Sub Axial Cervical Spine Trauma and its classification

This presentation is about sub axial cervical spine trauma and it classification system with it radiology.

1. Start with the Great name of ALLAH, the most merciful and the most beneficial

2. Sub Axial Spine Trauma Dr Zeeshan

3. Classification systems

4. Allen Ferguson classification

5. Punjabi and white for stability of spine

6. Compression flexion injury

7. Quadrangular Fracture Oblique vertebral body fracture Posterior subluxation Disrupted ALL and PLL Angular kyphosis

8. Distraction compression fracture

9. Hyper flexion sprain Kyphotic angulation 1-3 mm subluxation Anterior narrowing and posterior widening of disk space Widening of facet joint Fanning of interspinous space

10. Horizontal subluxation > 3.5 mm > 11° angulation

11. Perched facet: not completely lock facet But has associated ligamentous disruption Flexion Plus rotation. Unilateral Locked facet Hyperflexion . Bilateral locked facet

12. Bilateral locked facets Disruption of apophyseal joint, Ligament Flavum , Longitudinal and intra spinous Ligament And Anulus Most common C5-6, C6-7

13. Diagnosis Sagittal CT scan X.ray cervical spine Ap /lateral

14. Treatment options Close reduction

15. Initial weight ( 3x number of vertebral bodies ( lb ) Increase weight over 10-15 minutes (5 to 10lb) Lateral X rays MEP studies Stop: Don’t exceed 10 lb per vertebra Avoid over distraction Desired reduction archived Occipito cervical instability Disk space height increase 10mm Any neurological detoriation For unilateral lock: gentle And manual torsion toward lock facet Bilateral lock: gentle and posterior tension .i.e. Roll towel under the occipit Once Distracted and perched, gradual reduction of Weight improves Reduction Slightly extended position of neck Contraindications: Traumatic disk herniation

16. Open reduction Posterior Approach Anterior approach Combined Cervical laminectomy With Drilling of superior aspect of facet, sometimes foraminotomy to decompress the nerve root Anterior cervical diskectomy with exploration of epidural space Reduction can be achieved by manual traction Anterior cervical plate Risk of cord injury due to Traumatic disk Reduce risk of injury caused by traumatic disk Posterior lateral mass screw

17. Stabilization If fracture fragments of facet With halo vest satisfactory results after closed reduction Surgical treatment is clearly indicated in ligamentous injury

18. Extension Injury

19. Extension injuries without bony injury SCI without bony injury There can be, ALL disruption and intervertebral disk Associated with carotid artery dissection SCIWORA

20. Minor extension injuries Includes spinous And lamina fractures stable

21. Extension compression injury Lateral mass and facet fracture

22. Management

23. General management Immobilization with external reduction via traction 0- 7 days Indication of acute decompression: Foreign material in spinal cord, Complete block on CT mylogram or MRI And clinical judgement Stable fracture: Non halo orthosis 1-6 weeks Unstable fracture: Traction 7 week Followed by orthosis 8 weeks, Halo 11 weeks followed by orthosis 4 week, Surgical fusion with orthosis 15 weeks And surgical fusion and internal immobilization

24. Surgical treatment Patient with complete spinal cord injury? Patients with incomplete spinal injury Anterior or posterior

25. Posterior immobilization and fusion Mostly for flexion injuries Less compression of Anterior column Lateral mass screws and rods

26. Anterior approach Indications: Extension injuries, Bony fragment in cannal Corpectomy : wide corpectomy 12 to 16 mm, not more than 3mm Corpectomy lateral to medial border Of Longus colli muscle Graft Compression plates External immobilization

27. Complications Hardware problems Inadequate post operative immobilization Graft failure Judgmental error