This document provides an overview of acute trauma to the spine. It discusses the epidemiology of spine injuries, noting they most commonly occur in males during their productive years, often from motor vehicle accidents or falls. The presentation outlines evaluation of spine trauma patients, including maintaining cervical spine immobilization, assessing the airway, breathing, and circulation during the primary survey. It also details the physical exam, neurological exam including ASIA scoring, and imaging used in diagnosis. Common injury mechanisms and classifications of complete versus incomplete injuries are presented.
Spinal trauma management involves immobilization, intravenous fluids, medications, and prompt referral. Anatomy and mechanisms of injury vary by spinal region. Evaluation assesses neurological function using dermatomes, myotomes, and reflexes to localize injury level. Injuries may cause hypovolaemic or neurogenic shock. Corticosteroids within 8 hours may improve outcomes but evidence is limited. Prompt management aims to prevent secondary spinal cord injury.
The cervical spine anatomy is specialized to support the cranium while allowing a large range of motion. C1 (atlas) has no vertebral body and unique articular pillars. C2 (axis) has a dens that is embryologically derived from C1's body. The ligaments of the cervical spine, including the tectorial membrane and transverse ligament, allow for wide range of motion while maintaining stability. Common cervical spine injuries include flexion teardrop fractures from hyperflexion, wedge fractures from compression, hangman's fractures from hyperextension, and Jefferson fractures from axial loading. Odontoid fractures also occur from hyperextension or hyperflexion forces on the neck. Radiographic evaluation of
This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and management. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, initial treatment focuses on immobilization using rigid collars, braces, halo traction, or halo vests.
3. Common injuries include fractures of C1-C2 and the odontoid process. Type II odontoid fractures are prone to displacement and non-union, so may need open reduction and fusion
This document provides information on spinal cord anatomy, neuroanatomy, blood supply, and injury. It describes the following:
- The spinal cord extends from the foramen magnum to the L1 vertebra and is made up of 31 spinal nerve pairs that innervate different parts of the body.
- Spinal cord injury can be complete or incomplete and results from primary mechanical damage or secondary cellular processes. Injuries are classified using scales like ASIA.
- Clinical features depend on the level and severity of injury and may include motor/sensory deficits, respiratory issues, or autonomic dysfunction. Proper history and exam are needed to evaluate patients.
- Epidemiology shows injuries
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
1) There are several classifications for spine fractures based on the location and type of injury. Injuries to the cervical spine are divided into supra-axial injuries involving the occiput-C1-C2 complex and sub-axial injuries involving C3-C7.
2) Thoracolumbar spine fractures are classified based on the failure mode and stability. Compression fractures can be treated non-operatively if stable, but unstable fractures may require surgery.
3) Initial management of spine fractures involves immobilization, assessment for neurological deficits and imaging to evaluate fracture type and guide treatment, which could be non-operative or operative depending on stability.
This document provides information on orthopaedic spinal injuries from Zagazig University in Egypt. It discusses several topics in 3 paragraphs or less:
Spinal injuries are less common than extremity injuries but have worse functional outcomes. They involve the cervical, thoracic, and lumbar spine. Neurological involvement is common in high-energy trauma or polytrauma patients.
Cervical spine injuries account for one-third of spinal injuries. The C2 vertebrae and lower C6-C7 vertebrae are most commonly injured. A neurological injury occurs in 15% of spine trauma patients. Exam of the peripheral nervous system is important to fully assess injuries.
Initial management follows ATLS protocols - stabilize
Spinal trauma management involves immobilization, intravenous fluids, medications, and prompt referral. Anatomy and mechanisms of injury vary by spinal region. Evaluation assesses neurological function using dermatomes, myotomes, and reflexes to localize injury level. Injuries may cause hypovolaemic or neurogenic shock. Corticosteroids within 8 hours may improve outcomes but evidence is limited. Prompt management aims to prevent secondary spinal cord injury.
The cervical spine anatomy is specialized to support the cranium while allowing a large range of motion. C1 (atlas) has no vertebral body and unique articular pillars. C2 (axis) has a dens that is embryologically derived from C1's body. The ligaments of the cervical spine, including the tectorial membrane and transverse ligament, allow for wide range of motion while maintaining stability. Common cervical spine injuries include flexion teardrop fractures from hyperflexion, wedge fractures from compression, hangman's fractures from hyperextension, and Jefferson fractures from axial loading. Odontoid fractures also occur from hyperextension or hyperflexion forces on the neck. Radiographic evaluation of
This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and management. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, initial treatment focuses on immobilization using rigid collars, braces, halo traction, or halo vests.
3. Common injuries include fractures of C1-C2 and the odontoid process. Type II odontoid fractures are prone to displacement and non-union, so may need open reduction and fusion
This document provides information on spinal cord anatomy, neuroanatomy, blood supply, and injury. It describes the following:
- The spinal cord extends from the foramen magnum to the L1 vertebra and is made up of 31 spinal nerve pairs that innervate different parts of the body.
- Spinal cord injury can be complete or incomplete and results from primary mechanical damage or secondary cellular processes. Injuries are classified using scales like ASIA.
- Clinical features depend on the level and severity of injury and may include motor/sensory deficits, respiratory issues, or autonomic dysfunction. Proper history and exam are needed to evaluate patients.
- Epidemiology shows injuries
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
1) There are several classifications for spine fractures based on the location and type of injury. Injuries to the cervical spine are divided into supra-axial injuries involving the occiput-C1-C2 complex and sub-axial injuries involving C3-C7.
2) Thoracolumbar spine fractures are classified based on the failure mode and stability. Compression fractures can be treated non-operatively if stable, but unstable fractures may require surgery.
3) Initial management of spine fractures involves immobilization, assessment for neurological deficits and imaging to evaluate fracture type and guide treatment, which could be non-operative or operative depending on stability.
This document provides information on orthopaedic spinal injuries from Zagazig University in Egypt. It discusses several topics in 3 paragraphs or less:
Spinal injuries are less common than extremity injuries but have worse functional outcomes. They involve the cervical, thoracic, and lumbar spine. Neurological involvement is common in high-energy trauma or polytrauma patients.
Cervical spine injuries account for one-third of spinal injuries. The C2 vertebrae and lower C6-C7 vertebrae are most commonly injured. A neurological injury occurs in 15% of spine trauma patients. Exam of the peripheral nervous system is important to fully assess injuries.
Initial management follows ATLS protocols - stabilize
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,
The document discusses spinal and spinal cord injuries, including incidence, morbidity and mortality, anatomy, assessment, types of spinal cord injuries, management, and non-traumatic conditions. It provides details on the anatomy of the spine and spinal cord, mechanisms of spinal cord injury, approaches to assessing and managing spinal injuries, and specific spinal cord syndromes. Prevention, immobilization, and avoiding further injury to the spinal cord are the primary goals in managing spinal and spinal cord trauma."
This document discusses spinal injuries, focusing on injuries to the cervical and thoracolumbar spine. It begins by classifying spinal injuries based on the Denis classification system and mechanisms of injury such as flexion, flexion-rotation, and vertical compression. For each injury type, the document describes examples, anatomical structures involved, and stability. It also covers clinical features, evaluation, investigations including x-rays and MRI, treatment in three phases, and emergency care to immobilize the spine.
This document provides an overview of spinal injuries, including definitions, classifications, clinical features, investigations, and management. It defines spinal injuries as injuries to the spinal column, spinal cord, or both. Spinal injuries can be classified as complete or incomplete based on the extent of motor and sensory loss. Clinical assessment involves a detailed neurological exam to evaluate deficits. Imaging like X-rays, CT scans, and MRIs are used to investigate and classify injuries. Management depends on the type and severity of injury, and may involve immobilization, steroids, traction, or surgical decompression and stabilization.
The document discusses cervical spine injuries, their causes, mechanisms, classifications, investigations, treatments, and specific injury types. The main causes are trauma such as road traffic accidents. Investigations include x-rays, CT scans, and MRIs to evaluate injury severity and guide treatment. Treatments involve initial immobilization followed by either conservative care with devices like halos or surgical stabilization/fusion. Common injuries described include odontoid fractures, hangman's fractures, burst fractures, and cervical dislocations. Prevention through road safety is emphasized over finding cures for injuries.
Pelvic fractures are serious injuries that require prompt evaluation and management. The presentation summarizes the seminar on pelvic fractures, covering relevant anatomy, classification systems, mechanisms of injury, clinical and radiological evaluation, emergency management, and treatment options. Definitive treatment depends on the fracture pattern and stability, ranging from closed reduction and bracing to open reduction with internal or external fixation to address anterior or posterior ring injuries. Complications can include hemorrhage, thrombosis, infection, malunion, and neurological issues.
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 discusses spinal cord injuries, including the anatomy of the spine, mechanisms of injury, types of injury, assessment, management in the acute phase, and long term care. It notes that spinal cord injuries can cause paralysis, sensory deficits, and autonomic dysfunction depending on the level and completeness of injury. Initial management involves immobilization, minimizing secondary injury, and addressing airway, breathing and circulation problems. Definitive care includes early surgical fixation and rehabilitation to prevent complications like pressure sores, thrombosis, and psychological issues.
Atlantoaxial injuries can cause serious neurologic problems if not properly treated. Rotatory subluxation of C1 on C2 is the most common type and results from trauma or infection that disrupts the transverse atlantal ligament. Anterior subluxation involves displacement of C1 forward on C2 due to ligament disruption or odontoid process abnormalities. Fractures of C1 and C2 can also occur from trauma and require evaluation to assess stability and neurologic involvement. Treatment depends on the specific injury but may involve traction, immobilization, or fusion surgery to prevent further neurologic damage.
The document discusses spinal injuries, describing stable injuries that do not displace or endanger the spinal cord versus unstable injuries that may further displace and cause deformity or pain. It outlines the primary injury caused by the initial trauma and secondary injury from hemorrhage and ischemia. Various types of spinal injuries are described based on the mechanism of trauma. Evaluation involves assessing neurological function, location of injury, and determining if the injury is complete or incomplete. Imaging like CT and MRI can further characterize injuries. Treatment goals are preserving neurological function, relieving compression, stabilizing the spine, and rehabilitation.
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.
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
This document discusses spinal injuries and the assessment and treatment of potential spinal injuries by emergency medical technicians. It covers spinal anatomy, types of spinal injuries including spinal cord and column injuries, common mechanisms of injury, and the EMS spinal immobilization assessment protocol. The protocol determines whether full spinal immobilization is needed based on factors like pain, deformity, numbness, and other injuries rather than just mechanism of injury. Common mistakes in treatment like improper sizing of collars or inadequate strapping are also discussed.
This document provides an overview of tibial plateau fractures, including anatomy, classification systems, mechanisms of injury, diagnosis, and management. It describes the Shatzker and AO/OTA classification systems. Diagnosis involves history, physical exam, and imaging like X-rays, CT, and MRI. Treatment depends on the fracture type but generally involves closed reduction for nondisplaced fractures and open reduction with internal fixation using plates, screws, or external fixation for displaced fractures to restore alignment and the articular surface. Complications can include infection, DVT, loss of fixation, and posttraumatic arthritis.
Spinal Tumors: approach and managementAmit Agrawal
The spinal cord consists of
Central canal surrounded by an H-shaped gray matter region containing neurons
Outer myelinated nerve tracts, termed white matter, surround the central gray matter
Central canal is lined with ependymal cells
Astrocytes support gray matter neurons and white matter axons
1) Pelvic fractures usually result from high-velocity trauma like car accidents or falls and involve bones in the pelvis joining at the pubis, ischium, and ilium.
2) Initial assessment focuses on stabilizing the patient's airway, breathing, and circulation before examining for signs of pelvic fracture like pelvic hematomas.
3) Imaging like x-rays and CT scans are used to classify the fracture using systems like Young's, Tile's or Apley's to guide treatment.
4) Physical therapy plays an important role in pelvic fracture recovery by reducing pain, improving hip and leg movement, strength, and balance through a personalized home exercise program to help return to normal activities
The document discusses the pathology, clinical presentation, diagnosis, and management of ossification of the posterior longitudinal ligament (OPLL). It covers the epidemiology, genetics, radiological features, and various surgical approaches for treating OPLL, including anterior corpectomy with fusion and posterior laminectomy with or without fusion. Anterior decompression is preferred for large occupying lesions or kyphosis, while posterior laminoplasty is an option for smaller lesions with a preserved lordosis. The goal of surgery is decompression with stabilization to prevent postoperative progression of OPLL.
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 clinical manifestations and management of acute spinal cord injury. It begins with an introduction that defines spinal cord injury and discusses epidemiology and common causes. It then covers the clinical manifestations of complete and incomplete spinal cord injuries at different levels. The management section addresses pre-hospital care, hospital evaluation including history, exam, and imaging, as well as treatment approaches like surgical decompression and rehabilitation. Complications of spinal cord injury are also briefly mentioned.
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
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,
The document discusses spinal and spinal cord injuries, including incidence, morbidity and mortality, anatomy, assessment, types of spinal cord injuries, management, and non-traumatic conditions. It provides details on the anatomy of the spine and spinal cord, mechanisms of spinal cord injury, approaches to assessing and managing spinal injuries, and specific spinal cord syndromes. Prevention, immobilization, and avoiding further injury to the spinal cord are the primary goals in managing spinal and spinal cord trauma."
This document discusses spinal injuries, focusing on injuries to the cervical and thoracolumbar spine. It begins by classifying spinal injuries based on the Denis classification system and mechanisms of injury such as flexion, flexion-rotation, and vertical compression. For each injury type, the document describes examples, anatomical structures involved, and stability. It also covers clinical features, evaluation, investigations including x-rays and MRI, treatment in three phases, and emergency care to immobilize the spine.
This document provides an overview of spinal injuries, including definitions, classifications, clinical features, investigations, and management. It defines spinal injuries as injuries to the spinal column, spinal cord, or both. Spinal injuries can be classified as complete or incomplete based on the extent of motor and sensory loss. Clinical assessment involves a detailed neurological exam to evaluate deficits. Imaging like X-rays, CT scans, and MRIs are used to investigate and classify injuries. Management depends on the type and severity of injury, and may involve immobilization, steroids, traction, or surgical decompression and stabilization.
The document discusses cervical spine injuries, their causes, mechanisms, classifications, investigations, treatments, and specific injury types. The main causes are trauma such as road traffic accidents. Investigations include x-rays, CT scans, and MRIs to evaluate injury severity and guide treatment. Treatments involve initial immobilization followed by either conservative care with devices like halos or surgical stabilization/fusion. Common injuries described include odontoid fractures, hangman's fractures, burst fractures, and cervical dislocations. Prevention through road safety is emphasized over finding cures for injuries.
Pelvic fractures are serious injuries that require prompt evaluation and management. The presentation summarizes the seminar on pelvic fractures, covering relevant anatomy, classification systems, mechanisms of injury, clinical and radiological evaluation, emergency management, and treatment options. Definitive treatment depends on the fracture pattern and stability, ranging from closed reduction and bracing to open reduction with internal or external fixation to address anterior or posterior ring injuries. Complications can include hemorrhage, thrombosis, infection, malunion, and neurological issues.
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 discusses spinal cord injuries, including the anatomy of the spine, mechanisms of injury, types of injury, assessment, management in the acute phase, and long term care. It notes that spinal cord injuries can cause paralysis, sensory deficits, and autonomic dysfunction depending on the level and completeness of injury. Initial management involves immobilization, minimizing secondary injury, and addressing airway, breathing and circulation problems. Definitive care includes early surgical fixation and rehabilitation to prevent complications like pressure sores, thrombosis, and psychological issues.
Atlantoaxial injuries can cause serious neurologic problems if not properly treated. Rotatory subluxation of C1 on C2 is the most common type and results from trauma or infection that disrupts the transverse atlantal ligament. Anterior subluxation involves displacement of C1 forward on C2 due to ligament disruption or odontoid process abnormalities. Fractures of C1 and C2 can also occur from trauma and require evaluation to assess stability and neurologic involvement. Treatment depends on the specific injury but may involve traction, immobilization, or fusion surgery to prevent further neurologic damage.
The document discusses spinal injuries, describing stable injuries that do not displace or endanger the spinal cord versus unstable injuries that may further displace and cause deformity or pain. It outlines the primary injury caused by the initial trauma and secondary injury from hemorrhage and ischemia. Various types of spinal injuries are described based on the mechanism of trauma. Evaluation involves assessing neurological function, location of injury, and determining if the injury is complete or incomplete. Imaging like CT and MRI can further characterize injuries. Treatment goals are preserving neurological function, relieving compression, stabilizing the spine, and rehabilitation.
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.
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
This document discusses spinal injuries and the assessment and treatment of potential spinal injuries by emergency medical technicians. It covers spinal anatomy, types of spinal injuries including spinal cord and column injuries, common mechanisms of injury, and the EMS spinal immobilization assessment protocol. The protocol determines whether full spinal immobilization is needed based on factors like pain, deformity, numbness, and other injuries rather than just mechanism of injury. Common mistakes in treatment like improper sizing of collars or inadequate strapping are also discussed.
This document provides an overview of tibial plateau fractures, including anatomy, classification systems, mechanisms of injury, diagnosis, and management. It describes the Shatzker and AO/OTA classification systems. Diagnosis involves history, physical exam, and imaging like X-rays, CT, and MRI. Treatment depends on the fracture type but generally involves closed reduction for nondisplaced fractures and open reduction with internal fixation using plates, screws, or external fixation for displaced fractures to restore alignment and the articular surface. Complications can include infection, DVT, loss of fixation, and posttraumatic arthritis.
Spinal Tumors: approach and managementAmit Agrawal
The spinal cord consists of
Central canal surrounded by an H-shaped gray matter region containing neurons
Outer myelinated nerve tracts, termed white matter, surround the central gray matter
Central canal is lined with ependymal cells
Astrocytes support gray matter neurons and white matter axons
1) Pelvic fractures usually result from high-velocity trauma like car accidents or falls and involve bones in the pelvis joining at the pubis, ischium, and ilium.
2) Initial assessment focuses on stabilizing the patient's airway, breathing, and circulation before examining for signs of pelvic fracture like pelvic hematomas.
3) Imaging like x-rays and CT scans are used to classify the fracture using systems like Young's, Tile's or Apley's to guide treatment.
4) Physical therapy plays an important role in pelvic fracture recovery by reducing pain, improving hip and leg movement, strength, and balance through a personalized home exercise program to help return to normal activities
The document discusses the pathology, clinical presentation, diagnosis, and management of ossification of the posterior longitudinal ligament (OPLL). It covers the epidemiology, genetics, radiological features, and various surgical approaches for treating OPLL, including anterior corpectomy with fusion and posterior laminectomy with or without fusion. Anterior decompression is preferred for large occupying lesions or kyphosis, while posterior laminoplasty is an option for smaller lesions with a preserved lordosis. The goal of surgery is decompression with stabilization to prevent postoperative progression of OPLL.
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 clinical manifestations and management of acute spinal cord injury. It begins with an introduction that defines spinal cord injury and discusses epidemiology and common causes. It then covers the clinical manifestations of complete and incomplete spinal cord injuries at different levels. The management section addresses pre-hospital care, hospital evaluation including history, exam, and imaging, as well as treatment approaches like surgical decompression and rehabilitation. Complications of spinal cord injury are also briefly mentioned.
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
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 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 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
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
The document provides information about spinal cord injury including:
- Anatomy and physiology of the spinal cord and nerves.
- Types of spinal cord injuries such as complete vs incomplete, and tetraplegia vs paraplegia.
- Causes, signs and symptoms, assessment, diagnostic tests, and management including medical, surgical, and nursing considerations.
- Potential complications are also discussed such as autonomic dysreflexia, pressure sores, and loss of bladder/bowel control. Rehabilitation strategies aim to improve mobility and independence.
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.
Spinal cord injury results in loss of function below the site of damage. Common causes include vehicle accidents, falls, and sports injuries. Complete injuries result in total loss of sensation and movement below the injury, while incomplete injuries allow some sensation or movement. Management involves immobilization, surgery to decompress the spine, and rehabilitation to regain function. Nursing care focuses on preventing complications like pressure ulcers, respiratory issues, and autonomic dysreflexia.
Spinal cord injury results in loss of function below the site of damage. Common causes include vehicle accidents, falls, and sports injuries. Complete injuries result in total loss of sensation and movement below the injury, while incomplete injuries allow some sensation or movement. Management involves immobilization, surgery to decompress the spine, and rehabilitation to regain function. Nursing care focuses on preventing complications like pressure ulcers, respiratory issues, and autonomic dysreflexia.
This document discusses cervical spine injuries, their mechanisms, and assessment. It covers:
1) The different mechanisms of cervical spine injury including flexion, extension, rotation, and axial compression.
2) Types of injuries associated with each mechanism such as wedge fractures or facet dislocations.
3) Evaluation of cervical spine injuries including history, physical exam, and radiographic imaging. Plain films, CT, and MRI are imaging options.
4) Neurological assessment including spinal cord and nerve injuries. Complete versus incomplete injuries and associated syndromes are outlined.
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
The document discusses brachial plexus injuries, which involve damage to the network of nerves that control the arm and hand. It describes the anatomy of the brachial plexus and the mechanisms, classifications, signs and symptoms, investigations, and management of both adult and obstetric brachial plexus injuries. Specific injuries like Erb's palsy and Klumpke's palsy are also explained. The prognosis depends on the level and severity of the injury, with upper plexus injuries having a better prognosis than lower plexus or total plexus lesions. Early surgical intervention may be needed for severe injuries or root avulsions.
Traumatic spinal cord injuries can cause tetraplegia or paraplegia depending on the level of the lesion in the spinal cord. Injuries are often classified based on whether they are complete or incomplete. Common clinical manifestations include motor and sensory impairments, autonomic dysreflexia, respiratory issues, spasticity, and bladder and bowel dysfunction. Indirect impairments from SCI can also occur and include respiratory complications, pressure sores, deep vein thrombosis, and other issues.
This document summarizes the medical history, physical examination, investigations, diagnosis, and treatment for a 43-year-old male who presented with neck pain and weakness in his extremities after a motor vehicle accident. Physical examination revealed neck tenderness and decreased sensation below C6. Imaging showed a C5-C6 unilateral facet dislocation with complete spinal cord injury. The patient received high-dose steroids and was placed in skull traction. He was diagnosed with an incomplete spinal cord injury and underwent operative treatment including closed reduction and stabilization.
The brachial plexus is formed by the ventral rami of cervical and thoracic spinal nerves C5-T1. It is vulnerable to injury from trauma such as motor vehicle accidents, falls, or excessive traction during childbirth. Injuries are classified based on the location and roots involved. Evaluation involves neurological and sensory exams along with imaging like MRI. Management may include physiotherapy, splinting, nerve grafts or transfers to restore function. The goals are restoration of elbow flexion, shoulder abduction, and medial forearm sensation. Surgical options depend on if the injury is open or closed.
This document discusses spinal cord disorders and provides information on spinal cord anatomy and different types of spinal cord injuries and conditions. It outlines 15 questions regarding the anatomy of the spinal cord and characteristics of various spinal cord disorders including central cord syndrome, Brown-Sequard syndrome, anterior cord syndrome, transverse myelitis, syringomyelia, spinal epidural hematoma, spinal epidural abscess, diskitis, and spinal cord neoplasms. The document seeks to test the reader's knowledge on the topics covered through true or false questions.
1. The document discusses the approach to evaluating and diagnosing spinal trauma, with a focus on cervical spine injuries. It covers spinal anatomy, epidemiology, mechanisms of injury, clinical evaluation, and diagnostic imaging.
2. Key points discussed include the NEXUS and Canadian C-Spine Rules for determining when cervical spine radiography is necessary, how to read cervical spine x-rays, and challenges in clearing the cervical spine in unconscious or intubated patients.
3. CT scanning and MRI are more sensitive than plain films for detecting injuries, but have limitations. Clinical examination is important but impossible in unconscious patients, who require continued spinal precautions until fully conscious.
1. The document discusses various types of spinal cord injuries including complete injuries which involve a complete loss of motor and sensory function below the level of injury, and incomplete injuries which partially compromise spinal cord function with some sensation and muscle movement retained below the injury site.
2. It provides details on specific spinal cord syndromes like anterior cord syndrome, Brown-Séquard syndrome, and central cord syndrome which are characterized by variable patterns of motor and sensory loss.
3. The management of spinal cord injuries involves stabilizing the spine, treating shock, addressing airway and breathing issues, screening for associated injuries, and preventing complications like pressure sores through regular turning of immobilized patients.
The document provides an overview of incomplete spinal cord injuries. Some key points:
- Spinal cord injuries can range from complete to incomplete, depending on the severity and location of the lesion in the spinal cord. Incomplete injuries result in partial preservation of motor or sensory function below the injury level.
- The American Spinal Injury Association (ASIA) scoring system is used to clinically classify spinal cord injuries based on motor and sensory function. Injuries are classified on a scale from A (complete injury) to D (near normal function).
- Recovery from incomplete injuries is possible, though most occurs within the first year as spontaneous recovery plateaus. Sensory preservation is a predictor of potential motor recovery.
Similar to Evaluation of acute trauma in spine (20)
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
2. Epidemiology
Incidence: 15,000 new cases/year
Prevalence: 1,50,000 cases and rising
Prime occurrence: males(85%), peak
of their productive lives
Most common mechanism in India
RTA or fall from heights
Cervical spine injury occurs in 44% of
spine trauma and most common Singh G, Prakash R, Bhatti VK, Mahen A.
Spinal cord injury in organizational setup -
A hospital based descriptive study. J Mar
Med Soc 2019;21:46-50
3. Introduction
• All trauma patients have a cervical spine injury until proven otherwise
• Cervical spine clearance defined as confirming the absence of cervical spine injury
• important to clear cervical spine and remove collar in an efficient manner
• cervical clearance can be performed with
• physical exam
• radiographically
• Missed cervical spine injuries
• may lead to permanent disability
• careful clinical and radiographic evaluation is paramount
• high rate of missed cervical spine injuries due to
• inadequate imaging of affected level
• loss of consciousness
• multisystem trauma
• cervical spine injury necessitates careful examination of entire spine
• noncontiguous spinal column injuries reported in 10-15% of patients
8. In-Hospital Phase
Oral secretions should be cleared.
Modified jaw thrust and insertion of an oral airway
Intubation may be required in high SCI or if consciousness is
depressed.
Ideal technique : Fiberoptic intubation with cervical spine
control.
Alternative: Blind nasotracheal or oral intubation with in-line
immobilization .
Manual in line stabilisation of the neck is maintained
throughout a rapid sequence induction of anaesthesia.
Airway
9. In-Hospital Phase
Manual in line
stabilisation of
the neck is
maintained
throughout a
rapid sequence
induction of
anaesthesia.
Airway
10. In-Hospital Phase
SpO2 should be maintained above 95%
Assisted ventilation instituted if required
If a complete spinal cord injury occurs at
the C4 level or above, the diaphragm will
be paralyzed, and the individual will not
be able to breathe without external
assistance.
Breathing
11. In-Hospital Phase
Neurogenic shock occurs only in the presence of acute SCI above T6.
Most patients will stabilise with fluid loading alone but vasopressors
and ionotropic support may be needed in some patients
Circulation
Haemorrhagic shock : clinical findings may be affected as autonomic
dysfunction prevents tachycardia and peripheral vasoconstriction.
Hypotension and/or shock with acute SCI at or below T6 are caused by
haemorrhage
An adequate blood pressure should be maintained to perfuse
the cord and decrease secondary injury
13. Physical examination
After the ABC have been taken care of, the patient is gently log rolled
and whole of the spine is palpated for tenderness or a palpable step-off
deformity.
Neurogenic shock, Incontinence of bowel, bladder and penile erection
indicate severe spine injury.
15. Diagnosis of spinal injuries: clinical
evaluation
Inspection and palpation: Occiput to Coccyx
• Tenderness
• Gap or Step
• Edema and bruising
• Spasm of associated muscles
16. Diagnosis of spinal injuries: clinical
evaluation
Neurological assessment
• Sensation
• Motor function
• Reflexes
• Rectal examination
18. Neurological assessment: Motor
C5: Deltoids/biceps
C6: Wrist extensors
C7: Elbow extensors
C8: Finger flexors
T1: Finger Abductors
L2: Hip flexors
L3: Knee extensors
L4: Ankle dorsiflexors
L5: Long toe extensors
S1: Ankle plantar flexors
Grading Scale: 0-5
0: total paralysis
1: palpable or visible contraction
2: active movement; gravity eliminated
3: active movement: against gravity
4: active movement: against some resistance
5: active movement: against full resistance
NT: not testable
19. Neurological assessment: Rectal
Tone: the presence of rectal tone in itself does not indicate an
incomplete injury
Sensation
Volition: A voluntary contraction of the sphincter or the presence of
rectal sensation supports the presence of a communication between
the lower spinal cord and supraspinal centers – favorable prognosis
Bulbocavernosus reflex:
Positive: the presence of this reflex implies the lack of supraspinal
input to the sacral outflow and is suggestive of a complete spinal
injury
Negative: absent in spinal shock
20. Neurological Classification:
Use the ASIA International standards
Motor and sensory assessment
ASIA Impairment Scale (A-E)
Clinical Syndromes (patterns of incomplete injury)
21. Spinal Cord Injury grading
systems(SCI)
American Spinal Injury Association and the
International Medical Society of Paraplegia
(ASIA/IMSOP) impairment scale
Motor level: most caudal key muscle with
at least grade 3 power
Sensory level: most caudal segment with
normal sensory function
Complete versus Incomplete: evidence of
neurological function distally, including
preservation of perineal sensation (sacral
sparing)
22.
23. ASIA IMPAIRMENT SCALE
A = Complete: No motor or sensory function is preserved in the
sacral segments S4-S5
B = Incomplete: Sensory but not motor function is preserved
below the neurological level and includes sacral segments S4-5
C = Incomplete: Motor function is preserved below the
neurological level, and more than half of 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 key muscles below the
neurological level have a muscle grade of 3 or more
E = Normal: motor and sensory function are normal
24. A Complete loss of motor and sensory function
B Only sensory function remains
CMotor function present, but of no practical use (i.e.
person is unable to ambulate but can move legs)
D Motor function impaired (i.e. person can
ambulate but not with a normal gait)
E No neurologic impairment noted
Frankel Classification
26. •All ascending tracts from
below and descending tracts
from above are interrupted.
•Affects motor, sensory and
autonomic functions.
COMPLETE CORD TRANSECTION
27. SENSORY:
All sensations are affected.
Pin prick test is very valuable.
Sensory level is usually 2 segments below the level of
lesion.
Segmental paraesthesia occur at the level of lesion.
COMPLETE CORD TRANSECTION
28. MOTOR:
Paraplegia due to corticospinal tract involvement.
First spinal shock-followed by hypertonic hyperreflexic
paraplegia.
Loss of abdominal and cremastric reflexes.
At the level of lesion LMN signs occur.
COMPLETE CORD TRANSECTION
29. AUTONOMIC:
Urinary retention and constipation.
Anhidrosis, trophic skin changes, vasomotor instability
below the level of lesion.
Sexual dysfunction can occur.
COMPLETE CORD TRANSECTION
31. BROWN SEQUARD SYNDROME
= Hemi-section of the spinal cord
Caused by extramedullary lesions
Usually caused by penetrating trauma or tumour.
32.
33. SENSORY:
Ipsilateral loss of proprioception due to posterior
column involvement.
Contralateral loss of pain and temperature due to
involvement of lateral spinothalamic tract.
BROWN SEQUARD SYNDROME
34. MOTOR:
Ipsilateral spastic weakness due to descending
corticospinal tract involvement
LMN signs at the level of lesion.
BROWN SEQUARD SYNDROME
37. SENSORY:
Pain and temperature are affected.
Touch and proprioception are preserved.
Dissociative anaesthesia.
Shawl like (= Cape like) distribution of sensory loss.
MOTOR:
Upper limb weakness > Lower limb
CENTRAL CORD SYNDROME
38. Commonest causes include diabetes mellitus &
neurosyphilis.
Usually occurs 10 to 20 yrs after disease onset.
POSTERIOR CORD SYNDROME
39. FEATURES :
Paresthesia in feet
Loss of proprioception and vibration in legs
Sensory ataxia
Positive Rhomberg sign
Bladder atony
Corticospinal tract involvement:
◦ Spasticity
◦ Hyperreflexia
◦ Bilateral Babinski sign - Positive
POSTERIO LATERAL COLUMN
DISEASE
40. Due to acute disc herniation or ischemia from anterior
spinal artery occlusion.
Usually caused by hyperflexion injuries
Area supplied by anterior spinal artery is affected
ANTERIOR CORD SYNDROME
41. Sudden onset of paralysis
(quadriparesis/paraparesis)
below the level of lesion.
Pain and temperature loss.
Dorsal column is
preserved.
Prognosis is poor.
ANTERIOR CORD SYNDROME
42. SENSORY :
Loss of pain and temperature.
Preservation of position and vibration.
MOTOR :
Sudden onset flaccid and areflexic paraplegia.
AUTONOMIC :
Urinary incontinence +
ANTERIOR SPINAL ARTERY
SYNDROME
44. Lies opposite to vertebral bodies of T12 and L1.
Contributes to 25% of spinal cord injuries.
Caused by flexion distraction injuries and burst
fractures.
Both UMN and LMN deficits occur.
Development of neurogenic bladder.
CONUS MEDULLARIS
SYNDROME
45. Begins at L2 disk space
distal to conus medullaris.
occurs due to:
◦ Acute disk herniation
◦ Epidural haematoma
◦ Tumour
CAUDA EQUINA SYNDROME
46. MOTOR :
Flaccid lower extremities.
Knee and ankle jerk absent.
SENSORY :
Asymmetrical sensory loss
Saddle anaesthesia
Loss of sensation around perineum, anus, genitals.
CAUDA EQUINA SYNDROME
48. DDx: CONUS vs CAUDA
FEATURE CONUS MEDULARIS CAUDA EQUINA
PRESENTATION Sudden & Bilateral Gradual & Unilateral
REFLEXES Knee present, Ankle –
(If the epiconus is
involved, patellar reflex
maybe absent but
bulbocavernosus is
spared)
Knee & Ankle –
Bulbocavernosus reflex
is absent in low CE
(sacral) lesions
RADICULAR PAIN Less severe More severe
LOW BACKACHE More Less
Ref: http://www.emedicine.com/neuro/topic667.htm
49. FEATURE CONUS MEDULARIS CAUDA EQUINA
SENSORY
SYMPTOMS
Numbness tends to be
more localized to
perianal area;
symmetrical and
bilateral; sensory
dissociation occurs.
Sensory loss of pin
prick & temperature
sensations (Tactile
sensation is spared.)
Numbness tends to be more
localized to saddle area;
asymmetrical, maybe
unilateral; no sensory
dissociation; loss of sensation
in specific dermatomes in lower
extremities with numbness and
paresthesia; possible numbness
in pubic area, including glans
penis or clitoris.
Ref: http://www.emedicine.com/neuro/topic667.htm
50. FEATURE CONUS MEDULARIS CAUDA EQUINA
SPHINCTER
DYSFUNCTION
Urinary retention and
atonic anal sphincter
cause overflow urinary
incontinence and fecal
incontinence
Tend to present early
in course of disease.
Urinary retention
Tends to present late in
course of disease
EMG Mostly normal lower
extremity with external
anal sphincter
involvement
Multiple root level
involvement; sphincters may
also be involved.
OUTCOME Less favourable More Favourable
Ref: http://www.emedicine.com/neuro/topic667.htm
51.
52. One to two days Nerve cells become less responsive to sensory input,
resulting in full or partial loss of spinal cord reflexes. This is
known as hyporeflexia.
One to three days Initial return of some reflexes. Polysynaptic reflexes --
Bulbocavernosus Reflex,
One to three weeks a pattern of unusually strong reflexes, occurs. This is the
result of new nerve synapse growth, and is normally
temporary
One to twelve
months
Hyperreflexia continues, and spasticity may develop. This
process is due to changes in the neuronal cell bodies, and
takes much longer than the other stages
Spinal shock
53. NEXUS
N neurologic deficit (focal)
E (Etoh) alcohol/Intoxication
X extreme distracting injury
U unable to provide history(loss of consciousness)
S spinal tenderness
When to get a spine imaging
54. NEXUS
Sensitivity 99%
Negative predictive value 99.8%
Specificity 12.9%
Positive predictive value 2.7%
Hoffman JR, Mower WR, Wolfson AB, Todd KH,
Zucker MI. Validity of a set of clinical criteria to
rule out injury to the cervical spine in patients with
blunt trauma. National Emergency X-Radiography
Utilization Study Group. The New England journa
of medicine. 343 (2): 94-
9. doi:10.1056/NEJM200007133430203 -
56. Results of Canadian C-
Spine Study
8924 patients enrolled
100 % sensitivity for identifying 151
clinically important C-spine injuries
42.5 % specificity
deemed a highly sensitive decision rule for
use of C-spine radiography in alert and
stable trauma patients
The Canadian C-spine rule for radiography in alert and stable trauma patients
I G Stiell1, G A Wells, K L Vandemheen, C M Clement, H Lesiuk, V J De Maio, A Laupacis, M Schull, R D McKnight, R Verbeek, R
Brison, D Cass, J Dreyer, M A Eisenhauer, G H Greenberg, I MacPhail, L Morrison, M Reardon, J Worthington
•PMID: 11597285
•DOI: 10.1001/jama.286.15.1841
57. Imaging studies
Standard 3 views of the cervical spine (AP, lat
and odontoid)
AP and lat views of the thoracic and lumbar
spine.
The cervical spine radiographs must include
the C7-T1 junction to be considered adequate
X rays
58. Essential for evaluating
injury to the soft tissues and ligaments, discs,
intrinsic cord damage (oedema, hematoma, or
contusion)
Para vertebral soft tissues.
MRI is particularly useful in scenarios such as
central cord syndrome
MRI
59. CT scan cervical spine in all cases of
head injuries or intoxication at the
same time as the brain CT.
CT should be done when plain X-Ray
is inadequate particularly upper
cervical spine injuries and C7-T1
junction
Better delienation of bony anatomy in
axial, frontal and coronal planes
CT Scan
60. A patient of suspected spinal cord injury
should not be cleared and spine
immobilisation should not be removed
unless all the radiologic investigations
have been seen and cleared by an
experienced physician
IMPORTANT
61. How to read the Lateral Cervical Spine
X-Ray
Lateral cervical spine x-
ray must visualize
entire cervical spine .
A film that does not
show the upper border
of T1 is inadequate
Caudal traction on the
arms may help
AABCDS Adequacy, Alignment, Bone,
Cartilage, Disc, Soft tissues
62. Lateral Cervical Spine X-Ray
The anterior vertebral line,
posterior vertebral line, and
spinolaminar line should have a
smooth curve with no steps or
discontinuities
Malalignment of the posterior
vertebral bodies is more
significant than that anteriorly,
which may be due to rotation
A step of >3.5mm is
significant anywhere
63. Anterior subluxation of one
vertebra on another
indicates facet dislocation
Less than 50% of the width
of a vertebral body implies
unifacet dislocation
Greater than 50%
implies bilateral facet
dislocation
This is usually
accompanied by widening
of the interspinous and
interlaminar spaces
Lateral C-Spine X-
ray
64. Lateral C-Spine X-ray
Vertebral body and intervertebral disc
examination reveal compression and
burst type injuries
Bodies normally regular cuboids similar
in size and shape to the vertebrae
immediately above and below (not
C1/C2)
Anterior wedging of vertebral body or
teardrop fractures of antero-inferior
portion of body implies compression
fracture
65. Lateral C-Spine X-ray
Loss of height of an intervertebral
disc space may indicate disc
herniation
Soft tissue shadow is created by
pharyngeal and prevertebral tissue
Nasopharyngeal space (C1) - 10 mm
(adult)
Retropharyngeal space (C2-C4) - 5-7
mm
Retrotracheal space (C5-C7) - 14
mm (children), 22 mm (adults).
66. AP View
The height of the cervical
vertebral bodies should be
approximately equal
The height of each joint
space should be roughly
equal at all levels.
Spinous process should be
in midline and in good
alignment.
67. Odontoid View
An adequate film should include the entire
odontoid and the lateral borders of C1-C2.
Occipital condyles should line up with the
lateral masses and superior articular facet of
C1.
The distance from the dens to the lateral
masses of C1 should be equal bilaterally.
The tips of lateral mass of C1 should line up
with the lateral margins of the superior
articular facet of C2.
The odontoid should have uninterrupted
cortical margins blending with the body of
C2.
69. Plain Film
Radiology
If lower cervical spine difficult to see,
caudal traction on the arms may be used to
improve visualization
Repeated attempts at plain radiography are
usually unsuccessful
If the lower cervical spine is not visible, a CT
scan of the region is then indicated
70. MRI
Ideally all patients with an abnormal
neurological examination should be
evaluated with an MRI scan
Patients who report transient
neurological symptoms but who have a
normal examination should also
undergo an MRI assessment of their
spinal cord
71. •MRI
•Advantages
•highly sensitive for detection of soft tissue injuries
•disc herniations
•posterior ligament injuries
•spinal cord changes
•Disadvantages
•high rate of false positives
•only effective if done within 48 hours of injury
•can be difficult to obtain in obtunded or intoxicated patients
•MR and CT angiography
•Advantage
•effective for evaluating vertebral artery
72. Indication for spinal MRI
The main indications of MRI in spinal trauma include :
1. Radiographic and/or CT scan findings suggestive of ligamentous injury, such as prevertebral hematoma,
spondylolisthesis, asymmetric disc space widening, facet joint widening or dislocations, and inter-spinous
space widening.(unstable injury )
2. To look for epidural hematoma or disc herniation before attempting a closed reduction of cervical facet
dislocations.
3. To identify spinal cord abnormalities in patients with impaired neurological status.
4. To exclude clinically suspected ligamentous or occult bony injuries in patients with negative radiographs.
5. To determine the stability of the cervical spine and assess the need for cervical collar in lethargic trauma
patients.
6. To differentiate between hemorrhagic and non-hemorrhagic spinal cord injuries for the prognostic significance
as the presence of hemorrhage significantly worsens the final clinical outcome
73. According to American College of Radiology (ACR) appropriateness
criteria, MRI of spine combined with CT scan is appropriate in the setting
of acute spinal trauma if :
1. National Emergency X-Radiography Utilization Study (NEXUS) or
Canadian Cervical-Spine Rule (CCR) criteria are met and there are
clinical findings of myelopathy.
2. NEXUS or CCR criteria are met and there are clinical or imaging findings
to suggest ligamentous injury.
3. NEXUS or CCR criteria indicate imaging and the mechanically unstable
spine is anticipated.
74. T1W – anatomy and osseous fracture
STIR- edema, soft tissue, ligamentous injuries
T2W- cord edema
T2W GRE images are used to detect the hemorrhage in and around the cord
Anterior column - ALL, anterior two-thirds of the vertebral body and
anterior two-thirds of the intervertebral disc.
The middle column consists of posterior one-third of the vertebral body,
posterior one-third of the intervertebral disc, and PLL.
The posterior column consists of everything posterior to the PLL including
pedicles, facet joints and articular processes, ligamentum flavum, neural arch
and interconnecting ligaments
75.
76. Sagittal T2 weighted image (a) shows normal anterior longitudinal ligament (short single
arrow), posterior longitudinal ligament (short double arrows) and ligamentum flavum
(long arrow). Sagittal T2 weighted image (b) shows normal wavy supraspinous ligament
(short arrow), and normal striated interspinous ligament (long arrow)
77. Sagittal short tau inversion recovery (STIR) images show complete anterior longitudinal ligament tear
(arrow, a), complete posterior longitudinal ligament tear (short single arrow, b) and ligamentum flavum tear
(long arrow, b), ligamentum nuchae tear (short double arrows, b), facet capsular injury (arrow, c), and
interspinous ligament injury (short double arrows, d). Also note the presence of thoracic vertebrae contusions
(arrows
78. Axial gradient recalled echo (GRE) image (a) and sagittal T1
weighted image (b) show the presence of a small central disc
herniation (white arrows). Also note the presence of paraspinal
muscle edema (black arrow, a)
79. Sagittal T1 weighted image (a) and axial gradient recalled echo
(GRE) image (b) show the presence of epidural hematoma
(arrows), and axial T2 weighted image (c) shows subdural
hematoma (long arrow) deep to the dura (short arrow
80. Sagittal T2 weighted image (a) and axial gradient recalled echo
(GRE) image (b) show the presence of nonhemorrhagic
contusion in the spinal cord (arrows)
81. Sagittal T2 weighted image (a) and axial gradient recalled echo
(GRE) image (b) show the presence of hemorrhagic contusion
(arrow, a)
82. Sagittal CT image in the bone window (a) did not show any CT
evidence for a fracture in this trauma patient. However, sagittal
short tau inversion recovery (STIR) image (b) shows bone
marrow edema in the superior aspect of multiple vertebrae
(arrows) suggesting bone contusions
83. CT
Scanning
Thin cut CT scanning
should be used to
evaluate abnormal,
suspicious or poorly
visualized areas on plain
radiology
The combination of plain
radiology and directed CT
scanning provides a false
negative rate of less than
0.1%
84. Role of CT imaging
Radiographs of the cervical spine detect only 60% to 80% of
fractures, even when all 3 views are obtained
CT has a higher sensitivity and specificity for evaluating
cervical spine injury than radiographs, detecting 97% to 100%
of fractures
Rapid radiological clearence of cervical spine
The most important limitation of CT is the inability to provide
screening for ligamentous and spinal cord injury
Imaging of Spine Trauma
Lubdha M Shah1, Jeffrey S Ross
•PMID: 27404215
•DOI: 10.1227/NEU.0000000000001336
85. CT of the craniovertebral junction in
the coronal (A), sagittal (B), and
parasagittal (C, D) planes shows
atlantooccipital dissociation. There
is widening (white arrow) and
anterior subluxation (red arrows) of
the atlanto-occipital articulations.
The basion dens distance is
abnormally increased as well
(yellow arrow).
Imaging of Spine Trauma
Lubdha M Shah1, Jeffrey S Ross
•PMID: 27404215
•DOI: 10.1227/NEU.0000000000001336
86. Sagittal (A) CT reconstruction, T1-weighted (B), T2-
weighted (C), and STIR (D) Acute compression fractures
of C7 and T3 are also noted (white arimages illustrate a
type 2 dens
fracture (red arrows). rows). STIR, short tau inversion
recovery.
Imaging of Spine Trauma
Lubdha M Shah1, Jeffrey S Ross
•PMID: 27404215
•DOI: 10.1227/NEU.0000000000001336
87. Sagittal STIR (A), sagittal CT (B), and parasagittal CT (C,
D) images show traumatic spondylolisthesis of C2.
There are bilateral comminuted pars interarticularis
fractures (white arrows). Anterolisthesis and inferior
angulation of C2 on
C3 are observed. A small prevertebral hematoma (red
arrow) is noted. STIR, short tau inversion recovery
Imaging of Spine Trauma
Lubdha M Shah1, Jeffrey S Ross
•PMID: 27404215
•DOI: 10.1227/NEU.0000000000001336
88. Sagittal (A) CT reconstruction, T1-weighted (B), T2-weighted (C), and STIR (D) images show a midthoracic
flexion-distraction injury. There is a burst fracture of T7 with retropulsed bone fragments. In addition to fracture of
the posterior elements, there is ligamentous injury with stripping of the ALL (white arrow) and discontinuity of the
PLL (red arrow) and supraspinous ligament (yellow arrow). Ligamentum flavum rupture with epidural hemorrhage
is also noted (blue arrow). ALL, anterior longitudinal ligament; PLL, posterior longitudinal ligament; STIR, short tau
inversion recovery
Imaging of Spine
Trauma
Lubdha M Shah1, Jeffrey S Ross
•PMID: 27404215
•DOI: 10.1227/NEU.00000000000
01336
89. Clearance of Cervical Spine Injury in Conscious,
Symptomatic Patients
1. Radiological evaluation of the cervical
spine is indicated for all patients who do
not meet the criteria for clinical clearance
as described above
2. Imaging studies should be technically
adequate and interpreted by experienced
clinicians
90. Radiographic Examination and
Clearance of Cervical Spine Injury -
Unconscious, Intubated Patients
Key Points
1. The odontoid view is unreliable in
intubated patients
2. Clinical examination is impossible in the
unconscious patient
3. Plain film radiology cannot exclude
ligamentous instability
91. C-spine clearance in unconscious, intubated patients
Standard radiological examination of cervical spine in
unconscious, intubated patients is
1. Lateral cervical spine film
2. Antero-posterior cervical spine film
3. CT scan of occiput-C3
The open mouth odontoid radiograph is inadequate in
intubated patients and will miss up to 17% of injuries to
the upper cervical spine
92. C-spine clearance in unconscious,
intubated patients
Clearance of the spine in unconscious
patients is limited by the lack of clinical
information
Incidence of unstable spinal injury in adult,
intubated trauma patients is about 10.2%
Incidence of unstable, occult spinal trauma
(not visible on plain films) is about 2.5%
93. Magnetic Resonance
Imaging in unconscious
C-Spine Trauma
Extremely sensitive at detecting soft tissue
injuries without stressing cervical spine
High false positive rate
Few good studies on the use of MRI in
clearing the cervical spine in unconscious
patients
94. Four Basic Reasons Why Cervical Spine Fractures Are
Missed By Physicians
1. Failure to obtain indicated films
2. Inadequate films
3. Misinterpretation of the films
4. Films fail to adequately visualize the
injuries