. The cervical curvature is acquired when the infant begins to lift its head, and the lumbar curvature when the infant begins to walk.

Abnormal curvatures:Kyphosis is an increased thoracic curvature, commonlyseen in the elderly("Dowager hump"). It is usuallycaused by osteoporosis, resulting in anterior vertebral erosion or a compression fracture.An excessive lumbar curvature is termed a lordosis and is seen in association with weak trunk muscles, pregnancy, and obesity. Scoliosis is an abnormal lateral curvature of the spine, accompanied byrotation of the vertebrae.

Spondylolisthesis:The lumbosacral angle is created between the long axes of the lumbar vertebrae and the sacrum. It is primarilybecause of the anterior thickness of the L5 body.As the line of bodyweight passes anterior to the SI joints, anterior displacement of L5 over S1 may occur (spondylolisthesis), applying pressure to the spinal nerves of the cauda equina.

Sacralization:In about 5% of individuals, the L5 vertebra is partiallyor totallyfused with the sacrum. Because the L5/S1 level is now very strong, the L4/5 level is likelyto degenerate in these cases.

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Mnemonics

Memory Aids

Vertebral bodies:

Thoracic are heart-shaped since your heart is in your thorax

Lumbar are kidney-bean shaped as the kidneys are in the lumbar area

Craniovertebral joints:

Atlantooccipital joint is the yes-yes joint because it permits nodding

Atlantoaxial joint is the no-no joint because it permits turning the head from side to side

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