Cervical Fractures and Cervical spine injuries - Dr.KK

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Cervical spine injuries
Cervical Fractures by
Dr. Kalaivanan Kanniyan

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Cervical Fractures and Cervical spine injuries - Dr.KK

  1. 1. Cervical Spine Injuries
  2. 2. CERVICAL SPINE
  3. 3. CERVICAL SPINE • Seven Cervical Vertebrae • Eight pairs of Cervical spinal nerves
  4. 4. Cervical Spine Injuries Main Cause of the disease TRAUMA
  5. 5. RTA – leading cause
  6. 6. Mode of injury • Road side accidents (RSA) • Fall from height • Accidental injury due to carrying heavy weight over head • Sports injuries • Trivial Trauma in Pre-existing Spondylotic spine
  7. 7. Mode of injury
  8. 8. Mechanism of Injury • NO STUDY TILL DATE WHICH CORELATES SEVERITY OF INJURY WITH MODE OF TRAUMA / INJURY
  9. 9. Cervical Spine Injuries Cervical spine injuries with cord injury without cord injury
  10. 10. Cervical Spine Injuries • PRESENTING COMPLAINTS • Pain • Quadriplegia
  11. 11. Myotome and Dermatome Testing Nerve Root Sensory Testing Level Motor Testing Reflex Testing C1-C2 Front of face Neck flexion N/A C3 Lateral face and skull Lateral flexion N/a C4 Supraclavicular Shoulder shrug N/A C5 Lateral shoulder/upper arm Shoulder abduction Bicipital (musculocutaneous) C6 Lateral lower arm and hand (thumb and index finger) Elbow flexion and wrist extension Brachialradial (musculocutaneous) C7 Palmar aspect of hand – middle 3 fingers Elbow extension and wrist flexion Triceps (radial) C8 Medial lower arm and hand Finger flexion and thumb extension N/A T1 Medial elbow and upper arm Finger abduction N/A
  12. 12. DERMATOME DISTRIBUTION
  13. 13. INVESTIGATIONS • Radiological • X-rays AP, Lat , Swimmers view , odontoid view • CT Scan • MRI must for patients with neurological loss
  14. 14. DIGNOSTIC – PRE OPERATIVE
  15. 15. X-RAYS Lateral view • Top of T1 visible in idle lat view • Three smooth arcs maintained • Vertebral bodies of uniform height • Odontoid intact and closely applied to C1 AP view • Spinous processes straight and spaced equally • Intervertebral spaces roughly equal Odontoid view • Odontoid intact • Equal spaces on either side of odontoid • Lateral margins of C1 and C2 align
  16. 16. DIGNOSTIC – PRE OPERATIVE CT SCAN MRI
  17. 17. SIGNS OF INSTABILITY • AP translation > 3.5mm • spinous process widening on lateral • rotation of facets on lateral • facet joint widening • malalignment of spinous process on AP view • lateral tilting of vertebral body on AP view
  18. 18. LAT VIEW – X RAY
  19. 19. LAT VIEW – X RAY Prevertebral soft tissue Nasopharyngeal space Retropharyngeal space Retrotracheal space
  20. 20. AP and Odontoid View
  21. 21. Initial Treatment • CAB • Immobilization rigid cervical orthosisPhiladelphia collar Spine Board cervical traction with Halo or Gardner wells tongs.
  22. 22. Initial Treatment NO YES
  23. 23. Treatment - Conservative Halo traction Gardner wells tongs
  24. 24. Surgical Treatment • Stabilisation • Anterior • Posterior • Combined/ Global fusion
  25. 25. Surgical Treatment
  26. 26. Surgical Treatment
  27. 27. Surgical Treatment
  28. 28. Surgical Treatment
  29. 29. Ferguson and Allen Classification • Classification is Based on position of neck at time of injury and dominant force • • • • • • Compression and Flexion Vertical Compression Distraction Flexion Compression Extension Compression Distraction Lateral Flexion
  30. 30. Occipito-atlantal Dislocation hyperextension distraction and rotation of craniovertebral junction severe neurological injuries from complete C1 quadriplegia to incomplete syndromes
  31. 31. Surgical Treatment
  32. 32. ATLAS FRACTURE • Axial compression injuries • neurological injury rare • 3 types Jefferson fracture- direct compression and lateral masses forced apart asymmetric load fracture ant or post to mass and displaces it posterior arch fractures with an extension moment through it
  33. 33. Jefferson Fracture • Compression fracture of the bony ring of C1 • Odontoid view • Displacement of the lateral masses of vertebrae C1 beyond the margins of the body of vertebra C2.
  34. 34. Jefferson Fracture
  35. 35. Odontoid Fracture [Axis] • 15 % all cervical fractures • usually hyperflexion with anterior displacement • assoc injuries to C1 common • neurological deficit in 15-25% cases
  36. 36. Odontoid Fracture • Best seen on the lateral view • Types – I – Fx through superior portion of dens – II – Fx through the base of the dens – III – Fx that extends into the body of C2
  37. 37. Odontoid Fracture
  38. 38. Odontoid Fracture
  39. 39. Odontoid Fracture Type 1 - Philadelphia collar for 6-8 weeks Type 2 undisplaced - halo immobilization displaced - Primary C1-C2 fusion after reduction in traction [most recommend if displacement > 4-5mm] Type 3 Halo vest immobilization after reduction in traction ( 3-4 months)
  40. 40. C2 Hangman’s Fracture Fx through the pars reticularis of C2 secondary to hyperextension
  41. 41. Hangman’s C2 Fracture Traumatic spondylolithesis • Type 1 isolated minimally displaced fracture of ring with no angulation • Type 2 more unstable flesion type/extension type or listhetic type displaced > 3mm and angulation of C2-C3 disk space ALL, PLL Disc can be interrupted • Type 3 rare , anterior dislocation of C2 facets on C3 with 2 extension fracturing neural arch
  42. 42. Three types of Hangman’s fracture
  43. 43. TREATMENT • Type 1 Conservative - rigid cervical orthosis • Type 2 – closed reduction with traction – halo vest immobilization • Type 3 – Surgical management - C2 -C3 fusion
  44. 44. Clay Shoveler’s Fracture • Fracture of a spinous process C6-T1 • Signs: – Spinous process fracture on lateral view. – Ghost sign on AP view (i.e. double spinous process of C6 or C7 resulting from displaced fractured spinous
  45. 45. Burst Fracture • Fracture of C3-C7 • axial compression. • CT is required for all patients to evaluate extent of injury.
  46. 46. Wedge Fracture • Compression fracture resulting from flexion. Buckled anterior cortex. Loss of height of anterior vertebral body. Anterosuperior fracture of vertebral body.
  47. 47. DISLOCATIONS Bilateral Facet Dislocation Unilateral Facet Dislocation
  48. 48. Cervical spine injuries with Vertebral artery occlusion
  49. 49. Prevention is Better than Cure When meditating over a disease, I never think of finding a remedy for it, but instead, a means of preventing it ” Louis Pasteur
  50. 50. Cervical Spine Injuries …….. Known is a drop…. …………………..unknown is an ocean……….. Dr. Kalaivanan Kanniyan Assistant Professor – Orthopaedics Arthroplasty and Adult Reconstruction Unit SMCH, Saveetha University, chennai, Tamil Nadu, India.

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