This document provides an overview of classifications and management approaches for fractures and dislocations of the thoracic and lumbar spine. It discusses several classification systems, including the Denis system which divides the spine into three columns, and the TLICS system which scores injuries based on morphology, posterior ligament integrity and neurologic status to determine surgical vs non-surgical management. For most thoracolumbar injuries without neurologic deficit, non-surgical treatment is appropriate. Surgical intervention may improve mobilization and function for unstable fractures or injuries involving neurologic compression. The goals of management are maximizing neurologic recovery while stabilizing the spine to facilitate early rehabilitation.
This document discusses thoracolumbar fractures of the spine. It begins by describing the anatomy of the spine and functional spinal units. It then discusses the physiological anatomy of the thoracic and lumbar spine. It describes the etiology, classifications including the Denis three-column theory and AO/MAGREL classification, clinical presentations, investigations including x-rays, CT and MRI, and classifications of spinal instability for thoracolumbar fractures.
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically compromised patients. Treatment is based on fracture stability, deformity, and neurological status.
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically incomplete injuries. Treatment is based on fracture stability, deformity, and neurological status.
Thoracolumbar spine Injuries by Dr Rohan DhotreDrRohanDhotre
1. Thoracolumbar spine injuries most commonly occur at T11-L1 and are usually due to high-energy trauma like motor vehicle accidents or falls.
2. Classification systems like Denis column theory and AO/Magerl system help characterize the injury and guide treatment.
3. Treatment depends on the fracture type and neurological status. Uncomplicated compression fractures are typically managed conservatively while injuries involving the posterior ligaments or with neurological deficits usually require surgery.
The document discusses the anatomy, biomechanics, classification systems, and management of injuries to the subaxial cervical spine (C3-C7). Key points include: the subaxial spine consists of 7 vertebrae joined by ligaments and disks; common injury mechanisms are flexion, extension, compression, and rotation; the Allen-Ferguson and AO classification systems describe injury patterns; clinical instability is defined as loss of ability to avoid neurologic injury or deformity; the SLIC score guides treatment; and initial management priorities are airway control, immobilization, and prevention of hypoxia.
This document discusses the anatomy and physiology of the thoracolumbar spine and classifies different types of thoracolumbar spine injuries. It describes the anatomy of the spinal cord, blood supply, and biomechanics of the thoracic and lumbar regions. Various injury mechanisms are outlined including compression fractures, burst fractures, and chance fractures. Imaging techniques like x-rays, CT, and MRI are discussed. The Denis three-column theory and TLICS classification system are introduced to classify injuries as stable or unstable. Non-operative and surgical treatment options are provided based on the injury classification.
This document discusses spinal anatomy, trauma, and injury. It covers the epidemiology, mechanisms, classifications, diagnosis, and management of spinal cord injuries. Some key points include:
- The cervical spine has greater range of motion while the thoracic and lumbar vertebrae are more rigid.
- Spinal cord injuries can be complete or incomplete. Complete injuries have no motor or sensory function below the level of injury while incomplete injuries have some spared function.
- Common mechanisms of injury are motor vehicle accidents, falls, and sports/recreation injuries. Indirect injuries from compression are most likely to cause significant damage.
- Imaging like CT and MRI are important for diagnosis but patient stabilization takes priority over imaging in trauma situations
This document discusses thoracolumbar fractures of the spine. It begins by describing the anatomy of the spine and functional spinal units. It then discusses the physiological anatomy of the thoracic and lumbar spine. It describes the etiology, classifications including the Denis three-column theory and AO/MAGREL classification, clinical presentations, investigations including x-rays, CT and MRI, and classifications of spinal instability for thoracolumbar fractures.
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically compromised patients. Treatment is based on fracture stability, deformity, and neurological status.
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically incomplete injuries. Treatment is based on fracture stability, deformity, and neurological status.
Thoracolumbar spine Injuries by Dr Rohan DhotreDrRohanDhotre
1. Thoracolumbar spine injuries most commonly occur at T11-L1 and are usually due to high-energy trauma like motor vehicle accidents or falls.
2. Classification systems like Denis column theory and AO/Magerl system help characterize the injury and guide treatment.
3. Treatment depends on the fracture type and neurological status. Uncomplicated compression fractures are typically managed conservatively while injuries involving the posterior ligaments or with neurological deficits usually require surgery.
The document discusses the anatomy, biomechanics, classification systems, and management of injuries to the subaxial cervical spine (C3-C7). Key points include: the subaxial spine consists of 7 vertebrae joined by ligaments and disks; common injury mechanisms are flexion, extension, compression, and rotation; the Allen-Ferguson and AO classification systems describe injury patterns; clinical instability is defined as loss of ability to avoid neurologic injury or deformity; the SLIC score guides treatment; and initial management priorities are airway control, immobilization, and prevention of hypoxia.
This document discusses the anatomy and physiology of the thoracolumbar spine and classifies different types of thoracolumbar spine injuries. It describes the anatomy of the spinal cord, blood supply, and biomechanics of the thoracic and lumbar regions. Various injury mechanisms are outlined including compression fractures, burst fractures, and chance fractures. Imaging techniques like x-rays, CT, and MRI are discussed. The Denis three-column theory and TLICS classification system are introduced to classify injuries as stable or unstable. Non-operative and surgical treatment options are provided based on the injury classification.
This document discusses spinal anatomy, trauma, and injury. It covers the epidemiology, mechanisms, classifications, diagnosis, and management of spinal cord injuries. Some key points include:
- The cervical spine has greater range of motion while the thoracic and lumbar vertebrae are more rigid.
- Spinal cord injuries can be complete or incomplete. Complete injuries have no motor or sensory function below the level of injury while incomplete injuries have some spared function.
- Common mechanisms of injury are motor vehicle accidents, falls, and sports/recreation injuries. Indirect injuries from compression are most likely to cause significant damage.
- Imaging like CT and MRI are important for diagnosis but patient stabilization takes priority over imaging in trauma situations
Thoracic and lumbar fractures account for 30-50% of all spinal injuries. The majority occur between T11-L1 (thoracolumbar junction). They account for 50% of all spinal fractures, with an incidence of 4-5 per 100,000 people aged 18-35 years and occurring more in males. Neurological injuries occur in 25% of cases. Operative treatment is indicated for vertebral height loss over 40%, canal compromise over 40%, or kyphosis over 25 degrees. The goals of treatment are maximizing neurological recovery, maintaining spinal alignment, obtaining a healed and stable spine, and preventing deformity.
- Thoracolumbar injuries can cause neurological injury and long-term pain. They require assessment of fracture classification and the integrity of the posterior ligamentous complex to determine appropriate management as surgical or nonsurgical.
- Surgical approaches include posterior, anterior, or combined based on the fracture type and neurological status. Proper classification guides treatment to decompress the spine and restore stability.
- Complications include problems from immobilization as well as implant failure and infection. Careful consideration of fracture morphology, neurological findings, and ligamentous integrity directs optimal treatment.
1) Classification systems help determine treatment for thoracolumbar spine fractures and dislocations. The Denis system classifies injuries by their impact on the anterior, middle, and posterior spinal columns. The AO system further divides injuries based on the fracture pattern.
2) The TLICS score predicts the need for surgery versus nonsurgical treatment based on the injury morphology, integrity of the posterior ligaments, and any neurologic injury. A higher score indicates a greater need for surgery.
3) Injuries are considered stable if they cause less than a certain degree of kyphosis, vertebral body collapse, or spinal canal compromise and there is no neurologic injury. Unstable injuries have greater deformity or neurologic
The document summarizes thoracolumbar spine injuries, including:
- Anatomy of the thoracic and lumbar spine regions which predispose the thoracolumbar junction to injury.
- Epidemiology showing these injuries most commonly affect segments T11-L2 and have bimodal age distribution.
- Classification systems including Denis, McCormack, and TLICS which evaluate morphology, neurology, and ligamentous integrity to determine treatment.
- Treatment principles aim to preserve neurology, minimize compression, stabilize the spine, and rehabilitate the patient either via non-operative or operative means.
This document provides information on spinal injuries, including epidemiology, mechanisms of injury, clinical assessment, radiographic evaluation, and management. Some key points:
- Spinal injuries most commonly occur in the cervical region in individuals ages 16-30. Mortality is 40-50%.
- Clinical assessment includes inspection, palpation, and neurological examination to evaluate for tenderness, deficits, and classify the level of injury.
- The NEXUS and Canadian C-Spine rules can help determine which patients require radiographic imaging based on factors like mechanism of injury, neurological status, and range of motion.
- Management involves immobilization, monitoring ABCs, ruling out other injuries, pain control,
This document discusses the classification, clinical evaluation, and management of adult traumatic brachial plexus injuries. It describes Chuang's four-level classification of brachial plexus lesions and defines terms like rupture and avulsion. Preganglionic root injuries are described as the most common in adults and can involve single or multiple root injuries. A thorough motor, sensory and neurological examination is outlined to evaluate the specific nerves and spinal levels involved. Classification of injuries, prognostic indicators, and guidance on surgical decision making are provided.
1) Fractures of the talus are difficult to treat due to its complex anatomy and poor blood supply, which can lead to complications like avascular necrosis.
2) Hawkins classification is commonly used to describe talar neck fractures and predict risk of avascular necrosis, with type III fractures having the highest risk.
3) Treatment goals are anatomic reduction, stable fixation to allow early motion, and prevention of complications.
4) Surgical techniques may include closed or open reduction, internal fixation with screws or plates through one or two incisions, and occasionally arthrodesis or excision of small fragments.
The spinal cord extends from the brainstem down to the lumbar region and is protected by meninges. It conducts motor and sensory signals and coordinates reflexes. Spinal cord injuries can damage the cord or vertebrae and cause changes in motor and sensory function that are temporary or permanent. The most common causes are motor vehicle accidents. Injuries can be complete or incomplete. The cervical and thoracolumbar regions are most vulnerable. Complications include paralysis, respiratory issues, and bladder/bowel dysfunction. Treatment involves stabilization, monitoring for secondary injuries, and rehabilitation.
This document discusses vertebral fractures and spinal cord injuries. It begins by describing the anatomy of the vertebral column and typical vertebrae. It then discusses different types of lumbar vertebral fractures including wedge compression fractures, burst fractures, flexion-distraction injuries, and fracture-dislocations. Emergency management of spinal injuries is outlined including immobilization techniques. Spinal cord injuries are also summarized, covering topics like pathophysiology, classifications, consequences, and specific syndromes like central cord syndrome. Acute phase conditions like spinal shock and neurogenic shock are defined.
1. The document discusses the anatomy, mechanisms of injury, classification, clinical features, management, and imaging of cervical spine injuries.
2. Key points include the importance of manual handling and immobilization of patients with potential cervical spine injuries. Radiographic imaging including CT and MRI are important diagnostic tools.
3. Common cervical spine injuries include fractures of C1 (Atlas) and C2 (Axis) as well as fracture-dislocations. Clinical syndromes can occur based on the level and mechanism of injury.
This document discusses the management of foot and ankle trauma. It begins with an overview of the anatomy of the ankle joint and examination of the foot and ankle. It then covers the assessment and management of ankle fractures, including distinguishing stable from unstable fractures. Weight bearing x-rays may better determine stability compared to stress views. Finally, it discusses the management of Achilles tendon ruptures, noting early loading and mobilization leads to better outcomes compared to immobilization.
1. Thoracolumbar spinal injuries most commonly occur in the T11-L2 region due to the anatomical transition from the rigid thoracic spine to the more mobile lumbar spine.
2. They present with pain, loss of function, and potentially neurological deficits depending on the severity of the injury. Common causes are axial compression, flexion/distraction, or rotation.
3. Treatment depends on the fracture classification (AO/Denis), stability, and presence of neurological deficits. Unstable or injuries with deficits generally require surgical stabilization to restore alignment and prevent further injury, while stable injuries may be treated non-operatively with bracing or casting.
Thoracolumbar fractures account for 50% of spinal fractures and often occur between the T9 and L2 vertebrae. They are commonly caused by high-energy trauma like motor vehicle accidents or falls. Assessment involves neurological examination, imaging like x-rays and CT scans to evaluate bone injury and MRI to assess soft tissues. Treatment depends on factors like degree of vertebral compression and kyphosis, with non-operative options for mild cases and surgical stabilization and fusion for more severe injuries or neurological compromise. Rehabilitation focuses on restoring function, preventing complications, and bracing to solidify healing.
This document discusses idiopathic scoliosis, which is defined as a spinal deformity characterized by lateral bending and fixed rotation of the spine without a known cause. It is divided into subgroups based on age of onset, including infantile, juvenile, and adolescent idiopathic scoliosis. Treatment options include observation for mild curves, bracing to prevent progression of moderate curves, and surgery to correct severe or progressive curves. Surgical techniques have advanced from Harrington instrumentation to segmental fixation with hooks and more recently pedicle screws, allowing for improved three-dimensional correction while fusion fewer vertebrae.
This document discusses the anatomy and classification of fractures of the femoral neck. It begins by providing background on the increasing incidence of hip fractures globally. It then describes the anatomy of the hip joint and proximal femur, including the femoral neck, angles, blood supply, and trabecular patterns. It discusses several classification systems for femoral neck fractures, including the Garden, Pauwels, and OTA classifications, which are based on the location and degree of displacement of the fracture. Imaging modalities for evaluating these fractures such as radiography, CT, MRI, and nuclear medicine are also summarized.
This document provides information on clavicle fractures, including:
- Epidemiology: Middle third fractures account for 80% and lateral third fractures 15%.
- Treatment: Non-displaced fractures are typically treated non-operatively with slings or braces. Displaced or unstable fractures may require open reduction and internal fixation with plates or intramedullary nails.
- Complications: Include nonunion, hardware issues, infection, and injuries to nearby structures like blood vessels or the brachial plexus. Floating shoulder injuries involving both the clavicle and scapular neck often require surgical fixation.
The document discusses the anatomy and clinical features of spinal fractures. It begins with the anatomy of the vertebral column and its supporting ligaments. It then discusses the classification, mechanisms of injury, and clinical features of spinal fractures. Diagnosis involves history, physical exam including neurological exam, and imaging studies like x-rays, CT scans, and MRI to identify fractures and spinal cord injuries. Management aims to prevent secondary injury through immobilization of the spine.
This document provides an overview of traumatic paraplegia and spinal cord injury. It discusses the classification, epidemiology, mechanisms of injury, assessment, diagnostic modalities, management of complications like bladder dysfunction, and considerations for thoracolumbar injuries. Key points include that spinal cord injury results in changes to motor, sensory or autonomic function, most injuries occur in the cervical spine from motor vehicle accidents in young males, and diagnostic workup involves plain films, CT scans and potentially MRI to evaluate injury extent and neurological status.
This document provides an overview of spinal trauma. It begins with relevant spinal anatomy and the epidemiology of spinal injuries. The most common mechanisms of injury are motor vehicle accidents and falls. Clinical signs include neurological deficits that correspond to the level and completeness of injury. Radiological imaging such as X-rays, CT, and MRI are used to identify fractures and spinal instability. Early management focuses on immobilization, corticosteroids, and treating associated conditions like neurogenic shock. Surgical stabilization is indicated for incomplete injuries with neural compression or unstable fractures with neurological deficits. The goals of treatment are to preserve neurological function, minimize compression, stabilize the spine, and rehabilitate the patient.
Traumatic paraplegia & bladder management by dr ashutoshAshutosh Kumar
1) Traumatic paraplegia refers to spinal cord injury in the thoracic, lumbar, or sacral regions resulting in loss of muscle strength in the lower extremities. Initial management involves immobilization and transport to the emergency room for evaluation.
2) The bladder is commonly affected after paraplegia, resulting in either a flaccid or spastic bladder depending on the level of injury. Long-term management involves preventing complications like pressure ulcers, spasticity, and blood clots through rehabilitation therapies.
3) Rehabilitation is critical after spinal cord injury and involves a multidisciplinary team to address issues like bladder management, skin care, spasticity management, and prevention of secondary complications. The
Thoracic and lumbar fractures account for 30-50% of all spinal injuries. The majority occur between T11-L1 (thoracolumbar junction). They account for 50% of all spinal fractures, with an incidence of 4-5 per 100,000 people aged 18-35 years and occurring more in males. Neurological injuries occur in 25% of cases. Operative treatment is indicated for vertebral height loss over 40%, canal compromise over 40%, or kyphosis over 25 degrees. The goals of treatment are maximizing neurological recovery, maintaining spinal alignment, obtaining a healed and stable spine, and preventing deformity.
- Thoracolumbar injuries can cause neurological injury and long-term pain. They require assessment of fracture classification and the integrity of the posterior ligamentous complex to determine appropriate management as surgical or nonsurgical.
- Surgical approaches include posterior, anterior, or combined based on the fracture type and neurological status. Proper classification guides treatment to decompress the spine and restore stability.
- Complications include problems from immobilization as well as implant failure and infection. Careful consideration of fracture morphology, neurological findings, and ligamentous integrity directs optimal treatment.
1) Classification systems help determine treatment for thoracolumbar spine fractures and dislocations. The Denis system classifies injuries by their impact on the anterior, middle, and posterior spinal columns. The AO system further divides injuries based on the fracture pattern.
2) The TLICS score predicts the need for surgery versus nonsurgical treatment based on the injury morphology, integrity of the posterior ligaments, and any neurologic injury. A higher score indicates a greater need for surgery.
3) Injuries are considered stable if they cause less than a certain degree of kyphosis, vertebral body collapse, or spinal canal compromise and there is no neurologic injury. Unstable injuries have greater deformity or neurologic
The document summarizes thoracolumbar spine injuries, including:
- Anatomy of the thoracic and lumbar spine regions which predispose the thoracolumbar junction to injury.
- Epidemiology showing these injuries most commonly affect segments T11-L2 and have bimodal age distribution.
- Classification systems including Denis, McCormack, and TLICS which evaluate morphology, neurology, and ligamentous integrity to determine treatment.
- Treatment principles aim to preserve neurology, minimize compression, stabilize the spine, and rehabilitate the patient either via non-operative or operative means.
This document provides information on spinal injuries, including epidemiology, mechanisms of injury, clinical assessment, radiographic evaluation, and management. Some key points:
- Spinal injuries most commonly occur in the cervical region in individuals ages 16-30. Mortality is 40-50%.
- Clinical assessment includes inspection, palpation, and neurological examination to evaluate for tenderness, deficits, and classify the level of injury.
- The NEXUS and Canadian C-Spine rules can help determine which patients require radiographic imaging based on factors like mechanism of injury, neurological status, and range of motion.
- Management involves immobilization, monitoring ABCs, ruling out other injuries, pain control,
This document discusses the classification, clinical evaluation, and management of adult traumatic brachial plexus injuries. It describes Chuang's four-level classification of brachial plexus lesions and defines terms like rupture and avulsion. Preganglionic root injuries are described as the most common in adults and can involve single or multiple root injuries. A thorough motor, sensory and neurological examination is outlined to evaluate the specific nerves and spinal levels involved. Classification of injuries, prognostic indicators, and guidance on surgical decision making are provided.
1) Fractures of the talus are difficult to treat due to its complex anatomy and poor blood supply, which can lead to complications like avascular necrosis.
2) Hawkins classification is commonly used to describe talar neck fractures and predict risk of avascular necrosis, with type III fractures having the highest risk.
3) Treatment goals are anatomic reduction, stable fixation to allow early motion, and prevention of complications.
4) Surgical techniques may include closed or open reduction, internal fixation with screws or plates through one or two incisions, and occasionally arthrodesis or excision of small fragments.
The spinal cord extends from the brainstem down to the lumbar region and is protected by meninges. It conducts motor and sensory signals and coordinates reflexes. Spinal cord injuries can damage the cord or vertebrae and cause changes in motor and sensory function that are temporary or permanent. The most common causes are motor vehicle accidents. Injuries can be complete or incomplete. The cervical and thoracolumbar regions are most vulnerable. Complications include paralysis, respiratory issues, and bladder/bowel dysfunction. Treatment involves stabilization, monitoring for secondary injuries, and rehabilitation.
This document discusses vertebral fractures and spinal cord injuries. It begins by describing the anatomy of the vertebral column and typical vertebrae. It then discusses different types of lumbar vertebral fractures including wedge compression fractures, burst fractures, flexion-distraction injuries, and fracture-dislocations. Emergency management of spinal injuries is outlined including immobilization techniques. Spinal cord injuries are also summarized, covering topics like pathophysiology, classifications, consequences, and specific syndromes like central cord syndrome. Acute phase conditions like spinal shock and neurogenic shock are defined.
1. The document discusses the anatomy, mechanisms of injury, classification, clinical features, management, and imaging of cervical spine injuries.
2. Key points include the importance of manual handling and immobilization of patients with potential cervical spine injuries. Radiographic imaging including CT and MRI are important diagnostic tools.
3. Common cervical spine injuries include fractures of C1 (Atlas) and C2 (Axis) as well as fracture-dislocations. Clinical syndromes can occur based on the level and mechanism of injury.
This document discusses the management of foot and ankle trauma. It begins with an overview of the anatomy of the ankle joint and examination of the foot and ankle. It then covers the assessment and management of ankle fractures, including distinguishing stable from unstable fractures. Weight bearing x-rays may better determine stability compared to stress views. Finally, it discusses the management of Achilles tendon ruptures, noting early loading and mobilization leads to better outcomes compared to immobilization.
1. Thoracolumbar spinal injuries most commonly occur in the T11-L2 region due to the anatomical transition from the rigid thoracic spine to the more mobile lumbar spine.
2. They present with pain, loss of function, and potentially neurological deficits depending on the severity of the injury. Common causes are axial compression, flexion/distraction, or rotation.
3. Treatment depends on the fracture classification (AO/Denis), stability, and presence of neurological deficits. Unstable or injuries with deficits generally require surgical stabilization to restore alignment and prevent further injury, while stable injuries may be treated non-operatively with bracing or casting.
Thoracolumbar fractures account for 50% of spinal fractures and often occur between the T9 and L2 vertebrae. They are commonly caused by high-energy trauma like motor vehicle accidents or falls. Assessment involves neurological examination, imaging like x-rays and CT scans to evaluate bone injury and MRI to assess soft tissues. Treatment depends on factors like degree of vertebral compression and kyphosis, with non-operative options for mild cases and surgical stabilization and fusion for more severe injuries or neurological compromise. Rehabilitation focuses on restoring function, preventing complications, and bracing to solidify healing.
This document discusses idiopathic scoliosis, which is defined as a spinal deformity characterized by lateral bending and fixed rotation of the spine without a known cause. It is divided into subgroups based on age of onset, including infantile, juvenile, and adolescent idiopathic scoliosis. Treatment options include observation for mild curves, bracing to prevent progression of moderate curves, and surgery to correct severe or progressive curves. Surgical techniques have advanced from Harrington instrumentation to segmental fixation with hooks and more recently pedicle screws, allowing for improved three-dimensional correction while fusion fewer vertebrae.
This document discusses the anatomy and classification of fractures of the femoral neck. It begins by providing background on the increasing incidence of hip fractures globally. It then describes the anatomy of the hip joint and proximal femur, including the femoral neck, angles, blood supply, and trabecular patterns. It discusses several classification systems for femoral neck fractures, including the Garden, Pauwels, and OTA classifications, which are based on the location and degree of displacement of the fracture. Imaging modalities for evaluating these fractures such as radiography, CT, MRI, and nuclear medicine are also summarized.
This document provides information on clavicle fractures, including:
- Epidemiology: Middle third fractures account for 80% and lateral third fractures 15%.
- Treatment: Non-displaced fractures are typically treated non-operatively with slings or braces. Displaced or unstable fractures may require open reduction and internal fixation with plates or intramedullary nails.
- Complications: Include nonunion, hardware issues, infection, and injuries to nearby structures like blood vessels or the brachial plexus. Floating shoulder injuries involving both the clavicle and scapular neck often require surgical fixation.
The document discusses the anatomy and clinical features of spinal fractures. It begins with the anatomy of the vertebral column and its supporting ligaments. It then discusses the classification, mechanisms of injury, and clinical features of spinal fractures. Diagnosis involves history, physical exam including neurological exam, and imaging studies like x-rays, CT scans, and MRI to identify fractures and spinal cord injuries. Management aims to prevent secondary injury through immobilization of the spine.
This document provides an overview of traumatic paraplegia and spinal cord injury. It discusses the classification, epidemiology, mechanisms of injury, assessment, diagnostic modalities, management of complications like bladder dysfunction, and considerations for thoracolumbar injuries. Key points include that spinal cord injury results in changes to motor, sensory or autonomic function, most injuries occur in the cervical spine from motor vehicle accidents in young males, and diagnostic workup involves plain films, CT scans and potentially MRI to evaluate injury extent and neurological status.
This document provides an overview of spinal trauma. It begins with relevant spinal anatomy and the epidemiology of spinal injuries. The most common mechanisms of injury are motor vehicle accidents and falls. Clinical signs include neurological deficits that correspond to the level and completeness of injury. Radiological imaging such as X-rays, CT, and MRI are used to identify fractures and spinal instability. Early management focuses on immobilization, corticosteroids, and treating associated conditions like neurogenic shock. Surgical stabilization is indicated for incomplete injuries with neural compression or unstable fractures with neurological deficits. The goals of treatment are to preserve neurological function, minimize compression, stabilize the spine, and rehabilitate the patient.
Traumatic paraplegia & bladder management by dr ashutoshAshutosh Kumar
1) Traumatic paraplegia refers to spinal cord injury in the thoracic, lumbar, or sacral regions resulting in loss of muscle strength in the lower extremities. Initial management involves immobilization and transport to the emergency room for evaluation.
2) The bladder is commonly affected after paraplegia, resulting in either a flaccid or spastic bladder depending on the level of injury. Long-term management involves preventing complications like pressure ulcers, spasticity, and blood clots through rehabilitation therapies.
3) Rehabilitation is critical after spinal cord injury and involves a multidisciplinary team to address issues like bladder management, skin care, spasticity management, and prevention of secondary complications. The
- Cystic bone lesions include solitary bone cysts, aneurysmal bone cysts, intraosseous ganglion cysts, and epidermoid cysts. Unicameral bone cysts typically occur in the humerus or femur of children and adolescents and may heal spontaneously at skeletal maturity. Aneurysmal bone cysts contain blood-filled cavities and commonly involve the proximal humerus, distal femur, and proximal tibia. Intraosseous ganglion cysts have similarities to soft tissue ganglions and contain mucoid fluid. Epidermoid bone cysts are rare and contain keratinous material. Surgical curettage is often used to treat symptomatic cystic bone
The document provides an orientation for observers at Children's Hospital and Health System. It outlines the purpose of the observer program, which is to allow interested individuals to explore healthcare careers by shadowing hospital staff. It then details the organization's mission to provide high-quality pediatric care, education, research, and community advocacy. The document reviews rules of conduct, safety procedures during emergencies, infection control protocols, security information, and concludes by thanking the observer for completing the orientation.
This document provides information about several English tenses:
1. It explains the simple present tense, used to describe facts, habitual actions, and future schedules. Examples are given of affirmative, negative, and interrogative sentences.
2. The simple past tense is described as used for completed past actions and repeated past actions. Example sentences show its formation.
3. Details are given on the present continuous, past continuous, present perfect, and past perfect tenses. For each, examples demonstrate how to form affirmative, negative, and interrogative sentences in that tense.
Orthopaedic surgery patients are at very high risk for developing dangerous blood clots called deep vein thromboses (DVTs). Without preventative measures, the risk of DVTs in these patients ranges from 40-60%. However, using prophylaxis like blood thinners, compression stockings, or pneumatic compression devices can reduce the risk to 1.3-10%. Guidelines recommend low molecular weight heparins, low-dose unfractionated heparins, or newer oral anticoagulants to prevent DVTs in orthopaedic patients undergoing hip or knee replacement or hip fracture surgery. Mechanical methods alone are not sufficient prophylaxis due to non-compliance issues.
The hip joint is a ball and socket joint formed between the femur and acetabulum. It allows for flexion, extension, abduction, adduction, and rotation. The joint is stabilized by ligaments like the iliofemoral and labrum. Seventeen muscles control hip movement and are divided into four groups - gluteals, lateral rotators, adductors, and iliopsoas. The gluteals externally rotate and extend the hip while the iliopsoas flex and internally rotate.
The document provides an overview of equinus deformity and its surgical correction in patients with cerebral palsy. It discusses the anatomy and causes of equinus deformity. Several surgical techniques for correcting the deformity are described in detail, including open lengthening of the Achilles tendon using the White modification or Z-plasty techniques, as well as percutaneous and gastrocnemius-soleus lengthening procedures. Postoperative management involves casting and bracing to maintain correction while allowing for muscle growth. Surgical correction aims to improve ambulation and care but must be tailored to each patient's needs and deformity severity.
This document discusses surgical techniques for correcting foot deformities in cerebral palsy patients, including:
1) Lengthening the posterior tibial tendon through open Z-plasty or musculotendinous recession to treat equinovarus deformity.
2) Split tendon transfers like the Kling-Kaufer-Hensinger posterior tibial transfer or Hoffer anterior tibial transfer to balance muscle forces.
3) Osteotomy of the calcaneus using Dwyer's technique for fixed varus deformities, combined with soft tissue procedures.
PET (positron emission tomography) scan uses radioactive tracers and detects biochemical activity within the body. It provides quantitative data on physiological processes. The document discusses the basic physics behind PET including positron decay, annihilation, and detection of gamma rays. It describes the detectors and image acquisition system used in PET scans. The document outlines several clinical applications of PET scans including oncology, neurology, and cardiology. It provides examples of PET scan images and findings that demonstrate lesions detected.
This document provides strategies and guidelines for answering structure questions on the TOEFL exam. It discusses 9 key skills for these types of questions: subjects and verbs, objects of prepositions, present and past participles, coordinate connectors, adverb clause connectors, noun clause connectors, noun clause connector/subjects, and adjective clause connectors. For each skill, it provides examples of sentences with missing words and explains the underlying grammar rules to apply when considering which answer choice correctly completes the sentence. The overall document aims to help test-takers understand and apply English grammar concepts to correctly answer structure questions on the TOEFL exam.
Gradable adjectives can be compared using comparative and superlative forms to show degrees of a quality. The comparative form typically adds "-er" and uses "than" to compare two items or people, showing superiority or inferiority. The superlative uses "-est" and "the" to denote the highest degree of a quality compared to three or more items. Examples are given for common adjectives like fast, clean, and big.
This document discusses medical ethics and its principles. It begins by defining ethics and medical ethics, noting that medical ethics deals with moral issues in medical practice. It then outlines four basic principles of medical ethics: respect for patient autonomy, non-maleficence, beneficence, and justice. The document also discusses public health ethics, research ethics, and some top ethical issues in healthcare such as balancing care quality and access. It emphasizes that quality care is built upon ethical standards and principles.
SI dislocations and fractures can be incomplete or complete, with complete injuries rupturing the posterior ligaments and causing vertical and rotational instability. Crescent fractures involve an iliac wing fracture entering the SI joint. Injuries usually result from lateral compression and may be associated with open wounds or bowel involvement. Accurate reduction and stable fixation of the SI joint determines prognosis. Iliac wing fractures have a high risk of associated injuries like bowel entrapment.
The document summarizes the treatment options for osteoarthritis of the knee. It discusses conservative treatments like physiotherapy, analgesics, and lifestyle changes for early stage osteoarthritis. For intermediate stages, options like joint debridement, autologous chondrocyte grafting, and realignment osteotomies are covered. Late stage treatments discussed include arthroplasty procedures like knee replacement as well as arthrodesis. Surgical techniques for various realignment osteotomies and knee replacement are explained in detail.
This document summarizes common nerve injuries in the upper and lower extremities. In the upper limb, it describes injuries to the axillary, radial, median, and ulnar nerves, including their sensory and motor functions, common causes of injury, and clinical manifestations. For the lower limb, it discusses femoral, sciatic, and common peroneal nerve injuries, noting signs and symptoms such as sensory loss, muscle weakness or deformities like drop foot. The document provides an overview of peripheral nerve injuries and their presentations to help clinicians properly diagnose different conditions.
This document provides an overview of osteoarthritis of the knee. It defines osteoarthritis as a non-inflammatory degenerative joint condition. It describes the pathology and changes that occur in the articular cartilage, bone, synovial membrane, capsule, ligaments and muscles. Risk factors, clinical presentation, diagnostic tests including x-rays and MRI, and grading scales are outlined. Both non-surgical and surgical treatment options are discussed including exercises, braces, medications, injections, osteotomies and knee replacements.
Locked plating involves a screw and plate construct where the screw engages coupling holes in the plate, securing a fixed angle. It provides increased rigidity over non-locking plates through a locked interface between the screw head and plate. This monobloc effect allows all screws to bear weight simultaneously, reducing failure risks compared to sequential loading in non-locking plates. Correct usage of locked plating requires understanding its mechanics, indications, and techniques to achieve anatomic reduction and stability.
This document provides an overview of ankle fracture patterns, classifications, radiographic evaluation, treatment approaches, and postoperative management. Key points include that ankle fractures can be classified anatomically or using the Lauge-Hansen system, radiographs include stress views to assess ligament injuries, treatment depends on fracture displacement and stability, and goals are anatomic reduction and fixation to restore the ankle mortise. Complications include wound issues, infection, and post-traumatic arthritis.
1. The extensor mechanism of the fingers consists of the central slip and lateral bands which insert at various joints to extend the fingers.
2. Injuries can occur in different zones from the DIP to the forearm. Zone I injuries occur at the DIP joint while zone II injuries involve the lateral bands.
3. Boutonniere deformities result from zone III injuries where the central slip is disrupted. Management depends on the chronicity and severity of the deformity.
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2. Core Curriculum V5
Objectives
• Understand the anatomy and its impact on pathology
• Learn the patterns of neurologic injury
• Understand the widely used classification systems
• Learn how to determine operative versus non operative management
3. Core Curriculum V5
Introduction
• Males > females
• 30% males in 30s
• High energy injury
• MVA >> Fall
• Spinal column injury, 10-25%
neurologic deficit
• Thoracolumbar spine most
common site of spinal injuries
4. Core Curriculum V5
Introduction
• Frequency (Gertzbein 1994)
• T11-L1(52%) > L1-5(32%) > T1-10(16%)
• Up to 50% have associated injuries
• Intra-abdominal (liver, spleen)
• Pulmonary injury- up to 20%
• Up to 15% noncontiguous fractures
5. Core Curriculum V5
Clinical Anatomy
• Thoracic spine
• Kyphotic
• Facets in coronal plane
• Stabilized by ribs
• 2X Flexion stiffness
• 3X lateral bending stiffness
• Prevent rotation
• ↓ canal:cord ratio (T2 to T10)
• More susceptible to SCI
10. Core Curriculum V5
ASIA Classification
• A = Complete
• No motor or sensory function is preserved in the sacral segments S4-S5
• B = Incomplete
• Sensory but no motor function is preserved below the neurological level and
includes the sacral segments S4-S5
• C = Incomplete
• Motor function is preserved below the neurological level, and more than half of
the key muscles below the neurological level have a muscle grade less than 3
• D = Incomplete
• Motor function is preserved below the neurological level, and at least half of the
key muscles below the neurological level have a muscle grade of 3 or more
• E = normal
• Motor and sensory function are normal
11. Core Curriculum V5
Conus Medullaris Syndrome
• Thoracolumbar cord injury
• Presents with low back pain, lower extremity weakness, saddle
anesthesia, bowel/bladder dysfunction
• Injury to sacral myelomeres
• Can involve both upper and lower motor neurons (+/- root escape)
• Isolated: pure bowel, bladder & sexual dysfunction
• Combined root/cord injury: lumbar traversing roots
12. Core Curriculum V5
Conus Medullaris Syndrome
• Exam
• Absent bulbocavernosus reflex
• Bowel/bladder/sexual dysfunction more frequent than lower extremity
weakness
• Treatment: urgent decompression
• Prognosis
• ? Improved with early decompression
• Better for root recovery (L1-4) than cord recovery (L5-S)
14. Core Curriculum V5
Cauda Equina Syndrome
• Natural history: progressive weakness of lower extremities, loss of
bladder/bowel function
• Prognosis: presence of saddle anesthesia/bladder symptoms
associated with worse outcomes
• Treatment: Urgent decompression for best prognosis
• Treatment after 48 hours associated with worse outcomes
17. Core Curriculum V5
Thoracolumbar Trauma Classification
• Decision to operate often challenging
• >10 classification schemes described
• A useful classification system should:
• Be easy to remember, use, and communicate
• Predict patient outcome
• Drive treatment
• Have high inter- and intra-oberver reliability
21. Core Curriculum V5
Flexion-Distraction
• Seat belt injuries
• Chance fracture (bony,
ligamentous, both)
• Distraction of posterior and
middle columns
• 0-10% neuro involvement
• Often requires surgery
22. Core Curriculum V5
Fracture Dislocation
• Injury to all three columns
• Combination of high energy
forces (shear)
• High likelihood of neuro deficit
• Always requires surgery
26. Core Curriculum V5
Thoracolumbar Injury Classification and
Severity Score (TLICS)
• Developed to drive surgical versus nonoperative management of
thoracolumbar fractures (Vaccaro et al 2005)
• Score based on 3 factors
• Injury morphology/mechanism
• Posterior ligamentous integrity
• Neurologic injury
31. Core Curriculum V5
Stable vs. Unstable Injuries
• White and Panjabi (Spine 1978)
“the loss of the ability of the spine under physiologic conditions to maintain
relationships between vertebrae in such a way that there is neither damage
nor subsequent irritation to the spinal cord or nerve root and, in addition,
there is no development of incapacitating deformity or pain from structural
changes”
32. Core Curriculum V5
Stable vs. Unstable Injuries
• Stable (Burst fracture)
• < 25-30º kyphosis
• < 50% loss of height
• < 30–50% canal compromise
• Neuro intact
• Unstable
• Neurologic deficit
• > 25-30º kyphosis
• > 50% loss of height
• >50-60% canal compromise
*No study to date has shown direct correlation between percentage of canal
compromise and severity of neurologic injury following burst fracture
33. Core Curriculum V5
Surgical Decision Making
• Goals
• Maximize function
• Facilitate nursing care
• Prevent deformity/instability
• Potentially improve neurologic function
• Indications
• ? Instability
• Neurologic compression
• Posterior osteoligamentous disruption
35. Core Curriculum V5
Surgery
• Indicated in Unstable injuries
• Anterior surgery for anterior compression at TL junction
• Posterior surgery in lower Lumbar spine
36. Core Curriculum V5
Gunshot Wounds
• Non-operative treatment standard
• Steroids not useful (Heary, 1997)
• 10-14 days IV antibiotics for colonic perforations
ONLY
• Evidence for debridement and extraction of bullet
fragments is controversial, however patients with
incomplete injuries may improve (Scott 2019)
37. Core Curriculum V5
Treatment
• Decompression rarely of benefit
except for intra-canal bullet from
T12-L5
• Better motor recovery than
nonoperative
• Fractures usually stable despite
“3-column” injury
38. Core Curriculum V5
GSW to the spine Outcome and Complications
• Most dependent on SCI and associated injuries
• High incidence of CSF leaks with unnecessary decompression
• Lead toxicity rare, even with bullet in canal
• Bullet migration rare: late neurological sequelae
39. Core Curriculum V5
Summary
• There are several patterns of neurologic injury for thoracolumbar
trauma
• There are multiple classification schemes
• Most thoracolumbar injuries, in the absence of neurologic deficit, are
stable and can be treated successfully nonoperatively
• Surgical intervention may be beneficial in improving patient
mobilization and early functional return for unstable spine fractures
• Indications for surgical intervention, timing of intervention, and
approach remain controversial
40. Core Curriculum V5
Conclusions
• The goals of managing thoracolumbar injuries are to maximize
neurologic recovery and to stabilize the spine for early rehab
and return to a productive lifestyle
41. Core Curriculum V5
Key References
• Denis F. The three column spine and its significance in the
classification of acute thoracolumbar spinal injuries. Spine (Phila Pa
1976). 1983;8(8):817-831. doi:10.1097/00007632-198311000-00003
• Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of
thoracolumbar injuries: the importance of injury morphology, the
integrity of the posterior ligamentous complex, and neurologic
status. Spine (Phila Pa 1976). 2005;30(20):2325-2333.
doi:10.1097/01.brs.0000182986.43345.cb
42. Core Curriculum V5
Full References
Figures used with permission. Gendelberg D, Bransford RJ, Bellabarba C. Thoracolumbar Spine Fractures and Dislocations. In: Tornetta P, Ricci WM,
eds. Rockwood and Green's Fractures in Adults, 9e. Philadelphia, PA. Wolters Kluwer Health, Inc; 2019.
Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201.
Brouwers E, van de Meent H, Curt A, Starremans B, Hosman A, Bartels R. Definitions of traumatic conus medullaris and cauda equina syndrome: a
systematic literature review. Spinal Cord. 2017;55(10):886-890.
Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of
surgical outcomes. Spine (Phila Pa 1976). 2000;25(12):1515-1522.
Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983;8(8):817-831.
Spine. Journal of Orthopaedic Trauma. 2018;32(1):S145-S160.
Vaccaro AR, Lehman RA, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the
posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325-2333.
White AA, Panjabi MM. The basic kinematics of the human spine. A review of past and current knowledge. Spine (Phila Pa 1976). 1978;3(1):12-20.
Heary RF, Vaccaro AR, Mesa JJ, et al. Steroids and gunshot wounds to the spine. Neurosurgery. 1997;41(3):576-583; discussion 583-584.
Scott KW, Trumbull DA, Clifton W, Rahmathulla G. Does surgical intervention help with neurological recovery in a lumbar spinal gun shot wound? A case
report and literature review. Cureus. 2019;11(6):e4978.
Editor's Notes
Rockwood and Green 9e figure 48-1
A comprehensive classification of thoracic and lumbar injuries
F Magerl 1, M Aebi, S D Gertzbein, J Harms, S Nazarian
Affiliations expand
PMID: 7866834
DOI: 10.1007/BF02221591
Fractures often occur at the junction because it is a transition zone between the rigid thoracic spine and the relatively flexible cervical spine; Also, the plumb line often bisects this junction point so many compression/axial forces are transmitted through this area
Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review
E Brouwers 1, H van de Meent 2, A Curt 3, B Starremans 4, A Hosman 5, R Bartels 1
Affiliations expand
PMID: 28534496
DOI: 10.1038/sc.2017.54
Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes
U M Ahn 1, N U Ahn, J M Buchowski, E S Garrett, A N Sieber, J P Kostuik
Affiliations expand
PMID: 10851100
DOI: 10.1097/00007632-200006150-00010
Image: Rockwood and Green 9e figure 48-14
Spine (Phila Pa 1976). Nov-Dec 1983;8(8):817-31. doi: 10.1097/00007632-198311000-00003.
The three column spine and its significance in the classification of acute thoracolumbar spinal injuries
F Denis PMID: 6670016 DOI: 10.1097/00007632-198311000-00003
Image Rockwood and Green 9e figure 48-10
Image Rockwood and Green 9e figure 48-4
Image Rockwood and Green 9e figure 48-9
A drawback of Denis classification is poor ability to drive treatment
Image: Rockwood and Green 9e image 48-16
Image: Rockwood and Green 9e figure 48-17
A new classification of thoracolumbar injuries: the importance of injurymorphology, the integrity of the posterior ligamentous complex, and neurologic status.Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC.Spine (Phila Pa 1976). 2005 Oct 15;30(20):2325-33. doi: 10.1097/01.brs.0000182986.43345.cb.PMID: 16227897
A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.
Vaccaro, Alexander; Lehman, Ronald; Hurlbert, R; John MD, PhD; Anderson, Paul; Harris, Mitchel; Hedlund, Rune; Harrop, James; Dvorak, Marcel; Wood, Kirkham; Fehlings, Michael; MD, PhD; Fisher, Charles; MD, MHSc; Zeiller, Steven; Anderson, D; Bono, Christopher; Stock, Gordon; Brown, Andrew; Kuklo, Timothy; Oner, F; MD, PhD
Spine. 30(20):2325-2333, October 15, 2005.
DOI: 10.1097/01.brs.0000182986.43345.cb
Image: Rockwood and Green 9e, figure 48-5
A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.
Vaccaro, Alexander; Lehman, Ronald; Hurlbert, R; John MD, PhD; Anderson, Paul; Harris, Mitchel; Hedlund, Rune; Harrop, James; Dvorak, Marcel; Wood, Kirkham; Fehlings, Michael; MD, PhD; Fisher, Charles; MD, MHSc; Zeiller, Steven; Anderson, D; Bono, Christopher; Stock, Gordon; Brown, Andrew; Kuklo, Timothy; Oner, F; MD, PhD
Spine. 30(20):2325-2333, October 15, 2005.
DOI: 10.1097/01.brs.0000182986.43345.cb
Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325-2333. doi:10.1097/01.brs.0000182986.43345.cb
Image: Rockwood and Green 9e figure 48-15
Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325-2333. doi:10.1097/01.brs.0000182986.43345.cb
Image: Rockwood and Green 9e, anterior approach to thoracolumbar fracture
Neurosurgery. 1997 Sep;41(3):576-83; discussion 583-4.doi: 10.1097/00006123-199709000-00013. Steroids and gunshot wounds to the spine R F Heary 1, A R Vaccaro, J J Mesa, B E Northrup, T J Albert, R A Balderston, J M Cotler Affiliations expand PMID: 9310974 DOI: 10.1097/00006123-199709000-00013
Does Surgical Intervention Help with Neurological Recovery in a Lumbar Spinal Gun Shot Wound? A Case Report and Literature Review
Kyle W Scott 1, Denslow A Trumbull 4th 2, William Clifton 3, Gazanfar Rahmathulla 1 Affiliations expand PMID: 31467812 PMCID: PMC6706263 DOI: 10.7759/cureus.4978