Spine injuries in our daily lifestyle.ppt

Burden worldwide

1. TRAUMATIC SPINAL CORD INJURIES

2. Objectives
•Review anatomy
•Review mechanisms of injury
•Review management
•Review specific injury types

3. Introduction
•Spinal cord injury (SCI) is an insult to the spinal cord resulting
in a change, either temporary or permanent, in its normal
motor, sensory, or autonomic function.
•Spinal cord injuries can occur due to falls from height, sport
injuries, penetrating insults, MTA, violence

4. Anatomy
Vertebral Column
•Number of vertebrae:
•Cervical:7
•Thoracic:12
•Lumbar: 5
•Sacrum: 1
•Coccyx: 1

5. Anatomy -Vertebral Column

6. Radiographic Evaluation
•X-Rays:
•Lateral:
–Must see all 7 cervical vertebrae and top of
T1
–80% sensitivity for C-spine fractures
•Combined Lateral, AP, and Odontoid
views
–Increases sensitivity to 92% for C-spine
fractures

7. Radiographic Evaluation
•CT Scan:
•Indications:
–Any major fracture or dislocation of spine
–Poorly visualized areas of spine (C1-2 & C7-T1)
•MRI:
•Best for evaluating soft tissue
–Spinal cord in neurological deficits
–Ligamentous injuries

8. Anatomy
Radiograph
•Cervical Spine
–Lateral X-ray
•Spinolaminal line
•Posterior contour
line
•Anterior contour
line

9. spine columns
•The anterior spine column that consists of anterios half
of vertebral body, anterior longitudinal ligament and
anterior part of the disc
•the middle column that consists of posterior half of the
body and disc , posterior longitudinal ligament
•the posterior column that consists of posterior vertebral
arch which comprises of transverse process, spinous
process and accompanying ligaments
•Fracture that involves one column is stable but any
fracture involving more than one column is unstable
spine injury

10. Mechanism of Injury
•Causes of injury
–destruction from direct trauma
–ischemia from damage or impingement on the
spinal arteries
–compression by bone fragments, hematoma, or
disk material

11. Mechanisms of Injury
•C/T/L-spine
–Flexion: Simple wedge, bilateral facet dislocation, flexion teardrop
–Extension: Extension teardrop, traumatic spondylolisthesis
–Flexion-Rotation: Unilateral interfacetal dislocation
–Axial loading: Burst fx.
–Lateral Flexion: Uncinate process fx.
•Degree of instability is variable.

12. General Approach
•Goals:
•Identify life-threatening injuries (primary survey)
•Identify limb-threatening injuries (secondary survey)
•Systematic review (secondary survey)

13. General Approach
•Immobilize with C-spine Collar and
Backboard

14. History
•Information from scene:
•Description of scene
•MVC: degree of external and internal vehicle damage, use
of restraints
•Attempt to mentally reconstruct scene to anticipate
injuries
•Mechanisms of injury
•High energy: MVC, fall from great height
•Ejection, hanging
•Obtain AMPLE history
•Tetanus immunization status

15. Clinical Approach
•Involves ATLS; Airway, Breathing, Circulation.
•Neurological assessment
Inspection; muscle bulkness, swelling, open injury/bruices, deformity (e.g.
kyphosis)
Palpation; point tenderness, step-off deformity, crepitus.
Neurological Impairment-power and sensation, or reflexes impairment.
GCS, rectal examination.
ASIA impairment score.

22. •ttemporary loss of spinal cord function and
reflex activity below the level of a spinal cord
injury.
•characterized by
•flaccid areflexic paralysis
•bradycardia & hypotension (due to loss of
sympathetic tone)
•absent bulbocavernosus reflex
Dsyfunction with spinal cord injury
Spinal shock

23. Dysfunction With Spinal Cord Injury
•Neurogenic shock:
•Disruption of the sympathetic pathways
•Loss of vasomotor tone and sympathetic heart innervation
–Leads to hypotension and bradycardia
•Treat with fluids and vasopressors
•Diaphragm paralysis:
•C3-5 innervate the diaphragm through the phrenic nerve

24. Spinal Cord Syndromes
•Central Cord Syndrome
•Brown-Séquard Syndrome
•Anterior Cord Syndrome
•Conus Medullaris Syndrome
•Cauda Equina Syndrome

25. Central cord syndrome
•This is the most common incomplete SCI.
•Injury is caused by hyperextension of the neck leading
to compression of the cervical spinal cord, causing
damage primarily to the center of the cord.
•This pattern of injury leads to weakness affecting the
upper extremities more so than the lower extremities.

26. Anterior spinal cord syndrome
•Classically due to compromise of blood flow from the
anterior spinal artery.
•Bilateral injury to the spinothalamic tracts leads to
bilateral loss of pain and temperature sensation below
the level of injury.
•Bilateral injury to corticospinal tracts leads to weakness
or paralysis below the level of injury.
•As dorsal columns are unaffected, tactile sensation,
proprioception, and vibratory sensation remain intact.

27. Posterior cord syndrome
•This injury pattern rarely occurs due to
trauma. More often, injury is due to
infectious, toxic, or metabolic causes.
•Damage to dorsal columns causes loss of
tactile sensation, proprioception, and
vibratory sensation.
•As spinothalamic and corticospinal tracts are
unaffected, there is the preservation of pain
sensation, temperature sensation, and motor
functio

28. conus medullaris syndrome
•It is caused by injury to the terminal aspect of the
spinal cord, just proximal to the cauda equina.
•It characteristically presents with loss of sacral nerve
root functions. Loss of Achilles tendon reflexes, bowel
and bladder dysfunction, and sexual dysfunction may
be observable.

29. brown sequard syndrome
Injury results from right or left-sided hemisection of the
spinal cord.
Transection of the corticospinal and dorsal column
nerve tracts leads to ipsilateral loss of motor function,
tactile sensation, proprioception, and vibratory
sensation below the level of injury.
Transection of the spinothalamic tract leads to
contralateral loss of pain and temperature sensation
below the level of injury.

30. Loss of Motor Function With Spinal
Cord Injury
Loss of FunctionLesion Level
Spontaneous breathing C4
Shoulder shrug C5
Flexion at elbow C6
Extension at elbow C7
Flexion of fingers C8-T1
Intercostal& abdominal musclesT1-T12
Flexion at hip L1-L2
Adduction at hip L3
Abduction at hip L4
Dorsiflexfoot L5
Plantarflexfoot S1-S2
Rectal sphincter tone S2-S4

31. Management of Spinal Cord Injuries
•Immobilization
•Perform initial exam and serial exams
•Steriods
–Methylprednisolone
•Definitive stabilization

32. Specific Types of Spinal Fractures
•Jefferson Fracture
•Hangman’s Fracture
•Wedge fractures
•Vertebral body burst
fractures
•Flexion teardrop
fracture
•Extension teardrop
fracture
•Unilateral facet
dislocation
•Bilateral facet
dislocation
•Clay shoveler’s fracture
•SCIWORA

33. Jefferson Fracture

34. Hangman’s Fracture
•Bilateral pedicle
fracture at C2

35. Wedge Fractures

36. Vertebral Body Burst Fracture
C4 Burst Fracture

37. Burst Fractures of T/L-Spine
Burst Fracture of T10 Burst Fracture of L1

38. Flexion Teardrop Fracture

39. Extension Teardrop Fracture

40. Unifacet Dislocation
C5 on C6 Unifacet Dislocation

41. Complete (Bifacet) Dislocation
C5 on C6 Complete Dislocation

42. Clay Shoveler’s Fracture
C7 Clayshoveler’s Fracture

43. SCIWORA
•Spinal Cord Injury Without Radiologic
Abnormality
–Seen in children
–Mechanism
•longitudinal distraction with or without
flexion
•extension of the vertebral column

44. Conclusion
•Assume allinjured patients have a spinal
injury
•Immobilize the Spine
•Perform a thorough examination
•Know the capabilities of your institution and
transfer patients with serious injuries to high
level of care