Msigwa spinal injuries

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  • ESSENTIAL ORTHOPAEDICS
  • Nd neurological deficit basion (anterior rim of foramen magnum)
  • Artificial induction of joint ossification
  • Penetrating spinal cord injuries rarely cause neurogenic shock (258). The injured spinal cord cannot autoregulate blood flow
  • Msigwa spinal injuries

    1. 1. INJURIES OF THE SPINE 02/02/14 Presenter : MSIGWA SAMWEL S - MD5 (University of Dodoma-Tanzania) Moderator: D r . MANYAMA-ORTHOPAEDICS SURGEON MSIGWA SAM-MD5 1
    2. 2. Outline Introduction and Epidemiology Anatomy Mechanism of Injury Classification of Spinal cord injuries Clinical evaluation Treatment Complications 02/02/14 MSIGWA SAM-MD5 2
    3. 3. INTRODUCTION Fractures and dislocations of t he spine are serious injuries because they may be associated with damage to the spinal cord or cauda equina. The thoraco-lumbar segment is the commonest site of injury; the lower cervical being the next common. 02/02/14 MSIGWA SAM-MD5 3
    4. 4. About 20 per cent of all spinal injuries result in a neurological deficit in the form of paraplegia in the thoraco-lumbar spine injuries, or quadriplegia in the cervical spine injuries. Often, the patient does not recover from the deficit, resulting in prolonged invalidism or death. 02/02/14 MSIGWA SAM-MD5 4
    5. 5. Globally Globally Affects 10,000 a year Age group-16-30 years Male: female=4:1 Automobile accidents are the most common cause in person <65 years Falls are the most common cause in person>65years 02/02/14 MSIGWA SAM-MD5 5
    6. 6. Tanzania In TZ the research done at BMC 2012 showed that among the SI resulted from road traffic crashes most of them were caused by Motorcycle (58.8%) . Spine injuries was 0.7% out of all Injuries. Male to female ratio was of 2.1:1 The modal age group was 21-30 years, accounting for 52.1% patients. Students (58.8%) and businessmen (35.9%) . Mortality rate was 17.5%. 02/02/14 MSIGWA SAM-MD5 6
    7. 7. Basic Anatomy of the Spine 1.Structure: Extends from the skull to the tip of the coccyx, consisting of 33 vertebrae: Cervical(7), Thoracic(12), Lumbar(5), Sacral(5) and Coccygeal(4) Has 4 curvatures: cervical and lumbar (concave anteriorly), thoracic and sacral (concave posteriorly) 02/02/14 MSIGWA SAM-MD5 7
    8. 8. 02/02/14 MSIGWA SAM-MD5 8
    9. 9. Structure of a Typical Vertebra  Vertebral body Epiphyseal ring and central cancellous bone  Neural arch 2 pedicles and 2 laminae  7 Processes A spinous 2 transverse 2 superior articular 2 inferior articular  Vertebral foramen & canal 02/02/14 MSIGWA SAM-MD5 9
    10. 10. 02/02/14 MSIGWA SAM-MD5 10
    11. 11. Atlas (C1) 02/02/14 MSIGWA SAM-MD5 11
    12. 12. Axis (C2) 02/02/14 MSIGWA SAM-MD5 12
    13. 13. Lumbar Vertebra Superior view . 02/02/14 MSIGWA SAM-MD5 13
    14. 14. Lumbar Vertebra Lateral view  . 02/02/14 MSIGWA SAM-MD5 14
    15. 15. Thoracic Vertebra Lateral view  . 02/02/14 MSIGWA SAM-MD5 15
    16. 16. 2.Articulation: The entire vertebral column has similar articulation (except atlanto-axial joint). The v e r t e b r a l bodies are primarily joi n e d by intervertebral discs. Anteriorly, the vertebral bodies are connected to one another by a long, straplike, anterior longitudinal ligament, Posteriorly by a similar posterior longitudinal ligament. 02/02/14 MSIGWA SAM-MD5 16
    17. 17. Accessory Ligaments of the Intervertebral Joints  Ligamentum flavum Between lamina of adjacent vertebrae  Supraspinous Between tips of spinous processes  Interspinous Connects adjacent spinous processes  Nuchal Occipital protuberance and foramen magnum to cervical vertebrae  Intertransverse Connects adjacent transverse processes NB:These ligaments are together often termed the posterior ligament complex. 02/02/14 MSIGWA SAM-MD5 17
    18. 18. Saggittal Section Thru 2 Vertebrae . 02/02/14 MSIGWA SAM-MD5 18
    19. 19. Three-column concept The anterior column consists of the anterior longitudinal ligament and the anterior part of annulus fibrosus along with the anterior half of the vertebral body. The middle column consists of the posterior longitudinal ligament and the posterior part of the annulus fibrosus along with the posterior half of the vertebral body. 02/02/14 MSIGWA SAM-MD5 19
    20. 20. a) Anterior column b) Middle column c) Posterior column 02/02/14 MSIGWA SAM-MD5 20
    21. 21. The posterior column consists of the posterior bony arches along with the posterior ligament complex. 02/02/14 MSIGWA SAM-MD5 21
    22. 22.  Joints of the vertebral bodies Intervertebral discs which consist of annulus fibrosus and nucleus pulposus Anterior and posterior longitudinal ligaments  Joints of the neural arches  Atlantoaxial joints  Atlanto-occipital joints  Costovertebral joints  Sacroiliac joints 02/02/14 MSIGWA SAM-MD5 22
    23. 23. Simple General Classification Based on 3 Column concept Stable fractures Is one where further displacement between two vetebral bodies does not occur because of the intact 'mechanical linkages'. When only one column is disrupted (e.g., a wedge compression fracture of t h e vertebra) the spine is stable.  Posterior ligament complex, neural arch and articular facets intact; only vertebral bodies and anterior ligament complex 02/02/14 MSIGWA SAM-MD5 23
    24. 24. Unstable fractures Is one where further displacement can occur b e c a u s e of serious disruption of the structures responsible for stability. When two columns are disrupted (e.g., a burst fracture of the body of the vertebra) the spine is considered u n s t a b l e . When all the t h r e e columns are disrupted, the spine is always unstable (e.g., MSIGWA SAM-MD5 dislocation of one vertebra over other). 02/02/14 24
    25. 25. 3.Spinal cord 02/02/14 MSIGWA SAM-MD5 25
    26. 26. Dorsal root – sensory fibres Ventral root – motor fibres Dorsal and ventral roots join at intervertebral foramen to form the spinal nerve 02/02/14 MSIGWA SAM-MD5 26
    27. 27. 02/02/14 MSIGWA SAM-MD5 27
    28. 28. Physiology and function Grey matter – sensory and motor nerve cells White matter – ascending and descending tracts  Divided into - dorsal - lateral - ventral 02/02/14 MSIGWA SAM-MD5 28
    29. 29. 02/02/14 MSIGWA SAM-MD5 29
    30. 30. Ascending and descending pathways Connection between cerebrum and body (muscle, sensation) Corticospinal/pyramidal tract = voluntary movement Dorsal columns = vibration, proprioception and fine touch Lateral spinothalamic = pain and temperature Anterior spinothalamic = pressure and crude touch 02/02/14 MSIGWA SAM-MD5 30
    31. 31. 02/02/14 MSIGWA SAM-MD5 31
    32. 32. Dermatomes Area of skin innervated by sensory axons within a particular segmental nerve root Knowledge is essential in determining level of injury Useful in assessing improvement or deterioration 02/02/14 MSIGWA SAM-MD5 32
    33. 33. 02/02/14 MSIGWA SAM-MD5 Downloaded from: Rosen's Emergency Medicine (on 29 April 2009 06:34 PM) © 2007 Elsevier 33
    34. 34. Myotomes : Segmental nerve root innervating a muscle Again important in determining level of injury Upper limbs: C5 - Deltoid C 6 - Wrist extensors C 7 - Elbow extensors C 8 - Long finger flexors T 1 - Small hand muscles 02/02/14 MSIGWA SAM-MD5 34
    35. 35. Lower Limbs : L2 - Hip flexors L3,4 - Knee extensors L4,5 – S1 - Knee flexion L5 - Ankle dorsiflexion S1 - Ankle plantar flexion 02/02/14 MSIGWA SAM-MD5 35
    36. 36. Denis Classification Based on 3 Column Concept 1. Anterior column; ant. Long. Ligament, ant ½ of annulus and vertebral body 2. Middle column; post. Long. Ligament and post ½ of annulus and vertebral body 3. Posterior column; spinous processes, facet joints and capsule, supra and inter spinous ligaments 02/02/14 MSIGWA SAM-MD5 36
    37. 37. Basic Types of Spine Fractures and their Mechanisms 1• Flexion-injury 2• Flexion-rotation injury 3• Vertical compression injury 4• Extension injury 5• Flexion-distraction injury 6• Direct injury 7• Indirect injury due to violent muscle contraction 02/02/14 MSIGWA SAM-MD5 37
    38. 38. 1. Flexion injury This is the commonest spinal injury. Examples: (i) heavy blow across the shoulder by a heavy object (ii) fall from height on the heels or buttocks 02/02/14 MSIGWA SAM-MD5 38
    39. 39. Results In the cervical spine, a flexion force can result in: (i) a sprain of the ligaments and muscles of t he back of t he neck: (ii) compression fracture of the vertebral body, C5 to C7 (iii) dislocation of one vertebra over another (commonest C5 over C6). 02/02/14 MSIGWA SAM-MD5 39
    40. 40. In the dorso-lumbar spine, this force can result in The wedge compression of a vertebra (L1commonest followed by L2 and T12). It is a stable injury if compression of t he vertebra is less than 50 per cent of its posterior height. 02/02/14 MSIGWA SAM-MD5 40
    41. 41. 2. Flexion-rotation injury: This is the worst type of spinal injury because it leaves a highly unstable spine, and is associated with high incidence of neurological damage. Examples: (i) heavy blow onto opposite side one shoulder causing (ii) a blow or fall on posterolateral aspect of the head. the trunk to be in 02/02/14 41 MSIGWA SAM-MD5
    42. 42. Results In the cervical spine this force can result (i) dislocation of the facet joints on one or both sides (ii)(ii) fracture-dislocation of the cervical vertebra.  In the dorso-lumbar spine A fracture-dislocation of the spine. Here one vertebra is twisted-off in front of the one below it. There i s extensive damage to the neural arch and posterior ligament complex. It is 02/02/14 42 02/02/14 MSIGWA SAM-MD5 42
    43. 43. 3. Vertical compression injury It is a common spinal injury. Examples: (i) A blow on the top of the head by some object falling on the head (ii) a fall from height in erect position 02/02/14 MSIGWA SAM-MD5 43
    44. 44. RESULTS In the cervical spine, this force results in A burst fracture i.e., the vertebral body is crushed throughout its vertical dimensions. A piece of bone or disc may get displaced into the spinal canal causing pressure on the cord. In the dorso-lumbar spine, this force results in a fracture similar to that in the cervical spine, but due to a wide canal at this level, neurological deficit rarely occurs. It is an unstable injury. 02/02/14 MSIGWA SAM-MD5 44
    45. 45. Extension injury: This injury is commonly seen in the cervical spine. Examples: (i) motor vehicle accident — the forehead striking against the windscreen forcing the neck into hyperextension 02/02/14 (ii) shallow water diving —the head hitting the ground, extending the neck Results: This injury results in a hip fracture of the anterior rim of a vertebra. Sometimes, these injuries may be unstable. MSIGWA SAM-MD5 45
    46. 46. 02/02/14 MSIGWA SAM-MD5 46
    47. 47. 4. Flexion-distraction injury: This is a recently described spinal injury, being recognised in Western countries where use of a seat belt is compulsory while driving a car (chance fracture) Example: With the sudden stopping of a car, the upper part of t h e body is forced forward by inertia while the lower part is tied to the seat by the seatbelt. 02/02/14 MSIGWA SAM-MD5 47
    48. 48. 02/02/14 MSIGWA SAM-MD5 48
    49. 49. 5. Direct injury This is a rare type of spinal injury. Examples: (i) bullet injury; (ii) a lathi blow hitting the spinous processes of the cervical vertebrae. 02/02/14 Results: Any part of the vertebra may be smashed by a bullet, but, a lathi blow generally causes a fracture of t he spinous processes only. MSIGWA SAM-MD5 49
    50. 50. 6.Violent muscle contraction This is a rare injury. Example: Sudden violent contraction of the psoas. 02/02/14 Results: It results in fractures of the transverse processes of multiple lumbar vertebrae. It may be a s s o c i a t e d with a huge retroperitoneal haematoma. MSIGWA SAM-MD5 50
    51. 51. Spinal Column Injury 1. Cervical Spine Injuries Causes: –Fall from height –Diving accident –Whiplash injury 02/02/14 Mechanism  Flexion  Flexion and rotation  Extension  Compression MSIGWA SAM-MD5 51
    52. 52. Occipito – Atlantal Dislocation Fatal Subluxation without ND may survive Early & correct diagnosis with CT scan or MRI Dx by lateral cervical radiograph Tip of odontoid from basion: Alignment <5mm vertically & <1mm horizontally 02/02/14 MSIGWA SAM-MD5 52
    53. 53. OAD Imaging 02/02/14 MSIGWA SAM-MD5 53
    54. 54. OAD Imaging 02/02/14 MSIGWA SAM-MD5 54
    55. 55. OAD Treatment Initially by halo immobilisation without traction Definitive: posterior occipito – cervical fusion 02/02/14 MSIGWA SAM-MD5 55
    56. 56. 02/02/14 MSIGWA SAM-MD5 56
    57. 57. Atlas (C1) fractures Described as Jefferson # Axial load Usually no neurological deficit 1/3 have C2 # Usually stable 02/02/14 MSIGWA SAM-MD5 57
    58. 58. C1 fracture – Treatment Lateral masses – Undisplaced stable #s: semi rigid collar or halo – vest until it unites – Displaced: side ways spreading > 7mm; unstable & may require posterior C1/2 arthrodesis 02/02/14 MSIGWA SAM-MD5 58
    59. 59. 02/02/14 MSIGWA SAM-MD5 59
    60. 60. Axis (C2) # Includes Hangman’s # and Odontoid process # HANGMAN’S # Bilateral # of the isthmus of the pedicles of C2 with anterior sublaxation of C2-C3 Hyperextention and axial loading Usually stable 02/02/14 MSIGWA SAM-MD5 60
    61. 61. Spinal Column Injury Axis (C2) # Includes Hangman’s # and Odontoid process # I Odontoid # Flexion injury 15% of all cervical injuries II unstable,I & III stable 02/02/14 II III MSIGWA SAM-MD5 61
    62. 62. Odontoid Fracture (C2) Anderson & D’Alonzo classification: Type 1 – An avulsion fracture of tip of odontoid process due to traction of alar lig. Type 2 – # at the junction of odontoid process and the body. Most common & potentially dangerous type Type 3 – # thru the body of axis 02/02/14 MSIGWA SAM-MD5 62
    63. 63. Odontoid Fracture Cont’d Treatment Type 1 – Mobilise in rigid collar 8-12 wks Type 2 – Undisplaced #s: halo – vest for 8-12 wks – Displaced : Skull traction then wiring or screw fixation Type 3 – Traction or halovest depending on whether displaced or not 02/02/14 MSIGWA SAM-MD5 63
    64. 64. Spinal Column Injury Subaxial (C3-C7) # Whiplash injury:  Traumatic injury to the soft tissue in the cervical region  Hyperflexion, hyperextention  No fractures or dislocations  Most common automobile injury  Recover 3-6 months 02/02/14 MSIGWA SAM-MD5 64
    65. 65. Whiplash Injury X ray: loss of cervical lordosis due to muscle spasm MRI: disc herniation Cervical collar and graded exercises 02/02/14 MSIGWA SAM-MD5 65
    66. 66. Spinal Column Injury Subaxial (C3-C7) # Vertical compression injury:  Loss of normal cervical lordosis  Burst #  Compression of spinal cord  Unstable  Requires decompression and fusion 02/02/14 MSIGWA SAM-MD5 66
    67. 67. Spinal Column Injury Subaxial (C3-C7) # Compression flexion injury (teardrop #)  Classical diving injury  Posterior elements involved in >50%  Displacement of inferior margin of the body  Unstable  Requires stabilization 02/02/14 MSIGWA SAM-MD5 67
    68. 68. Spinal Column Injury Subaxial (C3-C7) # flexion distraction injury (locked facet)  >50% displacement  Unstable  Requires reduction and stabilization 02/02/14 MSIGWA SAM-MD5 68
    69. 69. Spinal Column Injury Subaxial (C3-C7) # extention injury (# posterior elements)  # lamina, pedicles or spinous process  With or without ligamentous injury  Usually stable 02/02/14 MSIGWA SAM-MD5 69
    70. 70. Clay Shoveller’s Injury Fracture of C7 spinous process with severe voluntary contraction of back muslces Painful but harmless Only analgesia 02/02/14 MSIGWA SAM-MD5 70
    71. 71. Spinal Column Injury Thoracic and lumbar # Stability (three column model of Denis)  Injury affecting two or more column is unstable 02/02/14 MSIGWA SAM-MD5 71
    72. 72. Spinal Column Injury Thoracic and lumbar # Compression # Burst # Chance # (seat belt) Flexion distraction Fracture dislocation 02/02/14 MSIGWA SAM-MD5 72
    73. 73. Wedge Compression Fracture Stable injury affecting only ant. column Semi – rigid collar 02/02/14 MSIGWA SAM-MD5 73
    74. 74. Posterior Lig. Injury Sudden flexion of mid cervical spine Damage to post. lig. Complex Upper vertebra tilts forward on one below & opening interspinous space 02/02/14 MSIGWA SAM-MD5 74
    75. 75. Posterior Lig. Injury Cont’d Treatment Unstable: – Angulation of VB with its neighbour >11º – Anterior translation of a vertebra >3.5mm – # or dislocation of facet Treated with post. fixation & fusion Stable – Semi – rigid collar x 6wks 02/02/14 MSIGWA SAM-MD5 75
    76. 76. Burst Fracture Axial loading as in diving or athletic accidents Comminuted fracture of vertebral body Frag. may enter spinal canal Halo vest or anterior decompression if neurological deficit present & immobilisation x 6-8 wks 02/02/14 MSIGWA SAM-MD5 76
    77. 77. Cervical Disc Herniation Severe pain radiating upper limbs Paresthesia and weakness may be present If there is paresis, then decompression is indicated – ant discectomy & interbody fusion 02/02/14 MSIGWA SAM-MD5 77
    78. 78. Signs and symptoms The extent of injury is defined by the American Spinal Injury Association (ASIA) Impairment Scale (modified from the Frankel classification), using the following categories. A – Complete: no sensory or motor function preserved in sacral segments S4 – S5 B – Incomplete: sensory, but no motor 02/02/14 MSIGWA SAM-MD5 78
    79. 79. C – Incomplete: motor function preserved below level and power graded < 3 D – Incomplete: motor function preserved below level and power graded 3 or more E – Normal: sensory and motor function normal
    80. 80. Spinal Shock vs Neurogenic Shock Spinal Shock :  Transient reflex depression of cord function below level of injury  Initially hypertension due to release of catecholamines  Followed by hypotension  Flaccid paralysis  Bowel and bladder involved  Sometimes priaprism develops  Symptoms last several hours to days
    81. 81. Neurogenic shock: Triad of i) hypotension ii) bradycardia iii) hypothermia More commonly in injuries above T6 Secondary to disruption of sympathetic outflow from T1 – L2
    82. 82. Loss of vasomotor tone – pooling of blood Loss of cardiac sympathetic tone – bradycardia Blood pressure will not be restored by fluid infusion alone Massive fluid administration may lead to overload and pulmonary edema Vasopressors may be indicated Atropine used to treat bradycardia
    83. 83. Neurogenic Shock Hypovolemic Shock As the Result of Loss of Sympathetic Outflow As the Result of Hemorrhage Hypotension Hypotension Bradycardia Tachycardia Warm extremities Cold extremities Normal urine output Low urine output 02/02/14 MSIGWA SAM-MD5 83
    84. 84. Types of incomplete injuries i) Central Cord Syndrome ii) Anterior Cord Syndrome iii) Posterior Cord Syndrome iv) Brown – Sequard Syndrome v) Cauda Equina Syndrome
    85. 85. i) Central Cord Syndrome :  Typically in older patients  Hyperextension injury  Compression of the cord anteriorly by osteophytes and posteriorly by ligamentum flavum
    86. 86. Also associated with fracture dislocation and compression fractures More centrally situated cervical tracts tend to be more involved hence flaccid weakness of arms > legs Perianal sensation & some lower extremity movement and sensation may be preserved
    87. 87. ii) Anterior cord Syndrome: Due to flexion / rotation Anterior dislocation / compression fracture of a vertebral body encroaching the ventral canal Corticospinal and spinothalamic tracts are damaged either by direct trauma or ischemia of blood supply (anterior spinal arteries)
    88. 88. Clinically: Loss of power Decrease in pain and sensation below lesion Dorsal columns remain intact
    89. 89. ii) Posterior Cord Syndrome: Hyperextension injuries with fractures of the posterior elements of the vertebrae   Clinically: Proprioception affected – ataxia and faltering gait Usually good power and sensation
    90. 90. ii) Posterior Cord Syndrome: Hyperextension injuries with fractures of the posterior elements of the vertebrae   Clinically: Proprioception affected – ataxia and faltering gait Usually good power and sensation
    91. 91. iv) Brown – Sequard Syndrome: Hemi-section of the cord Either due to penetrating injuries: i) stab wounds ii) gunshot wounds Fractures of lateral mass of vertebrae
    92. 92. Clinically: Paralysis on affected side (corticospinal) Loss of proprioception and fine discrimination (dorsal columns) Pain and temperature loss on the opposite side below the lesion (spinothalamic)
    93. 93. v) Cauda Equina Syndrome:  Due to bony compression or disc protrusions in lumbar or sacral region Clinically  Non specific symptoms – back pain - bowel and bladder dysfunction - leg numbness and weakness - saddle parasthesia
    94. 94. INVESTIGATIONS Good ante-posterior and lateral X-rays centring on the involved segment provide reasonable information about the injury. Sometimes, special imaging techniques are required e.g., Tomogram, C.T. scan, M.R.I, 02/02/14 MSIGWA SAM-MD5 98
    95. 95. Plain X-rays: (i) confirmation of diagnosis (ii) assessment of mechanism of injury and (iii) assessment of the stability of the spine. The following features may be noted on plain Xrays • Change in the general alignment of the spine i.e., antero-posterior bending (kyphosis) or sideways bending (scoliosis). • Reduction in t h e height of a vertebra. • Antero-posterior or sideways displacement of one vertebra over another. 02/02/14 MSIGWA SAM-MD5 • Fracture of a vertebral body. • Fracture of t h e 99
    96. 96. C.T. scan and M.R.I C.T. scan h a s proved to be a very helpful investigation. One can see the damaged structures more clearly, and make note of any bony fragment in the canal. M.R.I. is the best modality of imaging an injured spine. In addition to showing better, the details of injured bones and soft-tissues,it shows very well the anatomy of t he cord. 02/02/14 MSIGWA SAM-MD5 100
    97. 97. Tomogram: A tomogram helps in better delineation of a doubtful area. Myelogram has no role in the management of acute spinal injuries. 02/02/14 MSIGWA SAM-MD5 101
    98. 98. MANAGEMENT 02/02/14 MSIGWA SAM-MD5 102
    99. 99. The treatment of spinal injuries can be divided into three phases, as in other injuries: Phase I: Emergency care at the scene of accident or in emergency department. Phase II: Definitive care in emergency department or in the ward. Phase III: Rehabilitation 02/02/14 MSIGWA SAM-MD5 103
    100. 100. Phase I - At the scene of accident An acute pain in the back following an injury is to be considered a spinal injury unless proved otherwise. Also, all suspected spinal injuries are to be considered unstable unless their stability is confirmed on s u b s e q u e n t investigation. NB: A patient with a spinal injury has to be given the utmost care right at the scene of accident; the basic principle being to avoid any movement at the injured segment. 02/02/14 MSIGWA SAM-MD5 104
    101. 101. While moving a person with a suspected cervical spine injury, one person should hold the neck in traction by keeping the head pulled.  The rest of the body is supported at the shoulder, pelvis and legs by three other people. Whenever required, the whole body is to be moved in one piece so t h a t no movement occurs at the spine.  The same precaution is observed in a case with suspected dorso-lumbar injury. 02/02/14 MSIGWA SAM-MD5 105
    102. 102. In the emergency department The patient should not be moved from the trolley on which he is first received until stability of t he spine is confirmed A quick general examination of t h e patient is carried out in order to detect any other associated injuries to the chest, abdomen, pelvis, limbs etc. The spine i s examined for any tenderness, crepitus or haematoma. 02/02/14 MSIGWA SAM-MD5 106
    103. 103. PHASE II - DEFINITIVE CARE Definitive care of a patient with spinal injury depends upon the stability of the spine and the presence of a neurological deficit. The aim of treatment is: (i) to avoid any deterioration of the neurological status; (ii) to achieve stability of the spine by conservative or operative methods (iii) to rehabilitate the paralysed patient to the best possible extent. 02/02/14 MSIGWA SAM-MD5 107
    104. 104. Treatment of cervical spine injuries Cervical spine injuries are often associated with head injuries, the effect of which may mask the spinal lesion. Therefore, it is necessary to get an X-ray of the cervical spine in any serious case of head injury. The aim of treatment is to achieve proper alignment of vertebrae, and maintain it in that position till the vertebral column stabilises. This can be achieved in most cases by conservative methods. In some cases, an 108 02/02/14 MSIGWA SAM-MD5 operation may be required for-reducing or stabilising the spine.
    105. 105. Reduction is achieved by skull traction applied through skull calipers—Crutchfield tongs A weight of up to 10 kg is applied and check X-rays taken every 12 hours 02/02/14 MSIGWA SAM-MD5 109
    106. 106. 02/02/14 MSIGWA SAM-MD5 110
    107. 107. Operation: This may be required for: (i) irreducible subluxation because of 'locking' of the articular processes or (ii) persistent instability. The operation consists of inter-body fusion (anterior fusion) or fusion of the spinous processes and laminae (posterior fusion). Internal fixation may be required. 02/02/14 MSIGWA SAM-MD5 111
    108. 108. Treatment of thoracic and lumbar spine injuries Operative methods: Whenever necessary the following operative methods are performed • Harrington instrumentation — bilateral. • Luque instrumentation. • Hartshill rectangle fixation. • Pedicle screw fixation. 02/02/14 MSIGWA SAM-MD5 112
    109. 109. References: 1. Andrew T Raftery, et al. Applied Basic Science for Basic Surgical Training. Second edition 2008;8:219223 2. Essential Orthopaedics 3rd EDITION-Maheshwari 3. Handbook of Fractures 3rd Edition 4. Dr.Ferdinand Massaga-UDOM,classnotes 5. Spinal cord injuries-JC King 6. Muhas presentation
    110. 110. Thank you 02/02/14 MSIGWA SAM-MD5 114

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