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Spinal Trauma

Spinal Trauma. Re-written by: Daniel Habashi. Pathophysiology of spine injury. Division: A stable injury An unstable injury – anterior, middle, posterior column Neurological instability. Mechanism of injury. Traction injury Clay shoveller’s injury Direct injury

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Spinal Trauma

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  1. Spinal Trauma Re-written by: Daniel Habashi

  2. Pathophysiology of spine injury • Division: • A stable injury • An unstable injury – anterior, middle, posterior column • Neurological instability

  3. Mechanism of injury • Traction injury • Clay shoveller’s injury • Direct injury • Indirect injury (commonest) • Fall from height, violent free movement of the neck or the trunk • Forces: • Axial compression • Flexion • Extension • Lateral compression • Flexion-rotation • Shear • Flexion-distraction • Extension

  4. Principles of diagnosing and management • The spine must be immobilized • Thoracolumbar spine: log-rolling technique

  5. Diagnosis • History • Examination: • Neck: look, feel, but do not move • Shock: • Hypovolemic Shock • Neurogenic shock: paralysis, bradycardia, hypotension (atropine, vasopressors) • Spinal shock: temporal fail of the spinal cord

  6. Neurological examination • Cord longitudinal column function • Corticospinal tract (postero-lateral cord) • Ipsilateral motor power • Spinothalamic tract (antero-lateral cord) • Contra-lateral pain and temperature • Posterior column • Ipsilateral proprioception

  7. Unconscious patient • History of a fall or rapid deceleration • Head injury • Diaphragmatic breathing • Flaccid anal sphincter • Hypotension with bradycardia • Pain response above but not below the clavicle

  8. Muscle grading chart • A chart

  9. Tetraplegia • A picture about the respiration, sensation, reflex, and motor involvement at the level of C2/C3

  10. C4 • Can breath normally with the diaphragm (?) not quite sure... • Anyway, some more pictures about it. Perhaps well get the seminar so you can compare later.

  11. C5 • Again a picture. • Deltoid and biceps reflex present. We’ll c a patient like that 2mor so try to remember that

  12. Paraplegia • Sensory dermatomes of the trunk • T4: nipple • T6: xyphoid • T10: umbilicus • T12: Symphysis pubis

  13. Principles of definitive treatment • Preserve neurological function • Relieve any reversible neural compression • Restore alignment of the spine • Stabilize the spine • Rehabilitate the patient

  14. Pharmacological protection of the spinal cord • Methylprednisolone 30mg/kg/15 min • 45min break • 5.4 kg/h/24h if started within 6 hours after trauma for 24 hours • If started after a 6 hour delay then continue for 48 hours

  15. Imaging • X-ray high quality AP + lateral + open mouth (pulling down the shoulders, swimmers view)

  16. Imaging • CT scan • MRI • Etc.

  17. Imaging • Draw 3 lines in lateral view on an x-ray (for example) • Anterior line is on the anterior spines • Posterior line on the posterior spinal processes • 2nd line is on the tubercles • 3rd line is...well somewhere between the 2nd and 3rd;) and between those is the spinal cord ;)

  18. Upper cervical spine • Occipito-atlantal dislocation • C1 fracture • Odontoid fracture (C2) • Hangman’s fracture

  19. Odontoid fracture • Can be divided into 3 parts

  20. Hangman’s Fracture • A C2 fracture located along the pedicles. • Also divided into 3 types

  21. Lower Cervical Spine • Wedge compression fracture • Avulsion injury of the spinous process • Posterior ligament injury • Burst fracture • Tear-drop fracture • Flexion rotation injuries • Hyperextension injury • Cervical disc herniation • And 1 more

  22. Traumatic Paraplegia • Obtainable in thoracic spine injury and upper lumbar • L2/L3 is where the spinal cord ends

  23. Thoracolumbar Spine Injury • Compression and 3 more types, the same as mentioned earlier (basically same type of injuries as in the rest of the spine)

  24. Treatment • Conservative (corseted) • Traction (halo, skeletal) • Operative (anterior, posterior, lateral approach)

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