Spinal injuries

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A short review with simple classification and management. Suitable for med students but needs some additional reading.

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Spinal injuries

  1. 1. SPINAL INJURIES FOR FIFTH YEAR MEDICAL STUDENTS PROF. WALID S. MAANI JORDAN UNIVERSITY HOSPITAL AND MEDICAL SCHOOL12/05/12 SPINAL INJURIES 1 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  2. 2. ANATOMICAL CONSIDERATIONS  SPINAL CORD SHORTER THAN SPINAL COLUMN  CORD ENDS AT LOWER BORDER OF Ll  ADULT SPINOUS PROCESSES, VERTEBREA AND CORD SEGMENTS DO NOT LIE AT SAME LEVEL  CERVICAL ARTICULAR FACETS (HORIZONTAL)  DORSAL ARTICULAR FACETS (OBLIQUE)  LUMBAR ARTICULAR FACETS (VERTICAL)  CERVICAL SPINE VERY MOBILE  THORACIC CANAL IS VERY NARROW12/05/12 SPINAL INJURIES 2 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  3. 3. ETIOLOGY  ROAD TRAFFIC ACCIDENTS  INDUSTRIAL ACCIDENTS (BUILDING SITES)  FALLS  SPORT INJURIES (DIVING)  PENETRATING INJURIES (KNIVES)  MISSILE INJURIES12/05/12 SPINAL INJURIES 3 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  4. 4. CLASSIFICATION (A) SIMPLE OR MAJOR  SIMPLE:  FRACTURE SPINOUS PROCESS  FRACTURE TRANSVERSE PROCESS  MAJOR:  BODY FRACTURES & DISLOCATIONS12/05/12 SPINAL INJURIES 4 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  5. 5. CLASSIFICATION (B) STABLE OR UNSTABLE THE THREE COLUMN THEORY (C) WITH OR WITHOUT NEUROLOGICAL DAMAGE INTACT CORD AND ROOTS DAMAGED CORD AND OR ROOTS12/05/12 SPINAL INJURIES 5 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  6. 6. THE THREE COLUMN THEORY  ANTERIOR COLUMN ANTERIOR HALF OF VERTEBRAL BODY WITH ANTERIOR HALF OF DISC AND ANULUS FIBROSUS AND ANTERIOR LONGITUDINAL LIGAMENT (ALL)  MIDDLE COLUMN POSTERIOR HALF OF VERTEBRAL BODY WITH POSTERIOR HALF OF DISC AND ANULUS FIBROSUS AND POSTERIOR LONGITUDINAL LIGAMENT (PLL)  POSTERIOR COLUMN POSTERIOR BONY COMPLEX POSTERIOR LIGAMENTOUS COMPLEX12/05/12 SPINAL INJURIES 6 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  7. 7. CLINICAL PRESENTATION  HISTORY OF TRAUMA  SYMPTOMS  PAIN ON MOVEMENT OR AT SITE OF INJURY  DISTURBED SENSATION  INABILITY TO MOVE A LIMB OR PART OF IT  RETENTION OF URINE OR INCONTINENCE  SIGNS  DEPEND ON TYPE, LEVEL AND EXTENT  TENDERNESS OVER FRACTURE12/05/12 SPINAL INJURIES 7 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  8. 8. CLINICAL PRESENTATION  SIGNS RELATED TO CORD DAMAGE  SENSORY LOSS BELOW LEVEL  MOTOR LOSS BELOW LEVEL  HYPOTONIA BELOW LEVEL  AREFLEXIA BELOW LEVEL  SIGNS RELATED TO ROOT DAMAGE  SENSORY LOSS IN DERMATOME/S  MOTOR LOSS IN MUSCLE/GROUP  HYPOTONIA OF MUSCLE/S  REFLEX LOSS IN DERMATOME12/05/12 SPINAL INJURIES 8 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  9. 9. CLINICAL PRESENTATION COMPLETE TRANS-SECTION OF CORD  LOSS OF POWER BELOW LEVEL  LOSS OF SENSATION BELOW LEVEL  SUPERFICIAL  DEEP  POSTERIOR COLUMN  LOSSOF REFLEXES BELOW LEVEL  HYPOTONIA BELOW LEVEL  MUTE PLANTER REFLEX  RETENTION OF URINE12/05/12 SPINAL INJURIES 9 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  10. 10. CLINICAL PRESENTATION BROWNE-SEQUARD SYNDROME (HEMI-SECTION OF THE CORD)  CONTRALATERAL (SPINOTHALAMIC)  LOSS OF PAIN  LOSS OF THERMAL SENSATION  IPSILATERAL (CORTICOSPINAL & POSTERIOR COLUMN)  LOSS OF MOTOR POWER  LOSS OF PROPRIOCEPTION12/05/12 SPINAL INJURIES 10 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  11. 11. IMAGING  PLAIN X-RAYS  ANTERO-POSTERIOR AND LATERAL  DYNAMIC VIEWS  OPEN MOUTH VIEWS FOR ODONTOID  SKULL XRAY WITH CERVICAL FRACTURES  COMPUTERIZED TOMOGRAPHY  BONE WINDOWS  RECONSTRUCTION  ?MRI  OTHER SYSTEMS AS REQUIRED12/05/12 SPINAL INJURIES 11 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  12. 12. MANAGEMENT CARE IN HANDLING DURING RESCUE CARE IN HANDLING DURING TRANSPORT CARE IN HANDLING DURING XRAY12/05/12 SPINAL INJURIES 12 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  13. 13. MANAGEMENTTHE THREE PRINCIPLES APPLY TRACTION REDUCTION FIXATION12/05/12 SPINAL INJURIES 13 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  14. 14. MANAGEMENT  CARE FOR  SKIN  BLADDER  BOWEL  NURSING CARE  FEEDING  REHABILITATION12/05/12 SPINAL INJURIES 14 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  15. 15. MANAGEMENT (A) STABLE INJURY WITHOUT DEFICIT  FRACTURE SPINOUS PROCESS  FRACTURE TRANSVERSE PROCESS  WEDGE BODY FRACTURE LESS THAN 50% SYMPTOMATIC TREATMENT BED REST ANALGESIA PHYSIOTHERAPY AND MOBILIZATION12/05/12 SPINAL INJURIES 15 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  16. 16. MANAGEMENT (B) UNSTABLE INJURY WITHOUT DEFICIT  FRACTURE DISLOCATION OF CERVICAL SPINE  WEDGE FRACTURE MORE THAN 50%  FRACTURE INVOLVING TWO COLUMNS REDUCTION THEN IMMOBILIZATION TRACTION WITH TONGS TRACTION WITH HALO MANIPULATION OF LOCKED FACETS OPEN REDUCTION PLASTER OF PARIS FIXATION BY PLATES OR BONE GRAFTS12/05/12 SPINAL INJURIES 16 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  17. 17. MANAGEMENT (C) STABLE INJURY WITH DEFICIT  TEMPORARY DISLOCATION, DISPLACEMENT  INJURY TO SPONDYLOTIC SPINE  BONE OR DISC FRAGMENT INJURY COMPLETE INJURY CONSERVATIVE INCOMPLETE INJURY CONSERVATIVE SURGICAL PRESENCE OF COMPRESSING AGENT IMPROVEMENT THEN DETERIORATION12/05/12 SPINAL INJURIES 17 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  18. 18. MANAGEMENT (D) UNSTABLE INJURY WITH DEFICIT COMPLETE LESIONS REDUCTION AND IMMOBILIZATION INCOMPLETE LESIONS REDUCTION AND IMMOBILIZATION DECOMPRESSION OF THE SPINE AND IMMOBILIZATION12/05/12 SPINAL INJURIES 18 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  19. 19. MANAGEMENT (E) SPINAL CORD INJURY WITHOUT RADIOGRAPHIC ABNORMALITY (SCIWORA)  CHILDREN  NOTHING COULD BE SEEN ON X-RAYS  NOTHING ON CT SCANS  MAY BE AN HYPERINTENSE SIGNAL ON MRI12/05/12 SPINAL INJURIES 19 MEDICAL STUDENTS UNIVERSITY OF JORDAN
  20. 20. MANAGEMENT REHABILITATION PHYSIOTHERAPY PASSIVE ACTIVE OCCUPATIONAL THERAPY IN PATIENT OUT PATIENT12/05/12 SPINAL INJURIES 20 MEDICAL STUDENTS UNIVERSITY OF JORDAN

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