Transcript Spinal Injuries Tawechai Tejapongvorachai, M.D. Department

Spinal Injuries
Tawechai Tejapongvorachai, M.D.
Department of Orthopaedics
Chulalongkorn University
Mechanism of spinal injuries.
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Flexion / extension
Vertical compression / distraction
Rotation
Combined mechanisms
Initial evaluation
• Complete clinical examination
• Radiological examination
Objectives
• Classification of spinal injury
• Assessment of spinal stability
• Prognosis of recovery of
neurological deficits
Clinical Examination
• ABC
• Spinal examination
–Inspection
–Palpation
–Neurologic evaluation
High suspicion
associated injury
• Head injury
• Chest injury
• Abdominal injury
Spinal stability
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Muscular tension
Abdominal, thoracic pressures
Rib cage
Functional spinal unit
Functional spinal unit
• Intervertebral disc
• Vertebral bodies
• Facet joints
• Ligaments
Sagittal balance
• Cervical lordosis
• Thoracic kyphosis
• Lumbar lordosis
• Sacral kyphosis
Instability
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Trauma
Surgery
Inflammatory / Infections
Neoplasm
Degenerative diseases
History
• Mechanism of injury
(force, velocity)
• Associated injuries
Inspection
• Cervical collar, extremities
splint
• Log-rolled + Neck neutral
position
• Abrasion , Laceration
Palpation
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Spinous process
Fluid collection
Crepitus
Increased interspinous distance
Tenderness
Neurologic evaluation
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Dermatomal sensory testing
Motor function
Reflex
Spinal shock
Spinal shock
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Neurogenic shock
Flaccid parolysis
Areflexia
Bradycardia, Hypotension
Termination of
spinal shock
• Bulbocavernosus reflex
• Anal wink
Spinal cord lesions
• Concussion
• Contusion
– Incomplete cord
– Complete cord
Incomplete cord lesions
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Central cord syndrome
Anterior cord syndrome
Brown – Squared syndrome
Posterior cord syndrome
Radiologic Evaluation
• Plain radiograph
– AP, lateral , open month, oblique
– Abdomen, CKR
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• Myelography
Concept of spinal
instability
• Two column spine (Holdsworth)
• Three Column spine (Denis)
Classification of
C-spine injuries
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Upper C-spine
Occiput – C1 dislocation
Jefferson’s fracture
Odontoid fracture
C1-2 rotatory instability
Hangman’s fracture
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
Classification of T-L spine
injuries
• Compression fractures
• Burst fractures
• Seat-belt injuries (flexiondislocation)
• Fracture-dislocations
Management
• Transportation
• Initial management
– Immobilization
– Medical stabilization
– Restoration of spinal alignment
• Definitive management
– Reduction + stabilization
– Decompression
– Rehabilitation
Transportation
Immobilization (traction,
external orthosis)
• Prevent further injuries
• . Pain
Medical stabilization
• Spinal shock
– Vasopressor, cardiac pressors
– Methyl prednisolone
– Calcium antagonists
Reduction + Stabilization
• Skull traction
• Postural reduction
• Skull traction + femoral traction
Spinal stabilization
• Unstable – spinal fixation + fusion
(except Hangman’s , chance
fracture)
• Stable – spinal orthosis, cast)
Decompression
• Closed reduction (traction)
• Surgical decompression
– Laminectomy
– Corpectomy
Cervical spine instability
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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
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Posterior subluxation
Retrotracheal shadow (C6)>15 mm.
ADI > 3 mm (>5 mm in children)
Hangman’s fracture
Odontoid fracture
Burst, tear drop fracture
Thank You