Spinal Injuries

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Spinal Injuries
Spinal Injuries

• Tawechai Tejapongvorachai, M.D.
• Department of OrthopaedicsChulalongkorn
  University

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Mechanism of spinal injuries.

• Flexion / extension
• Vertical compression / distraction
• Rotation
• Combined mechanisms

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Initial evaluation

• Complete clinical examination
• Radiological examination

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Objectives

• Classification of spinal injury
• Assessment of spinal stability
• Prognosis of recovery of neurological deficits

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Clinical Examination

• ABC
• Spinal examination
• Inspection
• Palpation
• Neurologic evaluation

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High suspicion associated injury

• Head injury
• Chest injury
• Abdominal injury

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Spinal stability

• Muscular tension
• Abdominal, thoracic pressures
• Rib cage
• Functional spinal unit

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Functional spinal unit

• Intervertebral disc
• Vertebral bodies
• Facet joints
• Ligaments

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Sagittal balance

• Cervical lordosis
• Thoracic kyphosis
• Lumbar lordosis
• Sacral kyphosis

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Instability

• Trauma
• Surgery
• Inflammatory / Infections
• Neoplasm
• Degenerative diseases

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History

• Mechanism of injury (force, velocity)
• Associated injuries

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Inspection

• Cervical collar, extremities splint
• Log-rolled Neck neutral position
• Abrasion , Laceration

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Palpation

• Spinous process
• Fluid collection
• Crepitus
• Increased interspinous distance
• Tenderness

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Neurologic evaluation

• Dermatomal sensory testing
• Motor function
• Reflex
• Spinal shock

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Spinal shock

• Neurogenic shock
• Flaccid parolysis
• Areflexia
• Bradycardia, Hypotension

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Termination of spinal shock

• Bulbocavernosus reflex
• Anal wink

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Spinal cord lesions

• Concussion
• Contusion
• Incomplete cord
• Complete cord

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Incomplete cord lesions

• Central cord syndrome
• Anterior cord syndrome
• Brown Squared syndrome
• Posterior cord syndrome

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Radiologic Evaluation

• Plain radiograph
• AP, lateral , open month, oblique
• Abdomen, CKR
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• Myelography

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Concept of spinal instability

• Two column spine (Holdsworth)
• Three Column spine (Denis)

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Classification of C-spine injuries

• Upper C-spine
• Occiput C1 dislocation
• Jeffersons fracture
• Odontoid fracture
• C1-2 rotatory instability
• Hangmans fracture

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Classification of C-spine injuries

• Lower C-spine
• Compression fracture
• Burst fracture
• Unilateral facet dislocation
• Bilateral facet dislocation
• Clay-Shovers fracture
• Fracture lateral mass
• Whiplash injuries

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Classification of T-L spine injuries

• Compression fractures
• Burst fractures
• Seat-belt injuries (flexion-dislocation)
• Fracture-dislocations

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Management

• Transportation
• Initial management
• Immobilization
• Medical stabilization
• Restoration of spinal alignment
• Definitive management
• Reduction stabilization
• Decompression
• Rehabilitation

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Transportation
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Immobilization (traction, external orthosis)

• Prevent further injuries
• .? Pain

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Medical stabilization

• Spinal shock
• Vasopressor, cardiac pressors
• Methyl prednisolone
• Calcium antagonists

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Reduction Stabilization

• Skull traction
• Postural reduction
• Skull traction femoral traction

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Spinal stabilization

• Unstable spinal fixation fusion(except
  Hangmans , chance fracture)
• Stable spinal orthosis, cast)

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Decompression

• Closed reduction (traction)
• Surgical decompression
• Laminectomy
• Corpectomy

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Cervical spine instability

• Fanning of Spinous process
• Widening of disc space
• Disruption of facet joint
• Severe wedging compression
• Multiple fracture
• Anterior subluxation gt 3.5 mm.
• Angulation of body gt 11o

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• Posterior subluxation
• Retrotracheal shadow (C6)gt15 mm.
• ADI gt 3 mm (gt5 mm in children)
• Hangmans fracture
• Odontoid fracture
• Burst, tear drop fracture

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Thank You
Thank You