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Comprehensive Overview of Spinal Injury Classifications and General Principles of Care

This document provides a detailed classification of spinal injuries including isolated wedge-type fractures, burst fractures, flexion-distraction injuries, and fracture-dislocations. It also outlines the general principles of care, emphasizing pre-hospital and in-hospital protocols, such as spine stabilization, differentiation of spinal shock causes, and critical clinical examinations. Important imaging techniques for spinal assessment, potential complications stemming from spinal cord injuries (SCI), and associated risks like thromboembolic disease and neuropathic pain are discussed.

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Comprehensive Overview of Spinal Injury Classifications and General Principles of Care

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  1. Classification: General • Compression - Isolated wedge-type fractures of the anterior and middle aspects of the vertebral body • Burst - Comminution of the vertebral body with involvement of the posterior cortex • Flexion-distraction (seatbelt or chance type) - Rarely through bone alone, may have ligamentous failure • Fracture dislocation - Involvement of anterior and posterior columns with translational deformity

  2. Classification: AO

  3. Classification: Denis

  4. General Principles of Care • Pre hospital care • ABCs of resuscitation • Stabilization of the spine • Cervical collar • Flat spine board

  5. General Principles of Care • In hospital resuscitation • Hypotension and bradycardia in an unconscious patient may be signs of spinal shock • Important to differentiate neurogenic shock from hypovolemic shock in patients with SCI • Strict spinal precautions in multiply injured/trauma patients should be followed

  6. General Principles of Care • Clinical Examination • General inspection for ecchymoses, open wounds • Detailed neurologic examination if possible in awake patients who are able to communicate • Direct palpation of the spine for tenderness bogginess, crepitus, malalignment, or areas of palpable step-off. • Log rolling patient to assess injuries to the back • Assessment of perianal sensation, rectal tone, bulbocavernosus reflex

  7. Spinal Shock • Usually occurs after injury to the spinal cord • The extent of injury and prognosis cannot be assessed reliably in patients in spinal shock • The absence of bulbocavernosus reflex initially may indicate spinal shock • Usually ends after 48 hours or when bulbocavernosus reflex returns

  8. General Principles of Care • Initial imaging • plain x-rays of thoracic and lumbar spine • Anteroposterior (AP) • Lateral • CT scan • Saggitalreconstuction • Coronal reconstruction • MRI

  9. Possible complications of SCI • Thromboembolic disease due to venous stasis and hypercoagulability • Autonomic dysfunction • Neuropathic pain • Neurogenic bladder • Neurogenic bowel • Heterotopic bone formation • Pressure ulceration • Spasticity • Sexual dysfunction and infertility • Psychologic maladjustment

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