Spine Archive: Flexion

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Flexion

Flexions or actions of bending typically occur at a limb or joint. The human spine has various directions it can move. In the spine, a flexion commonly refers to bending forward while a spinal extension is the action of bending backwards.

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Cervical Cord Neurapraxia

When localized trauma is concentrated to the cervical spinal cord, this injury is referred to as neurapraxia. This trauma can be induced by over extension, flexion of a limb beyond it’s normal limits, or “head down” contact involving the head (often seen in football). The symptoms of neurapraxia typically last for a short time but can be persistent for two days or more.

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Hip Deformities, Buffalo NY

Spasticity and myelomeningocele can lead to serious complications. Contact Dr. Leone to learn more.

Hip flexion contracture in children with myelomeningocele is caused by muscle imbalance, spasticity as seen in tethered cord patients, or habitual sitting posture. During the first two years of life, hip flexion contracture decreases except in high thoracic-level patients.¹

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.

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Spinal Injuries in Child Abuse, Buffalo New York

Find out more about spinal trauma in children here in Dr. Anthony Leone’s Knowledge Center.

These spinal cord injuries result from severe hyperflexion caused by violent shaking. it is an atypical form of the shaken baby syndrome, in that retinal and cerebral hemorrhages are absent. Any young child with a recent and/or sudden onset of spinal cord dysfunction should be considered a possible victim of child abuse. The child at high risk is one with an implausible history, especially if the child has other inadequately explained injuries of various ages.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Sports Injuries, Erie County

The demands of sports such as football can lead to serious spine injuries. Contact Dr. Leone for more information.

The incidence of cervical spine injuries in football players has been estimated to range from 10% to 15%. Lineman, defensive ends, and linebackers who perform a lot of tackling are at greater risk for these injuries. When cervical injuries do occur, the most likely mechanism is from flexion and axial loading of the neck. Until the injured player is brought to the emergency room, all pads and the helmet should be left on because significant alterations in cervical alignment can occur during removal of the protective equipment.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Fractures and Dislocations of the Subaxial Spine

The most commonly used classification system for subaxial spine injuries is the system developed by Allen and associates. Six distinct phylogenies were described based on mechanism of injury, with each phylogeny being subdivided into stages of progressive severity. The three commonly observed categories are compressive flexion, distractive flexion, and compressive extension. Vertical compression is observed less commonly, and the two least common categories are distractive extension and lateral flexion.

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.

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Fractures of the Odontoid

Fractures of the dens are frequently missed because of the paucity of clinical symptoms other than neck pain. In addition, if the patient suffers from head trauma or is intoxicated or obtunded, the injury can easily be missed. Both flexion and extension mechanisms can cause fractures of the dens. Hyperflexion results in anterior displacement of the dens fracture and hyperextention results in posterior displacement.

¹Abitbol MD, Jean-Jacques. Orthopaedic Knowledge Update: Spine. Rosemont: American Academy of Orthopaedic Surgeons, 2002.

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Traumatic Spondylolisthesis of the Axis

Traumatic spondylosisthesis of the axis (hangman’s fracture) can be caused by a variety of mechanisms including extension, flexion, or distraction of the cervical spine. The fracture line passes through the neural arch of the axis. These fractures are best classified using a modification of the Effendi classification.

¹Abitbol MD, Jean-Jacques. Orthopaedic Knowledge Update: Spine. Rosemont: American Academy of Orthopaedic Surgeons, 2002.

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Anterior Cord Syndrome

This syndrome is the result of damage to the anterior two thirds of the spinal cord, which receives its blood supply from the anterior spinal artery, the posterior columns are preserved. The classic mechanism of injury involves a flexion-compression force on the cervical spine. Patients will have minimal if any distal motor function because of damage to the lateral corticospinal tracts.

¹Abitbol MD, Jean-Jacques. Orthopaedic Knowledge Update: Spine. Rosemont: American Academy of Orthopaedic Surgeons, 2002.

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Flexion Rotation

The combination of flexion and rotation produces an injury similar to that described in pure flexion with the addition of a rotational component. This mechanism can lead to failure of all three columns and a grossly unstable injury. There may be anterior column compressive failure due to the flexion force as well as posterior disruption of the facet articulations, capsules, and ligamentous structures.

¹Abitbol MD, Jean-Jacques. Orthopaedic Knowledge Update: Spine. Rosemont: American Academy of Orthopaedic Surgeons, 2002.

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