Spinal lnjury lecture for MBBS Class.pptx

MBBS lecture

1. Bikram Shakya, 16 Oct. 2024 Spinal injury (Management, Prevention and Prognosis) Kathmandu Medical College Teaching Hospital (KMCTH)

2. Learning Objectives Understand the anatomy and physiology of the spinal cord and vertebral column. Identify common mechanisms of spinal injury. Classify spinal injuries based on the affected region and severity. Diagnose and assess spinal injuries using clinical signs, imaging, and assessment tools. Discuss the acute management, stabilization, and long-term rehabilitation strategies. Recognize potential complications and their management Spine injury

3. Spine injury Introduction Spine injuries refer to trauma or pathology affecting the vertebral column, which may or may not involve the spinal cord. Globally, spine injuries occur most frequently due to road traffic accidents (RTAs) and falls. In Nepal, a significant proportion of spine injuries are related to falls and traffic accidents. Fehlings MG, et al. A global perspective on the outcomes of surgical management of acute traumatic spinal cord injury. Lancet Neurol . 2018;17(5):446-456. Lee BB, Cripps RA, Fitzharris M, Wing PC. The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord . 2014;52(2):110-116. Shrestha B, Shrestha L, Ojha S, Gurung G. Epidemiology of spinal injuries in Nepal: A hospital-based study. Nepal J Neurosci . 2021;15(2):23-27.

4. Spine injury Introduction Epidemiology : Global incidence: 10-83 cases per million annually. Nepal-specific data: Rising cases due to road traffic accidents (RTAs). High-Risk Groups : Trauma-related injuries (young adults). Falls (elderly population). Road traffic accidents. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol . 2014;6:309-331.

5. Spine injury Mechanisms of Spine Injuries Traumatic causes : RTAs account for the highest percentage of spine injuries worldwide 6 Falls are a common cause, especially in elderly populations 7 Sports-related injuries and violence (gunshots, stab wounds) are also significant 8 Non-traumatic causes : Degenerative spine diseases, such as herniated discs and osteophyte formation, can also lead to spine injuries 9 6. World Health Organization. Spinal Cord Injury Facts. WHO; 2020. 7. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol . 2014;6:309-331. 8. Lafta R, et al. Spinal injuries caused by violence: A global study. J Trauma Inj Infect Crit Care . 2019; 87(2):35-42. 9. Krishnan P, Jaiswal AK, Sharma V. Epidemiology of spinal tuberculosis in India: A comprehensive review. Indian J Neurosurg . 2018;7(1):65-70

6. Spine injury Classification of Spine Injuries Any injury affecting spinal cord, vertebral column or both Classification: By region : Cervical, thoracic, lumbar, and sacral injuries differ based on the affected vertebrae 10 . By severity : Vertebral fractures, dislocations, and compression injuries 11 . Complete vs. incomplete spine injuries based on the degree of vertebral and structural damage 12 . Traumatic spinal injuries (caused by external forces like accidents or falls) and Non-traumatic spinal injuries (due to diseases like infections or tumors). Complete , involving total loss of function below the injury, or Incomplete , where some motor or sensory function remains Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol . 2014;6:309-331. 0. Fehlings MG, et al. A clinical practice guideline for the management of acute spinal cord injury: Introduction, rationale, and scope. Global Spine J . 2017;7(3S):84S-94S. 11. Vaccaro AR, et al. Spine trauma: Operative treatment strategies. Spine J . 2013;13(3):221-229. 12. American Spinal Injury Association. International Standards for Neurological Classification of Spinal Cord Injury . 9th ed. ASIA; 2019.

7. Spine injury Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord Structure : Ascending tracts (sensory pathways). Descending tracts (motor pathways). Functional zones: Gray matter, white matter. Vertebral Column Regions : Cervical, thoracic, lumbar, sacral, coccygeal. Neurovascular Supply : Spinal arteries (anterior and posterior). Clinical relevance in injury (ischemia, vascular compromise).

8. Spine injury Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord Structure : Ascending tracts (sensory pathways). Descending tracts (motor pathways). Functional zones: Gray matter, white matter. Vertebral Column Regions : Cervical, thoracic, lumbar, sacral, coccygeal. Neurovascular Supply : Spinal arteries (anterior and posterior). Clinical relevance in injury (ischemia, vascular compromise).

9. Spine injury Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord Structure : Ascending tracts (sensory pathways). Descending tracts (motor pathways). Functional zones: Gray matter, white matter. Vertebral Column Regions : Cervical, thoracic, lumbar, sacral, coccygeal. Neurovascular Supply : Spinal arteries (anterior and posterior). Clinical relevance in injury (ischemia, vascular compromise).

10. Spine injury Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord Structure : Ascending tracts (sensory pathways). Descending tracts (motor pathways). Functional zones: Gray matter, white matter. Vertebral Column Regions : Cervical, thoracic, lumbar, sacral, coccygeal. Neurovascular Supply : Spinal arteries (anterior and posterior). Clinical relevance in injury (ischemia, vascular compromise).

11. Spine injury Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord Structure : Ascending tracts (sensory pathways). Descending tracts (motor pathways). Functional zones: Gray matter, white matter. Vertebral Column Regions : Cervical, thoracic, lumbar, sacral, coccygeal. Neurovascular Supply : Spinal arteries (anterior and posterior). Clinical relevance in injury (ischemia, vascular compromise).

12. Spine injury Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord Structure : Ascending tracts (sensory pathways). Descending tracts (motor pathways). Functional zones: Gray matter, white matter. Vertebral Column Regions : Cervical, thoracic, lumbar, sacral, coccygeal. Neurovascular Supply : Spinal arteries (anterior and posterior). Clinical relevance in injury (ischemia, vascular compromise).

13. Spine injury Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord Structure : Ascending tracts (sensory pathways). Descending tracts (motor pathways). Functional zones: Gray matter, white matter. Vertebral Column Regions : Cervical, thoracic, lumbar, sacral, coccygeal. Neurovascular Supply : Spinal arteries (anterior and posterior). Clinical relevance in injury (ischemia, vascular compromise).

14. Spine injury Mechanisms of Spinal Injuries Traumatic Causes : Road traffic accidents (RTAs). Falls. Sports-related injuries. Violence (gunshot, stab wounds). Non-Traumatic Causes : Tumors. Degenerative conditions (disc herniation, osteophytes). Infections (TB, spinal abscess).

15. Spine injury Classification of Spinal Injuries By Region : Cervical, thoracic, lumbar, sacral. By Severity : Complete vs. incomplete spinal cord injury. ASIA Impairment Scale.

16. Spine injury Clinical Presentation Neurological Symptoms : Motor and sensory loss. Reflex changes. Autonomic disturbances (hypotension, urinary retention). Spinal Shock vs. Neurogenic Shock : Differences in symptoms and management. Examination Techniques : Neurological exam. Imaging: X-rays, CT scans, MRIs

17. Spine injury Management of Spinal Injuries Pre-Hospital Care : Cervical spine immobilization. Transportation. Emergency Department Protocol : Airway management (ABC approach). Avoiding secondary injury. High-dose steroids (controversial). Surgical Management : Indications: fractures, dislocations, cord compression. Techniques: internal fixation, spinal fusion. Non-Surgical Management : Use of traction, braces, conservative treatments.

18. Spine injury Rehabilitation and Recovery Early Mobilization : Importance of physiotherapy. Rehabilitation Goals : Maximizing functional independence. Occupational therapy, assistive devices. Psychosocial Support : Mental health, societal reintegration, support groups.

19. Spine injury Complications of Spine Injuries Immediate Complications : Spinal shock. Respiratory failure. Cardiovascular instability. Late Complications : Pressure ulcers. DVT. Autonomic dysreflexia. Neuropathic complications (syringomyelia, spasticity).

20. Spine injury Prognosis and Outcomes Factors Affecting Prognosis : Level of injury. Time to treatment. Age and comorbidities. Long-Term Complications : Bowel, bladder, and sexual dysfunction. Recurrent infections. Mortality and Morbidity : Statistics globally and in Nepal.

21. Spine injury Preventive Measures Road Safety : Helmet use. Seat belt enforcement. Fall Prevention : Home modifications. Physical activity for strength and balance. Public Health Initiatives : Education programs on safety. Policy implementation.

22. Spine injury Key Take aways Early Intervention : Can significantly improve outcomes. Multidisciplinary Care : Neurosurgeons, rehab specialists, social workers. Preventive Measures : Road safety, fall prevention.

23. Spine injury Conclusions Spinal injuries are complex and require a multifaceted approach. Early intervention, multidisciplinary care, and prevention are key to improving outcomes.

24. Spinal injury Teaching Tools Case-Based Learning : Real-life case of a motorcycle accident with spinal injury. Discuss management steps. Clinical Videos/Imaging : Imaging examples of spinal fractures and injuries. Interactive Discussion : Involve students in assessing a patient with a suspected spinal injury.

25. Spinal injury Anatomy and Physiology of the Spine and Spinal Cord Anatomy and Physiology of the Spine and Spinal Cord Spinal Cord: Structure, Ascending and Descending Tracts, Functional Zones Lee BB, Cripps RA, Fitzharris M, Wing P. The global map for traumatic spinal cord injury epidemiology: Update 2011, global incidence rate. Spinal Cord . 2014;52(2):110-116.