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Thoraco-lumbar trauma

Thoraco-lumbar trauma. FRACTURE DISLOCATIONS ACUTE DISC PROLAPSE. POTENTIALLY DEVASTATING. FRACTURES. ASSOCIATED SOFT TISSUE TRAUMA COMPOUND FRACTURES OCCUR ASSOCIATED ORGAN ISSUES OTHER FRACTURES SPINAL CORD AND NERVE INJURIES. FRACTURE INVESTIGATIONS. PLANE X-RAY

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Thoraco-lumbar trauma

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  1. Thoraco-lumbar trauma FRACTURE DISLOCATIONS ACUTE DISC PROLAPSE SPINEWORKS

  2. POTENTIALLY DEVASTATING SPINEWORKS

  3. FRACTURES ASSOCIATED SOFT TISSUE TRAUMA COMPOUND FRACTURES OCCUR ASSOCIATED ORGAN ISSUES OTHER FRACTURES SPINAL CORD AND NERVE INJURIES SPINEWORKS

  4. FRACTURE INVESTIGATIONS PLANE X-RAY AP / LATERAL STANDING CONED LATERAL # DISLOCATION SPINEWORKS

  5. PLAIN XRAY SIGNS OF INSTABILITY PEDICLE WIDTH SPINEWORKS

  6. INVESTIGATION VIA CT SPINEWORKS

  7. BURST FRACTURES STABILITY RETROPULSED FRAGMENTS SCANS = SNAP SHOT, ? VIOLENCE TO THE SPINE CORD / CAUDA INJURY OPERATIVE / NONOPERATIVE SPINEWORKS

  8. POSSIBLE ASSOCIATED CORD INJURY[THORACIC INJURY] SPINEWORKS

  9. MECHANISM OF FRACTURE SPINEWORKS

  10. MECHANISM OF FRACTURE SPINEWORKS

  11. THREE COLUMN THEORY SPINEWORKS

  12. THREE COLUMN THEORY • ANTERIOR COLUMN: THE ANTERIOR COLUMN IS THE FRONT HALF OF THE VERTEBRAL BODY AND INTERVERTEBRAL DISC INCLUDING THE ANTERIOR LONGITUDINAL LIGAMENT. • MIDDLE COLUMN: THIS IS THE KEY PART OF SPINAL STABILITY. IT IS THE POSTERIOR PORTION OF THE VERTEBRAL BODY AND INTERVERTEBRAL DISC INCLUDING THE POSTERIOR LONGITUDINAL LIGAMENT. IF THERE'S A FRACTURE IN THE MIDDLE COLUMN IN ADDITION TO THE ANTERIOR OR POSTERIOR COLUMN THERE IS MUCH MORE LIKEHOOD OF NERVE DAMAGE AND SPINAL INSTABILITY. • POSTERIOR COLUMN: THIS INCLUDES THE PEDICLES, LAMINA, FACET JOINTS AND SPINOUS PROCESS. SPINEWORKS

  13. MAJOR AND MINOR FRACTURES • THIS IS A VERY SIMPLISTIC WAY TO TALK ABOUT FRACTURES: • A MINOR FRACTURE INVOLVES PART OF THE POSTERIOR ELEMENTS, THESE PARTS ARE NOT AS VITAL TO SPINAL STABILITY. THE POSTERIOR ELEMENTS INCLUDE THE SPINOUS PROCESS AND THE FACET JOINTS. • A MAJOR FRACTURE MEANS THAT PART OF THE VERTEBRAL BODY, THE PEDICLES OR THE LAMINA HAS BEEN FRACTURED. FRACTURING THE VERTEBRAL BODY IS CONSIDERED MAJOR BECAUSE OF THE ROLE IN WEIGHT BEARING AND FORCE DISTRIBUTION. BODY FRACTURES CAN LEAD TO DEFORMITY. FRACTURING THE PEDICLES OR LAMINA CAN LEAD TO NERVE DAMAGE. ADDITIONALLY, THE PEDICLES AND LAMINA PROVIDE STABILITY. SPINEWORKS

  14. FRACTURE STABILITY • THE STABILITY OF FRACTURES IS ANOTHER BASIC CLASSIFICATION FOR SPINAL FRACTURES. • STABLE FRACTURES DON'T CAUSE SPINAL DEFORMITY OR NEUROLOGICAL PROBLEMS. WITH A STABLE FRACTURE, THE SPINE CAN STILL CARRY AND DISTRIBUTE WEIGHT. • UNSTABLE FRACTURES CAUSE DIFFICULTY IN WEIGHT ABSORBTION. UNSTABLE FRACTURES ALSO HAVE A CHANCE OF PROGRESSING AND CAUSING FURTHER INJURY AND SPINAL DEFORMITY. SPINEWORKS

  15. SOME FRACTURE TYPES SPINEWORKS

  16. COMPRESSION FRACTURE • COMPRESSION FRACTURES: THIS TYPE OF FRACTURE IS VERY COMMON IN PATIENTS WITH OSTEOPOROSIS, OR PATIENTS WHOSE BONES ARE WEAKENED BY OTHER DISEASES (SUCH AS BONE TUMOURS). THE VERTEBRA CAN ABSORB AN AMOUNT OF PRESSURE; IF THERE'S A SUDDEN VIOLENT FORCE OR A MASSIVE INCREASE IN PRESSURE, THE BONE MAY NOT BE ABLE TO HANDLE THE STRESS. THIS CAN RESULT IN A FRACTURE. SPINEWORKS

  17. WEDGE FRACTURE • A WEDGE FRACTURE IS A SUBTYPE OF COMPRESSION FRACTURE. WITH A WEDGE FRACTURE, PART OF THE VERTEBRA, USUALLY THE ANTERIOR ASPECT, COLLAPSES UNDER PRESSURE AND BECOMES WEDGE SHAPED. SPINEWORKS

  18. BURST FRACTURES • BURST FRACTURE: BURST FRACTURES ARE CAUSED BY SEVERE TRAUMA (E.G., CAR OR RIDING ACCIDENTS). THEY HAPPEN WHEN THE VERTEBRA IS CRUSHED BY EXTREME FORCES. UNLIKE COMPRESSION FRACTURES, IT'S NOT JUST ONE PART OF THE VERTEBRA THAT'S FRACTURED. IN A BURST FRACTURE, THE VERTEBRA IS FRACTURED IN MULTIPLE PLACES. BECAUSE THE VERTEBRA IS CRUSHED COMPLETELY, BONY FRAGMENTS CAN SPREAD OUT AND CAUSE SPINAL CORD INJURY. BURST FRACTURES ARE MORE SEVERE THAN COMPRESSION FRACTURES. SPINEWORKS

  19. FLEXION-DISTRACTION • FLEXION-DISTRACTION FRACTURES: CAN OCCUR IN CAR ACCIDENTS WHEN THE BODY IS PUSHED FORWARD A FLEXION-DISTRACTION FRACTURE MAY OCCUR. THE SPINE CAN COPE WITH FLEXION, BUT IF THERE IS EXTREME FORCEABLE FLEXION THAT PLACES INCREDIBLE STRESS ON THE SPINE A FRACTURE CAN OCCUR. IN CONTEXT OF THE THREE-COLUMN CONCEPT, A FLEXION-DISTRACTION FRACTURE USUALLY CAUSES FRACTURES IN THE POSTERIOR AND MIDDLE COLUMN. SPINEWORKS

  20. FRACTURE DISLOCATION • FRACTURE-DISLOCATION: THIS CAN OCCUR IN ASSOCIATION WITH MOST FRACTURE TYPES. THESE FRACTURES USUALLY INVOLVE ALL THREE COLUMNS FROM THE THREE-COLUMN CONCEPT, AND THEY ARE ASSOCIATED WITH GROSS INSTABILITY. SPINEWORKS

  21. CHANCE FRACTURES TRANSVERSE # VIA DISC OR BONE [UNSTABLE] SPINEWORKS

  22. FRACTURE PATTERNS SPINEWORKS

  23. TREATMENT OPTIONSSPINAL BRACES SPINEWORKS

  24. OSTEOPOROTIC FRACTURES SPINEWORKS

  25. VERTEBROPLASTY / KYPHOPLASTY SPINEWORKS

  26. SURGERY SPINEWORKS

  27. POSTERIOR OPERATIVE STABILISATION SPINEWORKS

  28. POSTERIOR REDUCTION AND FIXATION USING PEDICLE SCREWS SPINEWORKS

  29. ANTERIOR RECONSTRUCTION WITH CAGES SPINEWORKS

  30. QUITE LARGE EXPOSURE SPINEWORKS

  31. CAGE INSERTED SPINEWORKS

  32. 360 DEGREE FIXATION SPINEWORKS

  33. KYPHOSIS AFTER FIXATION SPINEWORKS

  34. CT AFTER COLLAPSE SPINEWORKS

  35. ASSOCIATED DISC INJURY SPINEWORKS

  36. ASSOCIATED DISC INJURY SPINEWORKS

  37. THORACO-LUMBAR DISLOCATIONS SPINEWORKS

  38. FRACTURE DISLOCATION SPINEWORKS

  39. THORACIC DISC PROLAPSE SPINEWORKS

  40. MASSIVE DISC PROLAPSE SPINEWORKS

  41. CAUDA EQUINACONSTALATION OF SYMPTOMS • SIGNS INCLUDE WEAKNESS OF THE MUSCLES OF THE LOWER EXTREMETIES INNERVATED BY THE COMPRESSED ROOTS (OFTEN PARAPLEGIA), SPHINCTER WEAKNESSES CAUSING URINARY RETENTION AND POST-VOID RESIDUAL INCONTINENCE AS ASSESSED BY CATHETERIZING AFTER THE PATIENT HAS URINATED. ALSO, THERE MAY BE DECREASED ANAL TONE AND CONSEQUENT FECAL INCONTINENCE; SEXUAL DYSFUNCTION; SADDLE ANESTHESIA; BILATERAL LEG PAIN AND WEAKNESS; AND BILATERAL ABSENCE OF ANKLE REFLEXES. PAIN MAY, HOWEVER, BE WHOLLY ABSENT; THE PATIENT MAY COMPLAIN ONLY OF LACK OF BLADDER CONTROL AND OF SADDLE-ANAESTHESIA, AND MAY WALK INTO THE CONSULTING-ROOM. • DIAGNOSIS IS USUALLY CONFIRMED BY AN MRI SCAN OR CT SCAN, DEPENDING ON AVAILABILITY. IF CAUDA EQUINA SYNDROME EXISTS, SURGERY IS AN OPTION DEPENDING ON THE ETIOLOGY DISCOVERED AND THE PATIENT'S CANDIDACY FOR MAJOR SPINE SURGERY. SPINEWORKS

  42. CAUDA EQUINA • CAUSES • AFTER THE CONUS MEDULLARIS, THE CANAL CONTAINS A MASS OF NERVES (THE CAUDA EQUINA OR "HORSE-TAIL") THIS CONTAINS THE NERVE ROOTS FROM L1-5 AND S1-5. THE NERVE ROOTS FROM L4-S4 JOIN IN THE SACRAL PLEXUS WHICH AFFECTS THE SCIATIC NERVE. • TUMORS AND LESIONS • ANY LESION WHICH COMPRESSES OR DISTURBS THE FUNCTION OF THE CAUDA EQUINA MAY CAUSE NEUROLOGY ALTHOUGH THE MOST COMMON IS A CENTRAL DISC PROLAPSE. METASTATIC DISEASE MAY ALSO BE A CAUSE. TRAUMA • DIRECT TRAUMA FROM LUMBAR PUNCTURE CAN ALSO CAUSE CAUDA EQUINA SYNDROME. OTHER TRAUMA-RELATED CAUSES INCLUDE BURST FRACTURES RESULTING IN POSTERIOR MIGRATION OF FRAGMENTS OF THE VERTEBRAL BODY, SEVERE DISC HERNIATIONS, PENETRATING TRAUMA SUCH AS KNIFE WOUNDS OR BALLISTIC TRAUMA. • SPINAL STENOSIS • CES CAN BE CAUSED BY LUMBAR SPINAL STENOSIS, WHICH IS WHEN THE DIAMETER OF THE SPINAL CANAL NARROWS. THIS COULD BE THE RESULT OF A DEGENERATIVE PROCESS OF THE SPINE (SUCH AS OSTEOARTHRITIS) OR A DEVELOPMENTAL DEFECT WHICH IS PRESENT AT BIRTH. IN THE MOST SEVERE CASES OF SPONDYLOLISTHESIS CAUDA EQUINA SYNDROME CAN RESULT. INFLAMMATORY CONDITIONS • CHRONIC SPINAL INFLAMMATORY CONDITIONS SUCH AS PAGET DISEASE, CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY AND ANKYLOSING SPONDYLITIS CAN CAUSE IT. THIS IS DUE TO THE SPINAL CANAL NARROWING THAT THESE KIND OF SYNDROMES CAN PRODUCE SPINEWORKS

  43. TREATMENT OF CAUDA EQUINA • SURGERY WITHIN 48HRS SPINEWORKS

  44. THANK YOU SPINEWORKS

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