S1

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S1 Posterior surface of lower limb

Little toe

Gastrocnemius Soleus

Plantar flexion of ankle (cannot stand on toes) Flexion of toes

Tibial nerve i ankle jerk

'Note the correspondence between the dermatome affected and the compressed nerve root {shaded).

16. Cervical column trauma a. Teardrop fracture

(1) Teardrop fracture is caused by hyperflexion of the cervical region (e.g., diving into shallow water, whiplash).

(2) It places the spinal cord at risk.

(3) Teardrop fractures include the following pathology: avulsion fracture of the vertebral body ("teardrop body"), fracture of the spinous process, posterior subluxation of vertebrae, compression of the spinal cord, tear of the anterior longitudinal ligament, and tear or disruption of the posterior longitudinal ligament, ligamentum flavum, interspinous ligament, or supraspinous ligament.

b. Jefferson fracture

(1) Jefferson fracture is caused by compression of the cervical region (e.g., force applied to the top of the head).

(2) It places the spinal cord at risk.

(3) It includes the following pathology: fracture of vertebra CI at multiple sites, lateral displacement or location of vertebra CI beyond the margins of vertebra C2, and tear of the transverse ligament.

c. Hangman fracture

(1) Hangman fracture is caused by hyperextension of the cervical region (e.g., hanging, car accident in which the chin strikes the dashboard).

(2) This fracture places the spinal cord at risk.

(3) It includes the following pathology: bilateral fracture of the pars interarticu-laris of vertebra C2, anterior subluxation of vertebra C2, tear of the anterior longitudinal ligament, and continued attachment of the fractured portion of vertebra C2 to vertebra C3 (e.g., in a legal drop hanging).

17. Thoracolumbar column trauma (Chance fracture)

a. Thoracolumbar column trauma is caused by hyperflexion of the thoracic or lumbar region (e.g., *seat belt injury" that occurs when a car occupant is restrained only by a lap seat belt; associated with intraabdominal injuries).

b. It usually does not place the spinal cord at risk.

c. It includes the following pathology: transverse fracture of the vertebral body and spinous process, rupture of the intervertebral disk, and tear of the posterior longitudinal ligament, ligamentum flavum, interspinous ligament, and supraspinous ligament.

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