Thoracolumbar fractures

1. What is a Chance fracture? Are they associated with neurological compromise?
2. What is a vertebral body compression fracture? Is this fracture stable?
3. What is the result of multiple compression fractures?
4. How does spinal cord injury without radiological abnormality (SCIWORA) occur in children? What factors predispose to SCIWORA?
5. How does SCIWORA occur in the elderly? What is the treatment?

Answers:
1. Chance is a transverse fracture of the lumbar spine through body and pedicles, posterior elements, commonly associated with lapbelts. They are seldom associated with neurological compromise.
2. This is an anterior wedge fracture caused by axial compression and is stable if it occurs spontaneously.
3. Thoracic kyphosis (Dowager hump).
4. Mechanism is traction in a breech delivery or violent hyperextension or flexion. Predisposing factors include large head to neck ratio, elasticity of fibrocartilaginous spine, and horizonal orientation of the planes of the cervical facet joints.
5. Mechanism is a forward fall with a blow to the head causing central cord syndrome. Due to bulging of the ligamentum flavum, there may be narrowing of the canal by up to 50%. It is treated with 24 hr cervical collar and repeat films.