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Spinal Injuries

Spinal Injuries. Spinal Injuries. Tawechai Tejapongvorachai, M.D. Department of Orthopaedics Chulalongkorn University. Mechanism of spinal injuries. Flexion / extension Vertical compression / distraction Rotation Combined mechanisms. Initial evaluation. Complete clinical examination

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Spinal Injuries

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  1. Spinal Injuries Spinal Injuries Tawechai Tejapongvorachai, M.D. Department of OrthopaedicsChulalongkorn University

  2. Mechanism of spinal injuries. • Flexion / extension • Vertical compression / distraction • Rotation • Combined mechanisms

  3. Initial evaluation • Complete clinical examination • Radiological examination

  4. Objectives • Classification of spinal injury • Assessment of spinal stability • Prognosis of recovery of neurological deficits

  5. Clinical Examination • ABC • Spinal examination • Inspection • Palpation • Neurologic evaluation

  6. High suspicion associated injury • Head injury • Chest injury • Abdominal injury

  7. Spinal stability • Muscular tension • Abdominal, thoracic pressures • Rib cage • Functional spinal unit

  8. Functional spinal unit • Intervertebral disc • Vertebral bodies • Facet joints • Ligaments

  9. Sagittal balance • Cervical lordosis • Thoracic kyphosis • Lumbar lordosis • Sacral kyphosis

  10. Instability • Trauma • Surgery • Inflammatory / Infections • Neoplasm • Degenerative diseases

  11. History • Mechanism of injury (force, velocity) • Associated injuries

  12. Inspection • Cervical collar, extremities splint • Log-rolled + Neck neutral position • Abrasion , Laceration

  13. Palpation • Spinous process • Fluid collection • Crepitus • Increased interspinous distance • Tenderness

  14. Neurologic evaluation • Dermatomal sensory testing • Motor function • Reflex • Spinal shock

  15. Spinal shock • Neurogenic shock • Flaccid parolysis • Areflexia • Bradycardia, Hypotension

  16. Termination of spinal shock • Bulbocavernosus reflex • Anal wink

  17. Spinal cord lesions • Concussion • Contusion • Incomplete cord • Complete cord

  18. Incomplete cord lesions • Central cord syndrome • Anterior cord syndrome • Brown – Squared syndrome • Posterior cord syndrome

  19. Radiologic Evaluation • Plain radiograph • AP, lateral , open month, oblique • Abdomen, CKR • Computed tomography (CT scan) • Magnetic resonance imaging (MRI) • Myelography

  20. Concept of spinal instability • Two column spine (Holdsworth) • Three Column spine (Denis)

  21. Classification of C-spine injuries • Upper C-spine • Occiput – C1 dislocation • Jefferson’s fracture • Odontoid fracture • C1-2 rotatory instability • Hangman’s fracture

  22. Classification of C-spine injuries • Lower C-spine • Compression fracture • Burst fracture • Unilateral facet dislocation • Bilateral facet dislocation • Clay-Shover’s fracture • Fracture lateral mass • Whiplash injuries

  23. Classification of T-L spine injuries • Compression fractures • Burst fractures • Seat-belt injuries (flexion-dislocation) • Fracture-dislocations

  24. Management • Transportation • Initial management • Immobilization • Medical stabilization • Restoration of spinal alignment • Definitive management • Reduction + stabilization • Decompression • Rehabilitation

  25. Transportation

  26. Immobilization (traction, external orthosis) • Prevent further injuries • . Pain

  27. Medical stabilization • Spinal shock • Vasopressor, cardiac pressors • Methyl prednisolone • Calcium antagonists

  28. Reduction + Stabilization • Skull traction • Postural reduction • Skull traction + femoral traction

  29. Spinal stabilization • Unstable – spinal fixation + fusion(except Hangman’s , chance fracture) • Stable – spinal orthosis, cast)

  30. Decompression • Closed reduction (traction) • Surgical decompression • Laminectomy • Corpectomy

  31. Cervical spine instability • Fanning of Spinous process • Widening of disc space • Disruption of facet joint • Severe wedging compression • Multiple fracture • Anterior subluxation > 3.5 mm. • Angulation of body > 11o

  32. Posterior subluxation • Retrotracheal shadow (C6)>15 mm. • ADI > 3 mm (>5 mm in children) • Hangman’s fracture • Odontoid fracture • Burst, tear drop fracture

  33. Thank You Thank You

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