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Spinal Injuries

Spinal Injuries. Augustine A. Adeolu Senior Lecturer and Consultant Neurosurgeon NMA meeting, Oyo State May. 2013. Objectives. Familiar with common types of spinal injury Identify subtle symptoms and signs of spinal injury especially in incomplete injuries

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Spinal Injuries

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  1. Spinal Injuries Augustine A. Adeolu Senior Lecturer and Consultant Neurosurgeon NMA meeting, Oyo State May. 2013

  2. Objectives • Familiar with common types of spinal injury • Identify subtle symptoms and signs of spinal injury especially in incomplete injuries • Methods of preventing secondary injuries • Methods of preventing common complications in spinal injury • Aware of the common methods of managing spinal injury and their limitations

  3. Introduction • Edwin Smith Papyrus “If thou examinest a man having a dislocation in a vertebra of his neck, shouldst thou find him unconscious of his two arms (and) his two legs on account of it, while his phallus is erected on account of it, (and) urine drops from his member without his knowing it; his flesh has received wind; his two eyes are bloodshot; it is a dislocatxcion of a vertebra of his neck extending to his backbone which causes him to be unconscious of his two arms (and) his two legs. If, however, the middle vertebra of his neck is dislocated, it is an emissioseminis which befalls his phallus.Diagnosis: Thou shouldst say concerning him ….. An ailment not to be treated."

  4. Epidemiology • 40 cases/106 population or 11,000 new cases per year in US • Prevalence ~ 250,000 alive with SCI in US • Since 2000, the average age at injury is 37.6 years (prev28.7 years) • Approximately 80 cases are seen yearly in UCH, mostly complete injuries!!! • ~ 79.6% of subjects are male; M:F = 5:1 • Status at discharge: incomplete tetraplegia (34.5%), complete paraplegia (23.1%), complete tetraplegia (18.4%), and incomplete paraplegia (17.5%)

  5. Types of Injury Neuronal Injury: -Cord -Conus medullary -Cauda equina -Nerve Root Supporting Element Injury -Bone -Ligament -Disc

  6. Mechanism of Injury • Vertical Loading force • Hyperflexion/Hyperextension Injury • Lateral flexion • Flexion/rotation injury • Shearing force • Flexion-Distraction force [Seat-belt injuries] • Complex combination of these movt.

  7. Mechanisms of spinal cord injuries • Primary • Physical/Mechanical disruption: contusion, laceration, traction, transection • Secondary • Systemic Haemodynamic changes: Hypotension • Microvascular changes in the cord: haemo, reduction in bld flow, posttraumatic infarction • Compression from bld, disc, # bone • Spinal cord oedema • Electrolyte shift: Incr. i/c Ca, decr. i/c K • Free radical release from lipid peroxidation • Excitotoxic aa release eg glut, Asp

  8. Clinical Features/Diagnosis • History of accident • Back or neck pain • Stiff neck, • Unstable neck /back : neck or back falling forward • Neurologic deficit • Abraision forehead/ facial injuries • Spine: tenderness, swelling, gibbus,steppings, increased interspi space etc

  9. Frankel Classification of SCI • Absent motor and sensory function • Absent motor function with sensory sparing • Very weak motor function (not useful); sensation present • Weak but useful motor function; sensation present • Normal motor and sensory function

  10. Spinal Cord Injury Syndromes • Neurologically intact • Nerve root injury • Complete spinal cord injury • Incomplete spinal cord injury • Spinal Cord Syndromes • Anterior cord syndrome • Central cord syndrome • Posterior cord syndrome • Brown-Sequard syndrome • Conus medullaris syndrome • Cauda equina syndrome

  11. Spinal Cord Syndromes • Transverse Cord Lesion: • All sensory and motor pathways partially or completely interrupted. • Dermatomes affected will give localization

  12. Investigations -FBC, E&U, INR, PT,PTTK -X-ray C-spine: AP, Lat, OMV, ?obliq, (F-E) Th, Lumbosacral: AP,Lat, (FE) -CT scan,CT myelogram -MRI

  13. Management • Acc site • Transport to the hospital • Casualty • Definitive Bony element Resuscitation Reduction(Closed,open) Immobilisation(Closed,open) Rehabilitation

  14. Supportive management • Correct Hypotension • Regular turning two hourly • Exposure to good ventilation • Chest and limb physio • Clean intermittent catheterization • Anticoagulation • Liberal analgesia • ICU support when needed • Psychotherapy

  15. Figure 1 (Youmans, Neurological Surgery 4e)

  16. Figure 2 (Division of neurological surgery, Foothills Hospital Canada)

  17. Figure 3 (Adeolu et al technique, personal series)

  18. Fig 4 (Adeolu et al, Annals of African Medicine: In press

  19. Figure 5 (Adeolu, Ukachukwu, Malomo; NJPM: In press)

  20. Fig 6 (Personal Series)

  21. Fig 7 (personal series)

  22. Fig 8 (personal series)

  23. Fig 9 (personal series)

  24. Prognosis • Future trends

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