Injuries of the spine Injuries of the spine.pptx

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1. Injuries of the spine Stable and unstable injuries :

2. # A stable injury is one in which the vertebral components will not be displaced by normal movements; in a stable injury, if the neural elements are undamaged there is little risk of them becoming damaged . # An unstable injury is one in which there is a significant risk of displacement and consequent damage – or further damage – to the neural tissues . # All fractures involving the middle column and at least one other column should be regarded as unstable. ـ

3. Mechanism of injury Traction injury : In the lumbar spine resisted muscle effort may avulse transverse processes; in the cervical spine the seventh spinous process can be avulsed . Direct injury : Penetrating injuries to the spine, particularly from firearms and knives, are becoming increasingly common. Indirect injury : This is the most common cause of significant spinal damage; it occurs most typically in a fall from a height when the spinal column collapses in its vertical axis, or else during violent free movements of the neck or trunk.

4. PRINCIPLES OF DIAGNOSIS AND INITIAL MANAGEMENT Early management airway cervical spine control, breathing, circulation and haemorrhage control

5. Methods of temporary immobilization CERVICAL SPINE In-line immobilization The head and neck are supported in the neutral position. QUADRUPLE IMMOBILIZATION A backboard, sandbags, a forehead tape and a semirigid collar are applied. Because children have a relatively prominent occiput, care must be taken to ensure that the neck is not flexed: padding may be required behind the shoulders. Thoracolumbar spine The patient should be moved without flexion or rotation of the thoracolumbar spine. A scoop stretcher and spinal board are very useful; however in the paralysed patient, there is a high risk of pressure sores – adequate padding is essential and transfer to a special bed must be undertaken as soon as possible . If the back is to be examined, or if the patient is to be placed onto a scoop stretcher or spinal board, the logrolling technique should be used.

6. DIAGNOSIS History Examination NECK BACK

7. GENERAL EXAMINATION – ‘SHOCK ’ Hypovolaemic shock Neurogenic shock Spinal shock : occurs when the spinal cord fails temporarily following injury . NEUROLOGICAL EXAMINATION

8. IMAGING X-ray CT MRI

9. Treatment # PRINCIPLES OF DEFINITIVE TREATMENT The objectives of treatment are: • to preserve neurological function; • to minimize a perceived threat of neurological compression ; • to stabilize the spine; • to rehabilitate the patient. # Treatment options for thoracic and lumbar spine injuries include symptomatic treatment with reassurance, brace or cast immobilization, and spinal fusion with or without decompression .

10. NONSURGICAL TREATMENT # Minor fractures usually require nothing more than symptomatic treatment. # Patients with minor fractures may be treated with a few days of bed rest, followed by a gradual return to normal activities. Bracing is not required. # Most patients with compression fractures are more comfortable with an extension brace. # Studies have shown no difference between bed rest and casting. # We treat the majority of burst fractures in neurologically intact patients with a period of bed rest, followed by 6 to 12 weeks in a cast or thoracolumbosacral orthosis .

11. SURGICAL TREATMENT The indications for urgent surgical stabilization are: 1# an unstable fracture with progressive neurological deficit and MRI signs of likely further neurological deterioration. 2# controversially an unstable fracture in a patient with multiple injuries . 3# the presence of neurologic deficits, seat belt injuries with posterior ligamentous injuries, burst fractures not amenable to conservative treatment, and fracture-dislocations .

12. # Surgical treatment consists of spinal fusion with or without decompression . # We recommend decompression for all patients with incomplete neurologic injury. # Ideally, decompression should be performed in the first 8 hours after injury . # Most ligamentous seat belt injuries can be treated by simple posterior fusion.

13. # Burst fractures not amenable to conservative treatment and fracture-dislocations may be managed with either anterior or posterior fusion. In general, we prefer a posterior approach for reduction, decompression, and stabilization.

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