Motor vehicle accidents, falls, and violence are the most common causes of spinal cord injuries, which affect 30-40 million people per year globally. Spinal cord injuries cost between $7.3-8.3 billion annually to treat and rehabilitate. Proper pre-hospital care including immobilization, intubation if needed, and transport is important to prevent further injury. Diagnosis involves a thorough patient history, physical exam including neurological assessment, and imaging like x-rays, CT scans, or MRIs to identify fractures or other damage. Rehabilitation requires a coordinated, intensive team approach to help patients regain function.

1. Spinal Injuries: An Overview

2. Spinal Cord Injury
 Epidemiology
 30-40 million per year
 10,000 new cases per year
 Etiology
 Motor vehicle accident: 44.5%
 Falls: 18.1%
 Violence: 16.6% (and increasing)
6/11/20172 www.drgspatnaik.com

3. Pre Hospital Care
6/11/20173 www.drgspatnaik.com

4. Spinal Cord Injury
 Economic Consequences
 Between $7.3 billion and $8.3 billion per year
 A person with a high cervical injury at age 25 incurs
lifetime costs of more than $3 million
 Rehabilitation Treatment
 Systematic, intensive, coordinated team approach
6/11/20174 www.drgspatnaik.com

5. Spinal trauma should be suspected in
 All unconscious patients
 High energy trauma
 Evidence of neurological deficit
 Multiple injuries
6/11/20175 www.drgspatnaik.com

6.  Proper extraction
 Intubation
 Immobilization
 Cervical collar, sand bag, tape,
 ? Neck position
 ?pediatrics
While Transporting ……
6/11/20176 www.drgspatnaik.com

7. Why do we miss Spinal Injuries !!
A low level of suspicion
Failure to take proper radiographs
Poly trauma
Failure to interpret the x ray
Intoxication
Decrease level of consciousness
6/11/20177 www.drgspatnaik.com

8. History
 Mechanism of injury
 Position of the patient when found
 Transient motor or sensory loss
 Paradoxical breathing
 Seat belt
6/11/20178 www.drgspatnaik.com

9. Inspection
 All clothing should be carefully removed
 Any bleeding , abrasion or lacerations
 Limb asymmetry
 Voluntary limb movement
 Chest expansion
 Please document the findings..
6/11/20179 www.drgspatnaik.com

10. Palpation
To Remove Cervical collar carefully
1. Tenderness
2. Interspinous widening
3. Malialignement of spinous process
4. Step off
6/11/201710 www.drgspatnaik.com

11. Neurological Evaluation
1. Sensory evaluation
2. Motor evaluation
3. Reflexes
6/11/201711 www.drgspatnaik.com

12. Cresmatic reflex
 Stroking inner thigh & observing the
scrotum movement
 Absence means UMNL
 Unilateral absence suggest LMNL
6/11/201712 www.drgspatnaik.com

13. Bulbocavernosus reflex
 Pull glans or press
clitoris  anal
contraction (int.
sphincter) around
gloved finger
 Absence is indicator
of spinal shock
6/11/201713 www.drgspatnaik.com

14. RADIOLOGICAL
ASSESMENT
 PLAIN FILM
 AP & LATERAL
6/11/201714 www.drgspatnaik.com

15. CT SCAN
 Injury suspected on plain films
 Better visualize fracture (specificity and
sensitivity)
 Unable to adequately assess on plain films
 Fracture or soft tissue injury in the plane of the CT
can be missed
6/11/201715 www.drgspatnaik.com

16.  Invaluable for assessing cord and soft tissues
 R/O associated disc herniation ( facet dislocations)
 Hemorrhage vs edema in soft tissues ????
 Ligamentous tears and facet capsule disruptions visualized with
fat suppression
 May allow prognostic assessment of final motor function
 Intrasubstance hematoma
MRI SCAN
6/11/201716 www.drgspatnaik.com

17. T1 T2 GRE
MRI
6/11/201717 www.drgspatnaik.com

18. Compression Fracture
6/11/201718 www.drgspatnaik.com

19. Burst Fracture
6/11/201719 www.drgspatnaik.com

20. Fracture Dislocation
6/11/201720 www.drgspatnaik.com

21. Flexion Distraction
6/11/201721 www.drgspatnaik.com

22. Imaging
6/11/201722 www.drgspatnaik.com

23. Non-Operative Management
6/11/201723 www.drgspatnaik.com

24. Surgical intervention
6/11/201724 www.drgspatnaik.com

25. Surgical Intervention contd…
6/11/201725 www.drgspatnaik.com

26. Rehabilitation…..
6/11/201726 www.drgspatnaik.com

27. To Conclude…….
 Spinal injuries are serious, dangerous and have
far reaching consequences
 Prevention must be the top priority
 Legislation, Seat belt , Helmet
 Proper Ambulanve and paramedic services
 Emergency room assesment
 Specialized Treatment
TEAMWORK
6/11/201727 www.drgspatnaik.com

28. 6/11/201728 www.drgspatnaik.com