Common presentation of spine injury patient

1. PRESENTATION OF SPINAL
INJURY PATIENTS
DR.MUMTAZ ALI NAREJO
ASSISSTANT PROFESSOR OF NEUROSURGERY KMCH

2. OUTLINES
• Graphical representation of tracts
• Level & Complete vs incomplete cord injury
• Syndomes of incomplete cord injury
• Conus medullaris Vs Cauda equina
• Spinal Shock
• C1 injuries
• C2 injuries
• Subaxial /C3-C7 injuries
• Thoracolumbar injuries
• Saccral injuires
• Coccygeal injuires

3. GRAPHICAL REPRESENTATION

4. LEVEL & COMPLETE VS INCOMPLETE CORD
INJURY
• LEVEL :
lowest level
completely normal function
• Complete :
No preservation
Motor
sensory function
more than 3 segments below injury
absence of spinal shock
• Incomplete :
any residual function
Motor
sensory
more than 3 segments

5. SYNDROMES
• Incomplete cord injury:
Sensation
sacral sparing
Bulbocavernosus
• Syndromes:
Anterior cord
Posterior cord
Brown sequard
Central cord syndrome

7. CONUS MEDULLARIS VS CAUDA EQUINA

9. SPINAL SHOCK
1st Concept
HYPOTENSION SBP < 80 mm Hg
 interruption of sympathetics
○ loss of vasoconstrictors
○ leaves parasympathetics
 loss of muscle tone
2nd Concept:
transient loss of all
neurologic function:
 duration:72 hrs
 loss of the bulbocavernosus

10. C1 INJURIES
• OCCIPITAL CONYDLE #
blunt trauma with high energy
Type 1:comminuted
Type 2 : extension of basilar #
Type 3 :Avulsion of condyl
• C1/ATLAS #
Type 1: anterior arch #
Type 2: posterior arch #
Type 3:anterior+posterior arch #
Type 4:lateral mass #
• ATLANTOCCIPITAL SUBLUXATION
• ATLANTOAXIAL SUBLUXATION

11. C1 INJURIES
• ATLANTOCCIPITAL SUBLUXATION
Anterior dislocation
Longitudinal dislocation
Posterior dislocation
• ATLANTOAXIAL SUBLUXATION
Rotatory
Anterior
Distraction

12. C2 INJURIES
• HANGMAN #
Bilateral pars #
Subluxation of C2 on C3
5 types
• ODONTOID #
Type 1: thru tip
Type 2: thru base of neck
Type 3: thru body of C2

13. SUBAXIAL/C3-C7
INJURUES
• TEAR DROP #
• QUADRANGULAR #
• COMPRESSION #
• SUBLUXATION
• LOCKED FACET
• LATERAL MASS #
• FACET #

14. SUBAXIAL/C3-C7
INJURUES

15. THORACOLUMBAR INJURIES
• MINOR INJURIES
Transverse process #
Pars intraarticularis #
Spinous process #
• MAJOR INJURIES
Compression #
Burst fractures #
Seat belt #
Fracture dislocation

18. SACRAL INJURIES
• SACRAL #
• Type 1 : zone I
• Type 2 : zone II
• Type 3 : zone III

19. COCCYGEAL INJURIES
• COCCYDYNIA
• COCCYX #
Type 1
Type 2
Type 3
Type 4

20. THANKYOU