Main description:

Progress in traumatology of the vertebral spine has been restrained for a long time by two hindering factors. The first obstacle is presented by the differences in approach and a conflict of competences. The neurosurgeons, considering only the spinal chord, have confined themselves to indications for laminectomy, an insufficient and usually ineffective intervention. The orthopedic surgeons, on the other hand, obsessed by the fear of medullary lesions, have long hesitated to apply the fundamental rules for the treatment of fractures, namely precise reduction followed by strict immobilization, thus depriving themselves of the efficacy of radiculomedul lar decompression and of the protection this procedure affords to these structures when they are themselves involved in the trauma. Taking these facts into account, together with the rather poor results of laminectomy, the specialists have wisely and successfully recommended that one should abstain from treating the initial lesion, but rather attenuate the damage by appropiate nursing care and adequate reeducation. The second hindering factor was the insufficient knowledge of the extreme complexity of the anatomic lesions. This explains the orthopedists' relative caution; one only treats well what one knows well. More precise analysis of the lesions, not only of the bones but also of the joints, i. e., the osteofibrous involvement, is mainly based on strict radiologic semiology, which is rendered difficult because these structures are simultaneously affected. We are greatly indebted to Dr. DOSCH, radiologist at our Center, for having untertaken this difficult task, using all available conventional radiologic techniques.

Contents:

1 Descriptive and Functional Anatomy.- A. Descriptive Anatomy.- I. Vertebral Body.- 1. Cervical Segment.- 2. Dorsal Segment.- 3. Lumbar Segment.- II. Articular Pillars.- 1. Cervical Segment.- 2. Dorsal Segment.- 3. Lumbar Segment.- III. Bony Bridges: Pedicles and Laminae.- IV. Accessory Processes.- 1. Transverse.- 2. Spinous.- V. Intervertebral Means of Union.- 1. Vertebral Bodies.- 2. Posterior Arches.- B. Functional Anatomy.- I. Static Role.- II. Dynamic Role.- III. Neuroprotective Role.- 2 Trauma of the Cervical Spine.- A. Radiologic Investigation Techniques.- I. Conventional Roentgenograms.- 1. Cervico-occipital Joint.- 2. Middle and Lower Cervical Spine.- II. Tomographic Investigation.- B. Correlations Between Incidence and Radiographic Image.- C. Guide for Interpretation.- I. Cervico-occipital Joint.- II. Mobile Cervical Segment from C3 to C7.- 1. Alignment of the Vertebrae.- 2. Distances Between the Vertebrae.- D. Basic Radiosemiology of Cervical Lesions.- I. Upper Cervical Segment C0 to C2.- 1. Lesions of the Atlas Vertebra.- 2. Lesions of the Axis Vertebra.- II. Median and Lower Cervical Segment (C3 to C7).- 1. Corporeal Lesions.- 2. Lesions of the Posterior Arch.- 3. Sprains and Luxations.- 3 Traumas of the Thoracic and Lumbar Spine.- A. Radiologic Investigation Techniques.- I. Conventional Roentgenograms.- 1. Thoracic Spine.- 2. Lumbar Spine.- II. Tomographic Investigation.- B. Elementary Radiosemiology.- II. Lesions of the Posterior Arch.- 1. Isolated Lesions.- 2. Associated with Body Lesions.- III. Luxations and Sprains.- 1. Isolated Lesions.- 2. Associated with Body Lesions.- IV. Soft Parts.- 4 Comprehensive Study.- A. Lesional Diagnosis.- I. Rupture in the Continuity.- II. Displacements and Listhesis.- III. Vasculonervous Complications.- 1. Nervous Complications.- 2. Vascular Complications.- B. Dynamic Functional Diagnosis.- I. Bony Instability.- II. Discoligamentous Instability.- C. Genesis of Lesions.- 5 Classification.- A. Lesions Caused by Distraction Forces.- I. In Flexion.- 1. Discoligamentous Lesions.- 2. Bony Lesions (Seat-Belt Fracture).- II. In Extension.- 1. Discoligamentous Lesions.- 2. Bony Lesions.- B. Lesions Caused by Compression.- I. In Flexion.- 1. Partial or Anterior Wedge Compression.- 2. Global Compression.- 3. Body Fractures.- 4. Tear-Drop Fracture Type I.- II. In Extension.- 1. Fracture of the Spinous Processes and Laminae.- 2. Fracture of the Articular Pillars.- 3. Fracture of the Pedicles.- C. Lesions Caused by Rotation.- I. Cervical Segment.- II. Lumbar Segment.- D. Lesions Caused by Shearing Movements.- Conclusions.- References.