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Classification: General

Classification: General. Compression - Isolated wedge-type fractures of the anterior and middle aspects of the vertebral body Burst - C omminution of the vertebral body with involvement of the posterior cortex Flexion-distraction (seatbelt or chance type)

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Classification: General

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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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