INTERESTING CASES.pptx
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spine instetesting cases, ortho rare case, spine unique case, pg teaching case, spine exam case.Thoracolumbar Burst Fractures are a common high-energy traumatic vertebral fractures caused by flexion of the spine that leads to a compression force through the anterior and middle column of the vertebrae leading to retropulsion of bone into the spinal canal and compression of the neural elements. Diagnosis is made with radiographs of the thoracolumbar spine. CT scan is useful for fracture characterization and surgical planning. Treatment is bracing or surgical decompression and stabilization depending on whether the patient has neurologic deficits and whether the facture is unstable with a risk of drifting into kyphosis. pathoanatomy at thoracolumbar junction there is fulcrum of increased motion that makes spine more vulnerable to traumatic injury burst fractures typically occur between T10-L2 (thoracolumbar junction) neurologic deficits canal compromise often caused by retropulsion of bone maximum canal occlusion and neural compression at moment of impact tissue recoiling post-injury can minimize the extent of displacement retropulsed fragments resorb over time and usually do not cause progressive neurologic deterioration deficit type location of stenosis relative to conus determines spinal cord injury conus medullaris syndrome neurogenic claudication due to stenosis distal to conus.Thoracolumbar Injury Classification and Severity Score injury characteristic qualifier points injury morphology compression (+1 point) burst (+2 points) rotation/translation (+3 points) distraction (+4 points) neurologic status intact (0 point) nerve root (+2 points) incomplete Spinal cord or conus medullaris injury (+3 points) complete Spinal cord or conus medullaris injury (+2 points) cauda equina syndrome (+3 points) posterior ligamentous complex integrity intact (0 point) no interspinous ligament widening seen with flexion views. MRI shows no edema in interspinous ligament region suspected/indeterminate (+2 points) MRI shows some signal in region of interspinous ligaments disrupted (+3 points) widening of interspinous distance seen TLICS treatment implications score < 4 points nonsurgical management score = 4 points nonsurgical or surgical managment score > 4 points surgical management indicated Presentation History high-energy mechanism axial-loading and flexion mechanisms fall from height (e.g. fall from deer hunting stand, fall from ladder, etc.) high-speed motor vehicle collision
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INTERESTING CASES.pptx
- 2. Case 1 • A 39year old male with alleged h/o RTA on 27/8/22,sustained injury to neck, head, right shoulder, chest • No h/o abdomen injury • No h/o comorbidities
- 3. Physical examination • Tenderness at upper cervical region • Power in both upper limb and lower limb is 4/5 • Sensory absent below level of xiphisternum • Reflex diminished in upper and lower limb • Bowel and bladder control was normal • Blood parameters are normal
- 5. CT images
- 6. Pre op
- 7. Management • It’s a C2 vertebral body fracture , managed with C1 to C3 posterior stabilization and decompression • Power in upper and lower limb improved to 5/5 • Sensation improved below xiphisternum level
- 9. Case 2 • A 17years old male with alleged h/o fall from bike on 6/10/22 ,sustained injury to neck and right leg • No h/o injury to head,chest, abdomen • No other medical conditions associated
- 10. Physical examination • Tenderness at upper cervical region • Power in both upper limb and lower limb is 5/5 • Sensation normal in both upper limb and lower limb • Reflex normal in upper and lower limb • Bowel and bladder control was normal • Blood parameters are normal
- 12. CT
- 13. MRI
- 14. MANAGEMENT • It was type 2 odantoid fracture treated by screw fixation by anterior approach • Patient withstood the procedure well and given cervical collar and physiotherapy • Right leg fracture traeted by CRIF and tibia nailing
- 16. Case 3 • A 21year old male with upper neck pain inability to walk and sit with loss of bladder control over 2 weeks • H/o tingling sensation in both upper and lower limb since 10months • Pain is insidious onset and gradually progressive • No h/o fever, weight loss, loss of appetite • No other comorbidities
- 17. • O/E: Patient is non ambulatory • Terminal cervical movements painfull and restricted • Power both upper and lower limb 3/5 • Sensation is blunted both upper and lower limb • Reflexes exaggerated • Blood parameters are normal
- 18. Multipe swellings arising from left scapula, right proximal humerus, both proximal tibia
- 19. Bony swelling from right lamina of C2
- 20. management • Its swelling compressing spinal cord with cervical myelopathy • Patient underwent C2 hemilaminectomy on right side by posteriro approach • Tingling sensation in upper and lower limb improved immediately • Power in upper and lower limb , bladder control attained by 2months post op
- 21. Post op HPE confirmed it as Osteochondroma