1. Trauma ® #, dislocations/ subluxations
2. Infection ® tuberculous, pyogenic
3. Tumours ® metastasis

• Mechanism (pattern of injury) ® (1) MVA (2) Fall (3) Diving/ sport (4) Gunshot
• Eg. Flexion ® # vertebra, bifacet dislocation (whole vertebra moves forward, in AP view spinous processes are centred, lateral view shows subluxation)
• Eg. Flexion + rotation ® unifacet dislocation
• Delay in Dx ® (1) Head injury (2) Alcohol (3) Multiple injuries (LOC?)
• Always suspect and protect

• ABC (aw, breathing, circ) + C (cervical spine)
• Head to toe
• Spine - bruising, tenderness, ¯ motion
• Suspect neck injury if head and chest are injured (neck pain, stiffness, ¯ motion)
• Neurological exam ® sensory, motor, reflexes

• Name/ location/ date/ type
• A good X-ray ® over/ under-exposed
• Alignment
• ST ® density (6 cm in from of C2 + 2 cm in front of C6)
• Bone ® density, normal height (D density = #)
• Density - abnormal calcifications ® ST
• Pedicles eroded (eg. Tumour)
• #/ dislocation ® spinous processes moved
• height of vertebra ® ¯ / wedge-shaped
• Lumbar lordosis?

• Prevertebral ST shadow
• alignment
• density of bone/ #
• Must be able to see up to T1 \ shoulder pull-down
• Hangman's # ® hyperextension
• If unsure whether # or not ® CT scan
• If see loss of lordosis and ST swelling ® suspect injury/ #

• D in alignment
• Abn of bone shape
• St injury ® swelling, ligamentous rupture

• Onset insidious
• Destruction of vertebral bodies, discs, ligaments
• Structural stability destroyed
• Kyphosis and inflammatory debris + necrotic material compress SC ® progressive paraplegia

• Spectrum from discitis (child) to osteomyelitis (adult)
• Lumbar spine most commonly affected
• Haematogenous osteomyelitis ® first anterior portion of vertebral body, adjacent to endplate affected
• Radiographic changes take time
• Simultaneous involvement of 2 adjacent endplates with narrowing of IV disc plate

• Dramatic pain worsened by movement
• Persistent despite bed rest
• ­ with movement
• Fever not consistent
• Anorexia and wt loss
• Chill, night sweat, haemoptysis, chronic bronchial cough suggest infection
• Acute/ chronic
• Severe paraspinal muscle spasm associated with marked tenderness to palpation
• Pseudoscoliosis
• ¯ ROM
• Pt splint and guard to ¯ pain, ¯ bearing of wt
• Mass (usually lumbar) and concomitant deformity
• Neurological findings

• Disc space narrowing
• Endplate erosion
• Progressive vertebral body destruction
• Vertebral endplate sclerosis
• Spinal fusion (after this happens, no more movt \ no pain)

• No disc space narrowing until 24-36 months
• Large paravertebral ST mass with calcification (calcification only occurs in TB, not in pyogenic OM)
• TB involves 2 vertebra (1 above, 1 below) ® angular kyphosis
• Suspect TB ® CXR (upper lobe calcification?)

• ST swelling ® (1) Inflammation (2) Abscess - thoracic paravertebral, lumbar psoas, anterior cervical
• Disc space destruction
• TB - bony ankylosis
• Pyogenic - fibrous ankylosis

• Metastasis, from distant area (blood, lymph) accounts for 97% of all spinal column tumours
• Spine \ common site for metastasis
• Primaries ® lung, breast, prostate, kidney, GIT, thyroid

• Progressive
• Not related to activity, no response to rest (­ at night)
• Well-localised to spinal segment involved
• Reproduced by palpation/ percussion over involved area

• CBC, differential, sedimentation rate
• Serum and urine protein electrophoresis: if +ve ® bone survey + BM aspirate
• Renal US or abdominal CT
• Chest CT
• Bone scan
• P/E ® breast, prostate, rectal, thyroid

Tumour ® often eroded pedicle (but if no pedicle erosion, does not rule out tumour)

• Urinary retention
• Loss of anal tone (DRE) (Pt cough while PR) + loss of perianal sensation
• Urgent MRI to find site of compression
• Need to decompress (­ time ® ¯ prognosis)

• Anterior translocation of vertebra with step at back
• > 50% shift ® heart-shaped buttocks
• Hyperlordosis
• Shorter trunk
• Anterior abdominal fold
• Pelvic tilts so that buttocks stick out
• Tight hamstrings
• Aetiology
• Child - congenital; usually between L5/S1
• Adults - degenerative disease (eg. Arthritis; usually between L4/5
• Other

1. I ® ?
2. II ® 50%
3. III ® 75%
4. IV ® 100% slip
5. V ® whole vertebra drops down