If MRI is not feasible because of metallic implants like e.g. pacemaker or vessel clips, functional lateral x-rays in traction, https://www.selleckchem.com/products/JNJ-26481585.html extension and flexion or dynamic fluoroscopy can be performed by the experienced physician to visualize instability by e.g. intervertebral space widening [56, 58]. In addition to these signs of instability in the cervical spine, further injuries give way for diagnosis of instable thoracic and lumbar spine trauma. Fractures, especially serial fractures of the transverse process and

ribs account for instable, type C rotational injury. Patients with associated sternal fractures following hyperflexion injury in e.g. restrained motor vehicle passengers might suffer from discoligamentous posterior column injury (assigned type B) of the upper thoracic spine. In selleck kinase inhibitor contrast, retroperitoneal bleeding as shown in contrast medium selleck chemical CT-Scan is often associated with instable anterior spine injury from hyperextension to the thoracolumbar region. McLain and Benson reported that anterior vertebral body height loss of more than 50%, sagittal angulation of more than 25°, three-column injury, primary neurologic deficit and serial vertebral fracture are associated with instable spine injuries [28]. Classification and need to surgical stabilization Due to a similar vertebral structure, injuries to the

subaxial spinal column are classified according to Magerl et al. [72]. Various reports address this classification and the reader is kindly referred to these articles. In brief, based on Decitabine in vitro the two column concept of Whitesides from 1977 [73], injuries are classified by the injuring mechanical force applied to the spine and the consecutive fracture pattern of the vertebral column (see Figure 2). Regarding the given recommendations in this section, the reader should be aware that these can only rely on a hand full of RCTs and low-quality studies that have been published so far [74–80], as well as on third opinion and the article author’s personal experience. Controversial discussion regarding

all questions on where, how and when to perform surgery or even use conservative treatment strategies has been going on and will endure as long as no high-quality trials are published [79, 81–83], as it was brought up in a recent Cochrane review on thoracolumbar fractures [84], being able to enter only one poor-quality study into their review article which precluded firm conclusions. Figure 2 Classification of spinal injury and treatment recommendation in the polytraumatized patient. Classification of Magerl et al. (1993) [72] based on the two column concept of Whitesides (1977)[73]. The mechanism of applied forces to the spine generates specific fractures. Pure axial compression results in type A fractures. Distraction leads to type B and rotational momentum with compression or distraction results in type C fractures. Type A1 and A2 (except for A2.3) are regarded as stable. Whereas burst fractures, especially higher rated A3.