Regardless of technique, the ultimate goal is to achieve a stable bony fusion in flexion, extension, and rotation as soon as possible. Metallic internal fixation devices provide stability and increase…

The pins are first tightened by hand, then with a torque wrench to 6 to 8 lb to engage the outer table of the skull. The torque should be rechecked…

The surgical approach to the anterior cervical spine has not significantly changed for decades, but the various means of stabilization have changed dramatically. Typically, a transverse incision centered on the…

The entire spinal column is at risk; 15% of fractures are multiple and involve different spinal segments. The cervical spine can be partially immobilized by a hard cervical collar, but…

Initially, as force is progressively applied, there is blunting of the anterosuperior aspect of the vertebral body, with the subsequent development of oblique fracture lines through the centrum of the…

In its more severe forms, the forces producing distractive flexion result in progressive anterior to posterior ligament failure in one or more cervical motion segments. With complete ligamentous failure, the…

The lumbosacral junction is mechanically imperfect because of its angulation and the consequent sloping platform provided for the fifth lumbar vertebra by the first sacral vertebra (see Plate 3-9). The…

In the first phase of injury, the posterior ligaments fail, allowing the facets to displace anteriorly. In the second phase, there is unilateral facet dislocation as the interspinous ligament, facet…

The broader base of the sacrum faces anterosuperiorly toward the abdomen; its elevated central third is the upper part of the first sacral vertebral body and bears a smooth oval…

The anterior longitudinal ligament is a straplike band that increases in width from above downward and extends from the anterior tubercle of the atlas to the sacrum. It is firmly…