The document discusses classification systems for thoracolumbar spine injuries including the Denis three-column classification, AO classification, and TLICS classification. The TLICS classification scores injuries based on morphology, posterior ligament integrity, and neurologic status to determine treatment. It provides examples of clinical cases and reviews imaging findings to assess injuries like burst fractures, Chance fractures, and neurologic status to guide clinical decision making.
Dr. Donald Corenman (http://neckandback.com 970.479.5895) is a spine surgeon and spinal cord expert practicing at the Steadman Clinic in Vail, CO. He created this Power Point presentation on cervical spine injury and the evaluation of the cervical spine with an injury. The cervical spine (C spine) represents the neck area of the upper spine.
This presentation--clearing the cervical spine--offers an in-depth look at cervical spine injury of the neck (C spine) including fractures, cervical nonskeletal injuries, and also offers a 3-view radiograph approach into the exam.
Dr. Corenman is a spine expert and treats nonskeletal injuries such as ligamentous instability, sciwora and central cord injury. He is an expert in myelopathy, sciatica, degenerative disc disease, scoliosis and slipped disc.
This document provides an overview of pelvic fractures, including:
- Anatomy of the pelvis and mechanisms of injury like anteroposterior compression and lateral compression.
- Clinical examination involves assessing hemodynamic status, pelvic compression tests, and radiological exams like plain films and CT scan.
- Classification systems like the Tile system categorize fractures as stable or unstable.
- Early management focuses on ABCs, bleeding control techniques like external fixation or angiography, and treating associated injuries. Definitive treatment depends on fracture stability and displacement.
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.
This document provides an overview of thoracolumbar fractures, including epidemiology, clinical evaluation, classification systems, radiographic evaluation, treatment approaches, and specific surgical techniques. It discusses the anatomy of the thoracolumbar region, mechanisms of injury, neurological assessment tools, radiographic indicators of instability, and non-operative and operative treatment options depending on the fracture classification.
- 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.
The document discusses various types of cervical spine trauma and injuries that can occur. It describes fractures of the atlas including Jefferson's fracture and posterior arch fractures. Hangman's fractures and teardrop fractures of the axis are also summarized. Odontoid fractures are divided into Types I-III. Vertebral body compression fractures like wedge fractures and burst fractures are mentioned. The document also briefly summarizes clay shoveler's fractures and lamina and transverse process fractures of the cervical spine. Various imaging modalities for evaluating cervical spine injuries are also discussed.
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,
Cervical spine fracture radiology, classification and management AshrafJamal12
This document discusses the radiology, classification, and management of cervical spine fractures. It begins by covering the common radiographic views used to evaluate the cervical spine - lateral, AP, and open mouth views. CT is discussed as the primary imaging modality for high-risk patients. Injuries are classified based on location, including occipital condyle fractures and odontoid fractures. Non-operative management includes provisional stabilization with a cervical collar or skull traction. Surgical treatment is considered for more severe injuries.
Dr. Donald Corenman (http://neckandback.com 970.479.5895) is a spine surgeon and spinal cord expert practicing at the Steadman Clinic in Vail, CO. He created this Power Point presentation on cervical spine injury and the evaluation of the cervical spine with an injury. The cervical spine (C spine) represents the neck area of the upper spine.
This presentation--clearing the cervical spine--offers an in-depth look at cervical spine injury of the neck (C spine) including fractures, cervical nonskeletal injuries, and also offers a 3-view radiograph approach into the exam.
Dr. Corenman is a spine expert and treats nonskeletal injuries such as ligamentous instability, sciwora and central cord injury. He is an expert in myelopathy, sciatica, degenerative disc disease, scoliosis and slipped disc.
This document provides an overview of pelvic fractures, including:
- Anatomy of the pelvis and mechanisms of injury like anteroposterior compression and lateral compression.
- Clinical examination involves assessing hemodynamic status, pelvic compression tests, and radiological exams like plain films and CT scan.
- Classification systems like the Tile system categorize fractures as stable or unstable.
- Early management focuses on ABCs, bleeding control techniques like external fixation or angiography, and treating associated injuries. Definitive treatment depends on fracture stability and displacement.
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.
This document provides an overview of thoracolumbar fractures, including epidemiology, clinical evaluation, classification systems, radiographic evaluation, treatment approaches, and specific surgical techniques. It discusses the anatomy of the thoracolumbar region, mechanisms of injury, neurological assessment tools, radiographic indicators of instability, and non-operative and operative treatment options depending on the fracture classification.
- 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.
The document discusses various types of cervical spine trauma and injuries that can occur. It describes fractures of the atlas including Jefferson's fracture and posterior arch fractures. Hangman's fractures and teardrop fractures of the axis are also summarized. Odontoid fractures are divided into Types I-III. Vertebral body compression fractures like wedge fractures and burst fractures are mentioned. The document also briefly summarizes clay shoveler's fractures and lamina and transverse process fractures of the cervical spine. Various imaging modalities for evaluating cervical spine injuries are also discussed.
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,
Cervical spine fracture radiology, classification and management AshrafJamal12
This document discusses the radiology, classification, and management of cervical spine fractures. It begins by covering the common radiographic views used to evaluate the cervical spine - lateral, AP, and open mouth views. CT is discussed as the primary imaging modality for high-risk patients. Injuries are classified based on location, including occipital condyle fractures and odontoid fractures. Non-operative management includes provisional stabilization with a cervical collar or skull traction. Surgical treatment is considered for more severe injuries.
Pelvic fractures can be simple or complex and can involve any part of the bony pelvis. Pelvic fractures can be fatal, and an unstable pelvis requires immediate management.
This document provides an overview of pelvic ring injuries, including:
- Epidemiology, with an incidence of 3% of all fractures and 25% among polytrauma patients. Severity depends on mechanism of injury.
- Anatomy of the pelvic ring and ligaments that provide stability.
- Mechanisms of injury including low vs high energy and direction of forces.
- Clinical evaluation focuses on life threats and identifying all injuries, including signs of pelvic instability. Hemodynamic status and hemorrhage control are priorities.
- Options for immediate hemorrhage control include pelvic binders, C-clamps, external fixation, and angiographic embolization.
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.
Pelvic injuries and associated injuriespraneeth raju
Pelvic fractures can result from high-energy trauma like motor vehicle accidents and present risks of massive hemorrhage, vascular and organ injury. Diagnosis involves history of mechanism of injury, clinical exam for signs of instability and hemorrhage, and imaging like CT, FAST ultrasound, or diagnostic peritoneal lavage to identify fractures and internal bleeding. Proper classification of fracture patterns is important for determining management and prognosis.
This document provides guidance on the acute management of pelvic ring injuries. Key points include:
1. Pelvic ring injuries can cause significant hemorrhage and morbidity. Initial management focuses on airway, breathing, circulation and hemorrhage control through methods like pelvic sheeting, binding, or external fixation.
2. Indications for transfer include hemodynamic instability, bladder/urethra injury, open pelvic fractures, or significant displacement/instability on imaging. Physical exam assesses for injuries like degloving or limb deformities.
3. Sources of hemorrhage include external wounds, chest, long bones, abdomen, and retroperitoneum. Hemodynamic instability is evaluated through
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.
Cervical spine trauma can range from minor ligament injuries to spinal cord injuries. The cervical spine is commonly injured, with the most common mechanisms being falls and motor vehicle accidents. Common fractures include odontoid fractures of C2, hangman's fractures involving the pars interarticularis of C2, and flexion-extension teardrop fractures of the lower cervical vertebrae. Computed tomography is useful for evaluation of cervical spine injuries. Magnetic resonance imaging can help identify ligamentous injuries when other studies are negative. Treatment depends on the stability of the injury, with unstable injuries requiring immobilization.
- Proximal humerus fractures account for up to 45% of all humeral fractures and are classified based on the number of fractured fragments and their displacement.
- Treatment depends on the fracture pattern and patient factors. Undisplaced or minimally displaced fractures are typically treated non-operatively with immobilization followed by rehabilitation. Displaced fractures may require surgical management including closed reduction with pins, plates, nails or prosthetic replacement depending on the severity.
- Four-part fractures and fracture dislocations have a high risk of avascular necrosis due to disruption of the blood supply and often require hemiarthroplasty or reverse total shoulder arthroplasty in elderly patients.
Spine surgeon Dr Arun L Naik Bangalore india Dr Arun L Naik
Dr Arun L Naik is a Spine Surgeon practicing in India Bangalore for 14 years. He was trained at AIIMS New Delhi in 2000. He is well known for his surgery for ''failed back surgery syndrome'' where previous surgery was gone wrong. He has expertise in 'minimal invasive key hole spine surgery'' . He operates on complex spinal cord tumors which are challenges to any surgeon. Dr Naik is one of the few neurosurgeons in India to operate on cranio vertebral junction with excellent surgical results. Spinal cord injuries are special areas of interest to him. He has successfully treated hundreds of spinal injured patients many of whom are walking today. He has trained many surgeons in developing spine surgery technique.
1. Spinal cord injuries are commonly caused by motor vehicle accidents, falls, and sports. The cervical spine is most frequently injured.
2. Initial evaluation involves stabilizing the patient with a cervical collar and assessing for neurological deficits. Imaging such as X-rays and CT/MRI are used to classify fractures and guide treatment.
3. Treatment depends on the fracture type but may involve halo immobilization, surgery to stabilize fractures or decompress the spinal cord, or bracing for stable injuries. The goal is to restore spinal alignment and prevent further neurological injury.
This document discusses techniques for pedicle screw insertion during spinal surgery. It describes the lumbar vertebrae anatomy and steps for pedicle screw placement, including defining the entry point, opening the cortex, probing the pedicle tract, appropriate cranial-caudal and medial-lateral trajectories, tapping if needed, and inserting the screw across the pedicle and into the vertebral body. An example case is provided of a 25-year-old male patient who underwent this procedure to treat an L1 vertebral fracture with paraplegia.
This document provides information on tibial plateau fractures, including:
- The tibial plateau is the proximal end of the tibia including the articular surfaces.
- Tibial plateau fractures most often involve the lateral plateau and are commonly associated with soft tissue injuries.
- Surgical treatment aims to restore the joint surface and provide stability to allow early mobilization.
- Surgical approaches include anterolateral, posteromedial, and anterior. Fixation methods include plates, screws, and external fixators.
- Arthroscopic techniques are increasingly used to directly visualize and treat the articular surface with minimal soft tissue disruption.
Thoraco lumbar injuries can be categorized based on which spinal columns are affected. Injuries involving the middle column and at least one other column are considered unstable. Burst fractures involve failure of the anterior and middle columns and may require early stabilization, especially if they involve over 50% canal compromise, over 20 degrees of kyphosis, or over 45-50% canal compromise. Flexion distraction injuries can be categorized into types A through D depending on whether they involve bone or ligaments at one or two spinal levels.
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.
The document summarizes key aspects of spinal anatomy and injuries. It describes the characteristics of the cervical, thoracic, lumbar, and sacral regions. Common mechanisms of spinal injury include falls, motor vehicle crashes, and blunt or penetrating trauma. Signs suggestive of spinal injury include neck pain or tenderness, numbness, weakness, and loss of bowel or bladder control. Evaluation involves physical exam including motor and sensory function tests. Imaging with x-rays, CT, and MRI is used for diagnosis. Management principles focus on immobilization, resuscitation, corticosteroid administration in some cases, and surgery for unstable injuries with neurological deficits.
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.
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.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
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.
Pelvic fractures can be simple or complex and can involve any part of the bony pelvis. Pelvic fractures can be fatal, and an unstable pelvis requires immediate management.
This document provides an overview of pelvic ring injuries, including:
- Epidemiology, with an incidence of 3% of all fractures and 25% among polytrauma patients. Severity depends on mechanism of injury.
- Anatomy of the pelvic ring and ligaments that provide stability.
- Mechanisms of injury including low vs high energy and direction of forces.
- Clinical evaluation focuses on life threats and identifying all injuries, including signs of pelvic instability. Hemodynamic status and hemorrhage control are priorities.
- Options for immediate hemorrhage control include pelvic binders, C-clamps, external fixation, and angiographic embolization.
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.
Pelvic injuries and associated injuriespraneeth raju
Pelvic fractures can result from high-energy trauma like motor vehicle accidents and present risks of massive hemorrhage, vascular and organ injury. Diagnosis involves history of mechanism of injury, clinical exam for signs of instability and hemorrhage, and imaging like CT, FAST ultrasound, or diagnostic peritoneal lavage to identify fractures and internal bleeding. Proper classification of fracture patterns is important for determining management and prognosis.
This document provides guidance on the acute management of pelvic ring injuries. Key points include:
1. Pelvic ring injuries can cause significant hemorrhage and morbidity. Initial management focuses on airway, breathing, circulation and hemorrhage control through methods like pelvic sheeting, binding, or external fixation.
2. Indications for transfer include hemodynamic instability, bladder/urethra injury, open pelvic fractures, or significant displacement/instability on imaging. Physical exam assesses for injuries like degloving or limb deformities.
3. Sources of hemorrhage include external wounds, chest, long bones, abdomen, and retroperitoneum. Hemodynamic instability is evaluated through
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.
Cervical spine trauma can range from minor ligament injuries to spinal cord injuries. The cervical spine is commonly injured, with the most common mechanisms being falls and motor vehicle accidents. Common fractures include odontoid fractures of C2, hangman's fractures involving the pars interarticularis of C2, and flexion-extension teardrop fractures of the lower cervical vertebrae. Computed tomography is useful for evaluation of cervical spine injuries. Magnetic resonance imaging can help identify ligamentous injuries when other studies are negative. Treatment depends on the stability of the injury, with unstable injuries requiring immobilization.
- Proximal humerus fractures account for up to 45% of all humeral fractures and are classified based on the number of fractured fragments and their displacement.
- Treatment depends on the fracture pattern and patient factors. Undisplaced or minimally displaced fractures are typically treated non-operatively with immobilization followed by rehabilitation. Displaced fractures may require surgical management including closed reduction with pins, plates, nails or prosthetic replacement depending on the severity.
- Four-part fractures and fracture dislocations have a high risk of avascular necrosis due to disruption of the blood supply and often require hemiarthroplasty or reverse total shoulder arthroplasty in elderly patients.
Spine surgeon Dr Arun L Naik Bangalore india Dr Arun L Naik
Dr Arun L Naik is a Spine Surgeon practicing in India Bangalore for 14 years. He was trained at AIIMS New Delhi in 2000. He is well known for his surgery for ''failed back surgery syndrome'' where previous surgery was gone wrong. He has expertise in 'minimal invasive key hole spine surgery'' . He operates on complex spinal cord tumors which are challenges to any surgeon. Dr Naik is one of the few neurosurgeons in India to operate on cranio vertebral junction with excellent surgical results. Spinal cord injuries are special areas of interest to him. He has successfully treated hundreds of spinal injured patients many of whom are walking today. He has trained many surgeons in developing spine surgery technique.
1. Spinal cord injuries are commonly caused by motor vehicle accidents, falls, and sports. The cervical spine is most frequently injured.
2. Initial evaluation involves stabilizing the patient with a cervical collar and assessing for neurological deficits. Imaging such as X-rays and CT/MRI are used to classify fractures and guide treatment.
3. Treatment depends on the fracture type but may involve halo immobilization, surgery to stabilize fractures or decompress the spinal cord, or bracing for stable injuries. The goal is to restore spinal alignment and prevent further neurological injury.
This document discusses techniques for pedicle screw insertion during spinal surgery. It describes the lumbar vertebrae anatomy and steps for pedicle screw placement, including defining the entry point, opening the cortex, probing the pedicle tract, appropriate cranial-caudal and medial-lateral trajectories, tapping if needed, and inserting the screw across the pedicle and into the vertebral body. An example case is provided of a 25-year-old male patient who underwent this procedure to treat an L1 vertebral fracture with paraplegia.
This document provides information on tibial plateau fractures, including:
- The tibial plateau is the proximal end of the tibia including the articular surfaces.
- Tibial plateau fractures most often involve the lateral plateau and are commonly associated with soft tissue injuries.
- Surgical treatment aims to restore the joint surface and provide stability to allow early mobilization.
- Surgical approaches include anterolateral, posteromedial, and anterior. Fixation methods include plates, screws, and external fixators.
- Arthroscopic techniques are increasingly used to directly visualize and treat the articular surface with minimal soft tissue disruption.
Thoraco lumbar injuries can be categorized based on which spinal columns are affected. Injuries involving the middle column and at least one other column are considered unstable. Burst fractures involve failure of the anterior and middle columns and may require early stabilization, especially if they involve over 50% canal compromise, over 20 degrees of kyphosis, or over 45-50% canal compromise. Flexion distraction injuries can be categorized into types A through D depending on whether they involve bone or ligaments at one or two spinal levels.
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.
The document summarizes key aspects of spinal anatomy and injuries. It describes the characteristics of the cervical, thoracic, lumbar, and sacral regions. Common mechanisms of spinal injury include falls, motor vehicle crashes, and blunt or penetrating trauma. Signs suggestive of spinal injury include neck pain or tenderness, numbness, weakness, and loss of bowel or bladder control. Evaluation involves physical exam including motor and sensory function tests. Imaging with x-rays, CT, and MRI is used for diagnosis. Management principles focus on immobilization, resuscitation, corticosteroid administration in some cases, and surgery for unstable injuries with neurological deficits.
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.
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.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
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.
This document provides an overview of c-spine trauma, including the Nexus and Canadian c-spine rules for clinical assessment and imaging criteria. It discusses various c-spine injury types from different mechanisms of injury such as flexion teardrop fractures from hyperflexion and hangman's fractures from hyperextension. Imaging guidelines for radiography, CT, and MRI are provided. Examples of c-spine fractures are reviewed in quiz cases along with features to determine stability and need for further workup.
This document summarizes the anatomy of the thoracic and lumbar spine. It describes the typical structures of the 5 lumbar vertebrae and discs, as well as the lordosis and exiting nerve roots. It also outlines the anatomy of a typical lumbar vertebra, including the body, vertebral foramen, intervertebral foramen, and ligaments. Additionally, it discusses the spinal cord, nerve roots, conus medullaris, and cauda equina as they relate to the lumbar spine.
Colorado spine surgeon, Dr. Donald Corenman, M.D., D.C. (http://neckandback.com), is an expert in treating spinal cord injuries associated with a traumatic fall, sports related injury or accident. Many spine fractures include a thoracolumbar fracture, which is a break in one or more of the thoracic and lumbar vertebrae. Spine fractures can be very serious but are also treatable in many cases. This presentation on spinal cord injuries, spine fractures and thoracolumbar fractures details events that can lead to this injury, symptoms and treatment options.
Dr. Corenman is a renowned Colorado spine surgeon and also is an expert at all spine conditions and disorders including scoliosis, degenerative disc disease, spinal stenosis, sciatica, herniated disc, slipped disc and spondylolythesis. He is also a sports medicine specialist and treats athletes with traumatic sports related injuries. He recently launched his own website (http://neckandback.com) to educate patients on spine disorders and to offer second opinions to physicians and colleagues who are seeking additional information on specific spine injuries and treatment options.
The document provides an overview of spinal anatomy including:
- The 7 cervical, 12 thoracic, 5 lumbar vertebrae and sacrum/coccyx bones that make up the spine.
- Key structures like the anterior/posterior columns that provide compression/tension resistance.
- Facet joints that resist rotation and displacement.
- Important anatomical features of each region like the cervical facet orientation and thoracic transverse processes.
- Neural structures like the spinal cord, nerves and nerve roots.
- Key concepts like clinical instability and relationships between structures.
This document discusses various types of artifacts that can appear on radiographic images, grouping them into categories of processing artifacts, exposure artifacts, and artifacts related to handling and storage. Processing artifacts include hypo retention, pi-lines, guide shoe marks, and static caused by the film development process. Exposure artifacts involve issues like motion, improper positioning, or double exposure. Handling and storage artifacts involve light or radiation fog, scratches, and hypo retention caused after the image is processed.
X-rays are commonly used to image the spine. The cervical spine can be imaged using anteroposterior, lateral, open mouth, flexion/extension, and oblique views. Key anatomical structures like the vertebrae and discs can be evaluated. Common fractures include teardrop fractures and hangman's fractures. The thoracolumbar spine is also imaged with AP and lateral views. Unstable injuries like burst fractures involve vertebral body collapse while stable injuries include wedge fractures. Spondylolysis is a stress fracture of the pars interarticularis seen best on oblique views.
This document discusses common radiographic errors and artifacts that can occur during dental x-ray procedures. It identifies three main categories of errors: technique and projection errors, exposure errors, and processing errors. Technique errors include issues with patient preparation, film placement, and projection angles. Exposure errors result in over or underexposed images. Processing errors stem from chemical or film handling issues during development and fixing of the x-ray film. The document provides examples and explanations of specific errors like double images, cut-off areas, density problems, and chemical or physical marks that can affect image quality and interpretation.
The document discusses trauma radiography procedures and best practices. It outlines the different levels of trauma centers and describes specialized equipment used in trauma imaging. Key responsibilities of the radiographer are to perform diagnostic imaging quickly and accurately while prioritizing patient safety and ethical practices. Standard trauma projections are described for various body regions as well as considerations for patient positioning and immobilization.
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.
Trauma classification systems aim to improve communication, guide medical decisions, determine injury prognosis, and allow for standardized research. An ideal system provides both descriptive and prognostic information. Descriptively, it relays details of the traumatic condition based on consistent imaging and clinical findings. Prognostically, it accounts for injury outcomes to guide treatment. There are several classification systems for cervical spine trauma, including Holdsworth, Allen, Harris, Cervical Spine Injury Severity Score, Subaxial Cervical Spine Injury Classification, and AO Classification. They characterize injuries based on mechanism, morphology, neurologic status, and other factors. Anterior column injuries often result from hyperflexion and are identifiable on imaging as compression fractures or
The document summarizes information about spine injuries, including:
- Spine injuries can be stable or unstable depending on the risk of displacement. Primary injuries involve damage to vertebral structures while secondary changes hours later involve neurological damage.
- Common mechanisms of injury include traction, direct impact, and indirect injuries. The 3 column theory states that injury to more than 1 column results in instability.
- Cervical spine injuries require careful examination and imaging like X-rays from multiple angles to identify fractures or dislocations. Thoracolumbar injuries include compression fractures which can be wedge-shaped or burst fractures.
- Initial management focuses on immobilization and ruling out injuries before clearing the spine. Diagnosis involves
This document discusses classifications of spine fractures. It defines clinical instability as loss of ability to maintain vertebral relationships without damage to the spinal cord or nerves or development of pain or deformity. It reviews classification systems including Denis, AO, and TLICS. TLICS is based on fracture morphology, integrity of the posterior ligamentous complex, and neurological status. Each category is scored to determine treatment, with the highest score determining approach. PLC disruption generally requires posterior surgery, while incomplete neurological injuries and anterior compression require anterior procedures. Qualifiers like comorbidities can also influence treatment.
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.
This document discusses the management of thoracolumbar spine injuries. It begins by outlining common causes of injury and why the thoracolumbar junction is susceptible. It then covers fracture classification systems including Denis' three column concept and the AO/Magerl classification. Evaluation and management approaches are discussed including non-operative treatment with bracing and operative options depending on fracture pattern and neurological status. Surgical techniques like posterior instrumentation with or without decompression or combined anterior-posterior procedures are mentioned.
The document describes the anatomy and classification of injuries to the clavicle, acromioclavicular joint, and sternoclavicular joint. It discusses the clavicle bone, its joints, ligaments, muscle attachments, mechanisms of injury, physical exam, radiographic evaluation, classification of fractures, and treatment options for fractures and dislocations which can include nonoperative treatment, plate fixation, intramedullary fixation, coracoclavicular screw fixation, and distal clavicle excision.
The document discusses injuries to the acromioclavicular (AC) joint and sternoclavicular (SC) joint. It describes the anatomy, mechanisms of injury, clinical evaluation, classification systems, treatment approaches, and potential complications for each joint. AC joint injuries are more common and typically result from direct trauma, while SC joint injuries are rare but can cause serious issues due to nearby vital structures. Treatment involves rest, immobilization, and sometimes surgery depending on the severity of the injury.
This case presentation discusses a 33-year-old male who presented with pain and instability in his left knee following a motorcycle accident. Examination revealed a complete tear of the posterior cruciate ligament (PCL). An MRI confirmed a grade 1 ACL tear and grade 3 PCL tear with no meniscal injuries. The patient underwent arthroscopic reconstruction of the PCL using a doubled peroneus longus autograft. Post-operatively, the patient was placed in a functional brace and started a rehabilitation protocol focusing on range of motion, quadriceps strengthening, and return to sports at 9 months. The presentation reviews the relevant anatomy, mechanisms of injury, clinical evaluation, treatment options including conservative management and surgical reconstruction techniques for isolated
Pelvic fractures can be classified based on their stability and the mechanism of injury. Unstable and partially stable fractures often require surgical fixation while stable fractures may be treated non-operatively. Initial management focuses on controlling hemorrhage through fluid resuscitation, pelvic binding, angiography, or preperitoneal packing. Definitive treatment is then aimed at anatomic reduction and stabilization of the pelvis through external or internal fixation depending on the fracture pattern and stability. Close monitoring for complications such as infection, neurological injury, or persistent instability is important.
Traumatic knee dislocations are rare injuries that require careful evaluation and management. According to the document, knee dislocations often result from high-energy injuries like motor vehicle collisions or falls. A thorough examination is needed to assess vascular and neurological status. Imaging can identify associated fractures. While some stable injuries may be treated non-operatively, unstable injuries or those with ligament disruption typically require surgical reconstruction. Complications may include neurovascular injuries, infections, and long-term issues like osteoarthritis. Early surgical intervention within 3 weeks of injury may lead to better outcomes compared to delayed treatment.
This document discusses the presentation and management of a 34-year-old man with a left tibial plateau fracture from trauma. It was found that he had normal sensation and motor function in the leg with normal pulses and no signs of compartment syndrome. The document then reviews the mechanisms, imaging, classification, treatment options including non-operative and operative management, prognosis, complications and surgical approaches for tibial plateau fractures.
1. Elbow dislocations are most commonly caused by falls onto an outstretched hand and involve the disruption of the lateral and medial collateral ligaments and elbow capsule.
2. Simple elbow dislocations without fractures are typically treated non-operatively with closed manipulation and immobilization for less than 3 weeks to avoid stiffness.
3. Operative treatment is considered if closed reduction cannot be maintained or for recurrent dislocations and involves repair of the lateral collateral ligaments through bone tunnels or anchors.
This document provides an overview of spine injuries, including anatomy, imaging techniques, fracture types, and management. It discusses the cervical, thoracic, and lumbar regions of the spine. Common fracture types like compression, burst, Chance, and Jefferson fractures are described along with their mechanisms and radiographic features. The AO classification system and three column concept are introduced. Interpretation of x-rays, CT scans and MRI images is outlined. Factors like the TLICS score and integrity of the posterior ligamentous complex are discussed in determining non-operative vs operative management of various spine fractures and injuries.
Thoracolumbar fractures account for 30-50% of spinal injuries and most commonly occur between T11-L1. They can cause neurological deficits affecting the spinal cord or cauda equina. Classification systems evaluate the injury pattern, neurological status, and integrity of posterior ligaments to determine appropriate treatment. Management may involve bracing, bed rest, or surgery depending on factors such as vertebral body height loss, canal compromise, and kyphosis. The goal of treatment is neural decompression, stabilization, and fusion to allow rehabilitation.
This document discusses posterior cruciate ligament (PCL) tears. It begins with an overview of PCL anatomy and mechanisms of injury. It then covers clinical evaluation including physical examination tests like the posterior drawer test. Investigations like MRI are discussed. Finally, the document outlines management approaches for PCL tears, including non-operative treatment for mild injuries and surgical reconstruction or repair for more severe injuries. Surgical techniques like single versus double bundle reconstruction using autografts or allografts are compared. Post-operative rehabilitation protocols are also summarized.
The document discusses injuries to the spine. It covers the epidemiology, anatomy, classification of injuries as stable or unstable, and mechanisms of injury. It then describes specific cervical and thoracolumbar spine injuries, including fractures, dislocations, and treatment approaches which may involve immobilization, traction, or surgery.
A 71-year-old woman was in a car accident and presented with an incomplete spinal cord injury at C6-7. Imaging showed a distractive injury at C6-7. She underwent surgical treatment with lateral mass screws at C5-C6 and pedicle screws at C7-T1, which restored alignment. After 6 months, she had some neurologic improvement. Subaxial cervical fractures are common from C3-C7 and can occur from compression, burst, flexion, or extension mechanisms. Classification systems include the Subaxial Injury Classification Score and Cervical Spine Injury Severity Score to determine treatment. Nonoperative and operative treatment options were discussed.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
8. Anteriorly displaced center of gravity that creates a compressive force (dotted arrow) on
the spinal vertebrae similar to the force on the crane lifting arm. The resulting baseline
flexion force (solid arrow) on the PLC is similar to the tension on the crane’s lifting
cable
9. Critical factor for treatment decision making
Mechanical stability
Integrity of bone and ligamentous components.
Objective of treatment:
Prevent the development of neurologic injury
Prevent the development of progressive
deformity in response to physiologic loading and
a normal range of movement.
11. Thoracolumbar spine classification for clinical and
surgical treatment.
Denis three-column classification system
Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification
Thoracolumbar Injury Classification and Severity Score (TLICS)
12. Thoracolumbar spine classification for clinical and
surgical treatment.
Denis three-column classification system
Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification
Thoracolumbar Injury Classification and Severity Score (TLICS)
13. Based on Anatomic structures or proposed injury mechanism.
Denis three-column classification system:
This model is used to predict the soft tissue injury from bone
injury
Denis three-column classification system
14. Denis three-column classification system: Emphasis on the fracture involvement of the
“middle column,” (posterior half of the vertebral body and intervertebral disk and the
posterior longitudinal ligament)
15. Denis three-column classification system:
Spinal stability is dependent on at least two intact columns.
When two of the three columns are disrupted, it will allow
abnormal segmental motion, i.e. instability.
So a simple anterior wedge fracture or just sprain of the
posterior ligaments is a stable injury.
A wedge fracture with rupture of the interspinous ligaments
is unstable, because the anterior and the posterior column
are disrupted.
A burst fracture is always unstable because at least the
anterior and middle column are disrupted.
16. Criteria to predict soft-tissue injury from bony injury
are:
Angulation greater than 20 degrees.
Translation of 3.5 mm or more.
17. Major injuries
• Compression fracture
• Burst fracture
• Seat belt injury
• Fracture-dislocation
Minor injuries:
• Transverse process
fracture
• articular process fracture
• pars interarticularis
fracture
• spinous process fracture
Denis three-column classification system
Injury to the middle column renders the spine mechanically unstable
18. Modifications of the Denis classification:
Intact posterior ligamentous complex (PLC), two-column
unstable injuries can be successfully treated nonsurgically -
Unstable Stable.
All based on the premise that a fracture caused by forward
flexion should be treated by undoing the flexion by
positioning the patient in an extension brace, or by surgical
intervention correcting the spinal column in extension.
Some of the injuries thought to be due to extension
mechanisms, however, turn out to be due to flexion and vice
versa. These descriptions may thus be misleading.
19. Denis classification, Cons:
Does not provide prognostic information or consider the
patient’s neurologic status, and therefore it cannot adequately
guide surgical intervention.
Since it uses the terms stable and unstable. In many cases,
however, there is no good correlation with the necessity for
surgery
20. Stability
Ambiguous and may refer to:
Direct osseous stability
Neurological stability
Long-term (ligamentous) stability.
21. Thoracolumbar spine classification for clinical and
surgical treatment.
Denis three-column classification system
Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification
Thoracolumbar Injury Classification and Severity Score (TLICS)
22. Arbeitsgemeinschaft für Osteosynthesefragen (AO)
classification
Types (9 subtypes in each)
Group A: vertebral body compression
Group B: anterior and posterior element injuries with
distraction. Transverse disruption either anteriorly or posteriorly.
Group C: anterior and posterior element injuries with rotation.
axial torque.
23. Arbeitsgemeinschaft für Osteosynthesefragen (AO)
classification
Pros:
• Highly detailed subclassifications, the AO system has shown
limited inter-observer variability.
Cons:
• Difficult to use.
• Does not incorporate the patient’s neurologic status.
24. Thoracolumbar spine classification for clinical and
surgical treatment.
Denis three-column classification system
Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification
Thoracolumbar Injury Classification and Severity Score (TLICS)
25. Thoracolumbar Injury Classification and Severity Score
(TLICS) is a scoring and classification system developed
by the Spine Trauma Study Group .
• Scoring and classification system.
• Decide surgery vs no surgery
• Based on 3 components:
• Injury morphology (not mechanism).
• Integrity of the posterior ligamentous complex.
• Neurologic status of the patient.
26.
27. Injury Morphology
If more than one injury morphology exists, the single injury with the largest score is used.
If multiple levels of injury are involved, each injury is assessed independently
28. PLC Integrity
SIGNS OF PLC DISRUPTION:
• Widening of the interspinous space.
• Avulsion fracture of the superior or inferior aspects of contiguous spinous processes,
• Facet joints: widening, empty (“naked”), perched or dislocated.
• Vertebral body translation or rotation.
29. Normal PLC anatomy
MR imaging is the standard of reference for detecting PLC injury.
30. • Except, vertebral body translation or interspinous widening, osseous
findings such as a loss of vertebral body height and kyphosis have been
found to be unreliable in assessing PLC integrity because of the inverse
relationship between osseous destruction and ligamentous injury.
• Patients with severe osseous destruction may have less risk for PLC injury
because the vertebral injury dissipates energy, thereby sparing adjacent soft
tissues.
• Conversely, patients with a significant translation or rotation injury and less
vertebral fragmentation may have a higher risk for PLC injury.
• PLC must be directly assessed at MR imaging regardless of the severity of
vertebral body injury seen at CT
33. Axial compression with mild flexion, which results in nearly asymmetric height loss of
the anterior and middle columns and minimizes the risk of distraction injury to the PLC
37. Flexion-distraction mechanism and PLC
injury should also be suspected if a
superior or inferior posterior endplate
fracture is seen because this likely reflects
an avulsion fracture from the
comparatively strong annulus fibrosus of
the intervertebral disk.
PLC injuries can occur in this setting
with minimal kyphosis or vertebral body
height loss, a fact that further underscores
the importance of MR imaging in
42. Neurologic Status
Although clinical neurologic
status cannot be directly
determined at imaging, a cord or
nerve root injury identified on
MR images should be included in
the imaging report with the
percentage of spinal canal
narrowing .
43. Axial compression with significant burst fracture of the vertebral body, bone
retropulsion into the spinal canal, and resultant risk of neurologic injury.
44. • Anterior vertebral body compression percentage: percentage of anterior
vertebral body compression with respect to the average height of the anterior
vertebral bodies immediately cephalad and caudad to the injury level .
• Retropulsion: distance of a line drawn between the posterior margins of the
adjacent vertebral bodies and the most posterior margin of the bone fragment.
• Sagittal canal diameter: distance between the posterior canal border and the
anterior canal border.
• Posterior canal border: convergence of the superior margins of the left and
right laminae at the midline of the spinous process.
• Anterior canal border: posterior extent of the retropulsed midvertebral body.
45. Treatment
TLICS addresses three different categories of spine stability:
Immediate mechanical stability, suggested by injury morphology
Long-term stability, indicated by PLC status
Neurologic stability, indicated by the presence or absence of a neurologic deficit
46. Burst fracture, in the absence of a neurologic deficit is controversial
Osseous retropulsion alone does not imply neurologic injury or indicate a
need for surgical decompression.
Thoracic spine injury with retropulsion may cause significant neurologic
injury because the spinal canal in the thoracic area is narrow and blood
supply to the cord is sparse.
Lumbar spine fracture may result in marked displacement of the cauda
equina but no neurologic deficit because of the wider canal and cord
termination near L1
Highly comminuted vertebral body fracture is more likely to deform under
physiologic loading and may require short-segment posterior fixation and
anterior fusion or long-segment posterior fixation. In the absence of a
neurologic deficit, PLC integrity should be confirmed at MR imaging,
especially if conservative management of burst fracture is planned
53. 21-year-old female who presented after sustaining a seatbelt type injury. She had
an exploratory laparotomy for repair of a ruptured duodenum.
There was no neurologic deficit.
58. first described by G. Q. Chance in 1948
most common site: thoracolumbar junction (T12-L2)
"seat belt injury" due to sudden forward flexion in a
head-on automobile collision while being restrained
by a lap belt.
advent of both lap and shoulder belts in the 1980s,
Chance fractures have become less common
61. 31 year old male. He was working on a roof, fell
approximately 5 meters landing on his feet. He complained of
pain in left lower extremity and lower back.
67. 21-year-old woman presented with back pain after a motor vehicle
collision in which she was an unrestrained passenger in the
middle seat. CT and MR imaging findings are shown.
71. 21-year-old man presented with multiple injuries
and lower extremity paralysis after a high-speed
motor vehicle collision in which he was an
unrestrained driver.
84. Radiology report may include the TLICS total score
if there is clear imaging evidence of neurologic injury.
Generally the report will not include the total score if
the patient’s clinical neurologic status is unknown.
85. References:
• Khurana B, Sheehan SE, Sodickson A, Bono CM, Harris MB.
Traumatic thoracolumbar spine injuries: what the spine surgeon
wants to know. Radiographics. 2013 Nov-Dec.
• Radiology assistant
• A Magerl F1, Aebi M, Gertzbein SD, Harms J, Nazarian S.
comprehensive classification of thoracic and lumbar injuries. Eur
Spine J. 1994;
• Google images
Editor's Notes
1. The upper thoracic region (T1-T8) is rigid due to the ribcage which provides stability.
2. The transition zone T9-L2 is the transition between the rigid and kyphotic upper thoracic part and the flexible lordotic lumbar spine. This is where most injuries occur.
3. Finally we have the L3-Sacrum zone which is flexible and this is the region where axial loading injuries occur.
coronal orientation of the thoracic facet joints minimizes extension but allows rotation.
sagittal oblique orientation of the lumbar articular facets minimizes rotation
1. The anterior portion of the functional unit contains two aligned vertebral bodies, the intervertebral disk, and the anterior and posterior longitudinal ligaments.
2. The posterior portion consists of the vertebral arches, facet joints, and posterior elements.
1. Upper thoracic spine: center of gravity is anterior to the spine.
Axial loading will result in compressive forces anteriorly and tensile forces posteriorly. This will result in flexion-type of injuries.
2. lumbar spine due to the lordosis, the center of gravity is posteriorly.
Flexion type of injuries will straigthen the lumbar spine and result in axial loading.
In this area we will see burst fractures.
The vertebral bodies resist compressive loading.
The intervertebral disks contain a central nucleus pulposus that absorbs and hydrostatically distributes compressive loading and an annulus fibrosus that resists the resulting circumferential tensile stress
In axial compression injury, PLC, plays a critical stabilizing role.
PLC:
supraspinous ligament- strong cordlike ligament that connects the tips of the spinous processes from C7 to the sacrum. high collagen content, and their high tensile strength limits flexion of the spine
interspinous ligaments - weaker, thin, membranous structures that connect the adjacent spinous processes. high collagen content, and their high tensile strength limits flexion of the spine
articular facet capsules -
ligamentum flavum - thick broad structure that connects the laminae of the adjacent vertebrae. high elastin content and exerts a contractile force on the vertebral arches when it is elongated during flexion
has strong emphasis on stability. But stability is ambiguous
Group A through C represent a continuum of progressively increasing injury severity and instability, with a concomitant increasing likelihood of the need for surgical stabilization
The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description led to the development of Thoracolumbar Injury Classification and Severity Score.
Pattern-based approach for efficient imaging interpretation and communication with spine surgeons
(a) compression fracture (1 point) - loss of vertebral body height or disruption of the vertebral endplate.
(b) Compression with burst fracture (2 points) - involve the posterior vertebral body with retropulsion.
(c) translation or rotation injury (3 points) - horizontal displacement or rotation of one vertebral body with respect to another.
(d) distraction injury (4 points) - anatomic dissociation along the vertical axis and can occur through the anterior and posterior supporting ligaments, the anterior and posterior osseous elements, or a combination of both
protects the spine from excessive flexion, rotation, translation, and distraction.
If disrupted, the injured segment of the PLC usually requires surgical intervention because of its poor healing potential. Without surgery, an injured PLC can result in kyphotic progression and subsequent vertebral collapse
Mild superior endplate compression fracture of T12 with an intact PLC. Sagittal T1 and axial T2.
white arrow: supraspinous ligament
black arrow: interspinous ligament
arrowhead: ligamentum flavum
Greater flexion component increases the risk for a destabilizing PLC injury.
17-year-old woman after a mechanical fall. (a) Sagittal CT image shows a compression fracture with predominant involvement of the anterior column (arrow), resultant kyphotic curvature (dotted line), and mild fanning of the spinous processes at the level of injury. (b) Sagittal CT image of the lateral vertebral bodies shows facet perching (arrow) with articular facet fracture, findings suggestive of a significant flexion component to the injury. (c, d) Sagittal T1-weighted (c) and STIR (d) MR images at the same level as a and b show disruption of the supraspinous ligament (black arrow) and ligamentum flavum (white arrow). Edema (arrowhead in d) in the posterior soft tissues and interspinous ligament is better visualized on the STIR image and illustrates the severity of the PLC injury.
Increased flexion component of the injury mechanism, which results in asymmetric height loss with increased anterior wedging. Relative height maintenance of the middle column exacerbates the distraction force on the PLC and results in a destabilizing injury.
Flexion injury of L1. (a, b) Sagittal T1-weighted (a) and STIR (b) MR images show avulsion of the posterior margin of the inferior endplate (arrowhead) and minimal anterior column compression (* in a). Fanning of the spinous processes (bracket in a) and disruption of the dark lines of the supraspinous ligament (black arrows in a) and ligamentum flavum (white arrows) are seen. Complete disruption of the interspinous ligament is shown (black arrow in b). (c) Axial T2-weighted MR image at the same level as a and b shows hemorrhage and edema throughout the PLC and no identifiable ligamentum flavum in the expected location (arrow), a finding indicative of disruption with retraction.
Incomplete spinal cord injury or cauda equina syndrome is assigned 3 points because patients with this type of injury may receive greater potential benefit from surgical decompression than patients with complete spinal cord injury or no initial neurologic injury
Thoracolumbar spine injury in a 38-year-old man. (a) Sagittal CT image shows a burst fracture of L1 (arrow) with fragment retropulsion into the spinal canal. (b, c) Sagittal (b) and axial (c) T2-weighted MR images show bone retropulsion with near-complete obliteration of the spinal canal (white arrow) and associated signal intensity change within the cord at a level superior to the injury (arrowhead in b). Disruption of the ligamentum flavum (black arrow) is also seen, a finding indicative of severe PLC injury.
based primarily on the patient’s neurologic status and the integrity of the PLC
Compression fracture of L1. (a) In one patient, sagittal T1-weighted MR image (a) shows vertebral body compression and fragment retropulsion into the spinal canal but no clear PLC disruption. Postoperative lateral radiograph (d) shows the anterior (anterolateral) surgical approach used. (b, c) In another patient, sagittal T1-weighted MR image (c) shows complete disruption of the PLC but minimal vertebral body compression and no significant retropulsion. Lateral radiograph (e) shows the posterior surgical approach used. (c) In a third patient, sagittal T1-weighted MR image (e) shows significant vertebral body compression, fragment retropulsion, and PLC disruption. Lateral radiograph (f) shows the combined anterior and posterior surgical approach used. The anterior approach included a vertebral body implant cage, lateral body plate, and screw fusion.
fracture of the calcaneus and a lumbar spine fracture.
it is clear that we are looking at an unstable fracture, because this is a burst fracture.
Both the anterior and the middle column are disrupted.
In addition there is edema in the posterior soft tissues indicating that there is also involvement of the posterior column.
Notice also the marrow edema in the adjacent bodies due to the severe axial loading.
classic example of a chance fracture, which is a three column injury with a horizontal orientation of the fracture.
What is unique about the Chance fracture is the horizontal orientation, which is nicely demonstrated on the sagittal reconstructions
coronal reconstructions we can see the horizontal orientation of the fracture.
This is a pure ligamentous injury, which is analogous to bilateral interfacet dislocation, which is also a pure ligamentous injury.
There is rupture of the interspinous ligament, dislocation of the facet joints and a horizontal rupture of the disc.
Pure ligamentous and combined osseous / ligamentous variants have an increased risk of instability compared to the osseus type.
It is imperative to look for a split of the posterior elements, disc widening or widening of the spinous processes and facets.
hyperflexion injury of L1 with involvement of the anterior column and possible involvement of the middle column.
Posterior part of the vertebral body is of normal height, but there is some involvement of the posterior part of the vertebral body.
If you are aggressive you could call this a two column injury, which would require stabilizing surgery.
If you are conservative you could call this an injury with only minor involvement of the middle column.
coronal reconstruction and an axial image at the level of the fracture.
Next step- Continue with the MR.
MR images show bone marrow edema in the involved vertebral body, but no additional soft tissue injury.
Since, MR did not show any additional findings, this patient was treated as having a single column injury.
Consultation with orthopedic surgery recommended conservative management with a TLSO brace.
There is a tendency to treat these thoracolumbar injuries conservatively, even if there is slight involvement of the middle column.
Compression burst fracture. (a–c) Sagittal CT image (a) and sagittal T2-weighted (b) and STIR (c) MR images show a fracture of L1 (white arrow) with significant fragment retropulsion but no cord or conus medullaris signal intensity abnormality. There is mild soft-tissue edema (arrowhead in c) and edema in the supraspinous and interspinous ligaments (black arrow in b and c) without definite ligament disruption. The ligamentum flavum appears intact. (d) Axial T2-weighted MR image shows a mild degree of impression on the thecal sac at the level of injury (arrow). The injury was classified as a burst fracture with indeterminate PLC status, and a posterior surgical approach was chosen because of clinical instability. At surgery, the interspinous ligament was found to be injured
Anterior translation injury. Sagittal CT (a) and T2-weighted MR (b) images show a translation injury of T12 and L1 with secondary flexion. There is prominent widening of the interspinous space (bracket in a) and an annulus avulsion fracture of the inferior endplate of T12 (white arrow). Severe cord compression with signal intensity change (black arrow in b) and disruption of the supraspinous ligament (black arrowhead in b) and ligamentum flavum (white arrowhead in b) are seen. The patient underwent posterior-approach open reduction and stabilization.
Patient underwent posterior-approach open reduction and stabilization.
Distraction injury. Sagittal CT image (a) and sagittal STIR (b) and axial T2-weighted (c) MR images show a distraction injury of T10 (white arrow in a) with fracture line extension through the middle and posterior columns and subsequent distraction of the posterior element fracture fragments. Disruption of the ligamentum flavum (arrowhead in b), interspinous ligament (white arrow in b and c), and supraspinous ligament (black arrow in b and c) is seen. The patient underwent posterior-approach surgical repair
Thoracic spine lateral translation injury. Coronal CT image (a) and sagittal T2(b) and axial (c) T2-weighted MR images show a lateral translation injury of T11 and T12 with lateral vertebral body overlap and marginal fractures (arrows in a), lateral canal compression with T11 nerve root injury (white arrow in b and c), and ligamentum flavum disruption (black arrow in b and c). The patient underwent posterior-approach surgical repair