1 / 33

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

pillan
Download Presentation

Spinal Injuries

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related