The document provides an overview of injuries of the spine. It discusses the anatomy and structure of the spine, mechanisms of spinal injuries including flexion, flexion-rotation, compression, and extension injuries. It also covers classifications of spinal cord injuries, clinical evaluation, treatment, and complications. Globally, spinal injuries affect 10,000 people per year mostly among those aged 16-30 years. In Tanzania, motorcycle accidents are the leading cause of spinal injuries.
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Detailed history and its evaluation , examination of spine in general and local with special tests in cervical , thoracic outlet syndrome , lumbar spine and SI joint with diagrams, neurological examination both sensory and motor.
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Detailed history and its evaluation , examination of spine in general and local with special tests in cervical , thoracic outlet syndrome , lumbar spine and SI joint with diagrams, neurological examination both sensory and motor.
5% -10% of unconscious patients who present to the Emergency Dept. as the result of a M.V.A. or fall, have a major injury to the Cervical Spine
Spinal cord injury occurs in more than 11.000/USA pts per year/USA or in 40- 50 persons per million
Injuries of the Cervical Spine produce neurological damage in approximately 40% of patients
Whiplash describes a range of injuries to the neck caused by or related to a sudden distortion of the neck. The typical clinical picture in whiplash injury is that following the injury there is no obvious immediate pain.
Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Acute trauma of the spine
Acute spinal trauma refers to any injury to the spinal cord that happens suddenly. It can be a very serious condition, as it can damage the nerves that carry messages between the brain and the rest of the body. This can lead to loss of movement, feeling, and even paralysis.
There are many different causes of acute spinal trauma, including:
Car accidents
Falls
Diving accidents
Sports injuries
Violence
the symptoms of acute spinal trauma will vary depending on the severity of the injury and the location of the injury. Some common symptoms include:
Pain in the back or neck
Weakness or paralysis in the arms or legs
Numbness or tingling in the arms or legs
Loss of bladder or bowel control
Difficulty breathing
Spinal fracture also called a vertebral fracture or a broken back is a fracture affecting the vertebrae of the spinal column. Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. INJURIES OF THE SPINE
02/02/14
Presenter : MSIGWA SAMWEL S - MD5
(University of Dodoma-Tanzania)
Moderator:
D r . MANYAMA-ORTHOPAEDICS
SURGEON
MSIGWA SAM-MD5
1
3. INTRODUCTION
Fractures and dislocations of t he spine
are serious injuries because they may be
associated with damage to the spinal cord
or cauda equina.
The thoraco-lumbar segment is the
commonest site of injury; the lower
cervical being the next common.
02/02/14
MSIGWA SAM-MD5
3
4. About 20 per cent of all spinal injuries
result in a neurological deficit in the form
of paraplegia in the thoraco-lumbar spine
injuries, or quadriplegia in the cervical
spine injuries.
Often, the patient does not recover from
the deficit, resulting in prolonged
invalidism or death.
02/02/14
MSIGWA SAM-MD5
4
5. Globally
Globally
Affects 10,000 a year
Age group-16-30 years
Male: female=4:1
Automobile accidents are the most
common cause in person <65 years
Falls are the most common cause in
person>65years
02/02/14
MSIGWA SAM-MD5
5
6. Tanzania
In TZ the research done at BMC 2012
showed that among the SI resulted from
road traffic crashes most of them were
caused by Motorcycle (58.8%) .
Spine injuries was 0.7% out of all Injuries.
Male to female ratio was of 2.1:1
The modal age group was 21-30 years,
accounting for 52.1% patients.
Students (58.8%) and businessmen
(35.9%) . Mortality rate was 17.5%.
02/02/14
MSIGWA SAM-MD5
6
7. Basic Anatomy of the Spine
1.Structure:
Extends from the skull to the tip of the
coccyx, consisting of 33 vertebrae:
Cervical(7), Thoracic(12), Lumbar(5),
Sacral(5) and Coccygeal(4)
Has 4 curvatures: cervical and lumbar
(concave anteriorly), thoracic and sacral
(concave posteriorly)
02/02/14
MSIGWA SAM-MD5
7
9. Structure of a Typical Vertebra
Vertebral body
Epiphyseal ring and central cancellous bone
Neural arch
2 pedicles and 2 laminae
7 Processes
A spinous
2 transverse
2 superior articular
2 inferior articular
Vertebral foramen & canal
02/02/14
MSIGWA SAM-MD5
9
16. 2.Articulation:
The entire vertebral column has similar
articulation (except atlanto-axial joint).
The v e r t e b r a l bodies are primarily joi
n e d by intervertebral discs.
Anteriorly, the vertebral bodies are
connected to one another by a long, straplike, anterior longitudinal ligament,
Posteriorly by a similar posterior
longitudinal ligament.
02/02/14
MSIGWA SAM-MD5
16
17. Accessory Ligaments of the
Intervertebral Joints
Ligamentum flavum
Between lamina of adjacent vertebrae
Supraspinous
Between tips of spinous processes
Interspinous
Connects adjacent spinous processes
Nuchal
Occipital protuberance and foramen magnum to cervical vertebrae
Intertransverse
Connects adjacent transverse processes
NB:These ligaments are together often termed the posterior
ligament complex.
02/02/14
MSIGWA SAM-MD5
17
19. Three-column concept
The anterior column consists of the
anterior longitudinal ligament and the
anterior part of annulus fibrosus along with
the anterior half of the vertebral body.
The middle column consists of the
posterior longitudinal ligament and the
posterior part of the annulus fibrosus
along with the posterior half of the
vertebral body.
02/02/14
MSIGWA SAM-MD5
19
21. The posterior column consists of the
posterior bony arches along with the
posterior ligament complex.
02/02/14
MSIGWA SAM-MD5
21
22. Joints of the vertebral bodies
Intervertebral discs which consist of annulus fibrosus and nucleus pulposus
Anterior and posterior longitudinal ligaments
Joints of the neural arches
Atlantoaxial joints
Atlanto-occipital joints
Costovertebral joints
Sacroiliac joints
02/02/14
MSIGWA SAM-MD5
22
23. Simple General Classification
Based on 3 Column concept
Stable fractures
Is one where further displacement
between two vetebral bodies does not occur
because of the intact 'mechanical linkages'.
When only one column is disrupted (e.g., a
wedge compression fracture of t h e
vertebra) the spine is stable.
Posterior ligament complex, neural arch
and articular facets intact; only vertebral
bodies and anterior ligament complex
02/02/14
MSIGWA SAM-MD5
23
24. Unstable fractures
Is one where further displacement can
occur b e c a u s e of serious disruption of
the structures responsible for stability.
When two columns are disrupted (e.g., a
burst fracture of the body of the vertebra)
the spine is considered u n s t a b l e .
When all the t h r e e columns are
disrupted, the spine is always unstable (e.g.,
MSIGWA SAM-MD5
dislocation of one vertebra over other).
02/02/14
24
26. Dorsal root – sensory fibres
Ventral root – motor fibres
Dorsal and ventral roots join at
intervertebral foramen to form the spinal
nerve
02/02/14
MSIGWA SAM-MD5
26
28. Physiology and function
Grey matter – sensory and motor nerve
cells
White matter – ascending and descending
tracts
Divided into - dorsal
- lateral
- ventral
02/02/14
MSIGWA SAM-MD5
28
30. Ascending and descending
pathways
Connection between cerebrum and body
(muscle, sensation)
Corticospinal/pyramidal tract = voluntary
movement
Dorsal columns = vibration, proprioception and
fine touch
Lateral spinothalamic = pain and temperature
Anterior spinothalamic = pressure and crude
touch
02/02/14
MSIGWA SAM-MD5
30
32. Dermatomes
Area of skin innervated by sensory axons
within a particular segmental nerve root
Knowledge is essential in determining
level of injury
Useful in assessing improvement or
deterioration
02/02/14
MSIGWA SAM-MD5
32
34. Myotomes :
Segmental nerve root innervating a muscle
Again important in determining level of injury
Upper limbs:
C5 - Deltoid
C 6 - Wrist extensors
C 7 - Elbow extensors
C 8 - Long finger flexors
T 1 - Small hand muscles
02/02/14
MSIGWA SAM-MD5
34
36. Denis Classification
Based on 3 Column Concept
1.
Anterior column; ant. Long. Ligament, ant ½ of annulus
and vertebral body
2.
Middle column; post. Long. Ligament and post ½ of
annulus and vertebral body
3.
Posterior column; spinous processes, facet joints and
capsule, supra and inter spinous ligaments
02/02/14
MSIGWA SAM-MD5
36
37. Basic Types of Spine Fractures
and their Mechanisms
1• Flexion-injury
2• Flexion-rotation injury
3• Vertical compression injury
4• Extension injury
5• Flexion-distraction injury
6• Direct injury
7• Indirect injury due to violent muscle
contraction
02/02/14
MSIGWA SAM-MD5
37
38. 1. Flexion injury
This is the
commonest spinal
injury.
Examples:
(i) heavy blow across
the shoulder by a
heavy object
(ii) fall from height on
the heels or buttocks
02/02/14
MSIGWA SAM-MD5
38
39. Results
In the cervical spine, a flexion force can
result in:
(i) a sprain of the ligaments and muscles
of t he back of t he neck:
(ii) compression fracture of
the vertebral body, C5 to C7
(iii) dislocation of one vertebra over another
(commonest C5 over C6).
02/02/14
MSIGWA SAM-MD5
39
40. In the dorso-lumbar spine, this force can
result in
The wedge compression of a vertebra
(L1commonest followed by L2 and T12).
It is a stable injury if compression of t he
vertebra is less than 50 per cent of its
posterior height.
02/02/14
MSIGWA SAM-MD5
40
41. 2. Flexion-rotation injury:
This is the worst type
of spinal injury
because it leaves a
highly unstable spine,
and is associated with
high incidence of
neurological damage.
Examples:
(i) heavy blow onto
opposite side
one shoulder causing (ii) a blow or fall on posterolateral
aspect of the head.
the trunk to be in
02/02/14
41
MSIGWA SAM-MD5
42. Results
In the cervical spine this force can result
(i) dislocation of the facet joints on one or both
sides
(ii)(ii) fracture-dislocation of the cervical
vertebra.
In the dorso-lumbar spine
A fracture-dislocation of the spine.
Here one vertebra is twisted-off in front of the one
below it. There i s extensive damage to the
neural arch and posterior ligament complex. It is
02/02/14
42
02/02/14
MSIGWA SAM-MD5
42
43. 3. Vertical compression injury
It is a common spinal
injury.
Examples:
(i) A blow on the top of
the head by some
object falling on the
head
(ii) a fall from height in
erect position
02/02/14
MSIGWA SAM-MD5
43
44. RESULTS
In the cervical spine, this force results in
A burst fracture i.e., the vertebral body is
crushed throughout its vertical dimensions. A
piece of bone or disc may get displaced into the
spinal canal causing pressure on the cord.
In the dorso-lumbar
spine, this force results in a fracture similar to
that in the cervical spine, but due to a wide canal
at this level, neurological deficit rarely occurs. It
is an unstable injury.
02/02/14
MSIGWA SAM-MD5
44
45. Extension injury:
This injury is commonly
seen in the cervical
spine.
Examples:
(i) motor vehicle accident
— the forehead striking
against the windscreen
forcing the neck into
hyperextension
02/02/14
(ii) shallow water diving
—the
head hitting the ground,
extending the neck
Results: This injury results
in a hip fracture of
the anterior rim of a
vertebra. Sometimes, these
injuries may be unstable.
MSIGWA SAM-MD5
45
47. 4. Flexion-distraction injury:
This is a recently described spinal injury,
being recognised in Western countries
where use of a seat belt is compulsory
while driving a car (chance fracture)
Example:
With the sudden stopping of a car, the
upper part of t h e body is forced forward by
inertia while the lower part is tied to
the seat by the seatbelt.
02/02/14
MSIGWA SAM-MD5
47
49. 5. Direct injury
This is a rare type of
spinal injury.
Examples:
(i) bullet injury; (ii) a
lathi blow hitting the
spinous processes of
the cervical vertebrae.
02/02/14
Results:
Any part of the
vertebra may be
smashed by a bullet,
but, a lathi blow
generally causes a
fracture of t he
spinous processes
only.
MSIGWA SAM-MD5
49
50. 6.Violent muscle contraction
This is a rare injury.
Example: Sudden
violent contraction of
the psoas.
02/02/14
Results: It results in
fractures of the
transverse processes
of multiple lumbar
vertebrae.
It may be a s s o c i a
t e d with a huge
retroperitoneal
haematoma.
MSIGWA SAM-MD5
50
52. Occipito – Atlantal Dislocation
Fatal
Subluxation without ND may survive
Early & correct diagnosis with CT scan or
MRI
Dx by lateral cervical radiograph
Tip of odontoid from basion: Alignment
<5mm vertically & <1mm horizontally
02/02/14
MSIGWA SAM-MD5
52
60. Axis (C2) #
Includes Hangman’s #
and Odontoid process #
HANGMAN’S #
Bilateral # of the isthmus
of the pedicles of C2 with
anterior sublaxation of
C2-C3
Hyperextention and axial
loading
Usually stable
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61. Spinal Column Injury
Axis (C2) #
Includes Hangman’s
# and Odontoid
process #
I
Odontoid #
Flexion injury
15% of all cervical
injuries
II unstable,I & III
stable
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62. Odontoid Fracture (C2)
Anderson & D’Alonzo
classification:
Type 1 – An avulsion
fracture of tip of odontoid
process due to traction of
alar lig.
Type 2 – # at the junction
of odontoid process and
the body. Most common
& potentially dangerous
type
Type 3 – # thru the body
of axis
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63. Odontoid Fracture Cont’d
Treatment
Type 1 – Mobilise in rigid
collar 8-12 wks
Type 2
– Undisplaced #s: halo –
vest for 8-12 wks
– Displaced : Skull traction
then wiring or screw
fixation
Type 3 – Traction or halovest depending on
whether displaced or not
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64. Spinal Column Injury
Subaxial (C3-C7) #
Whiplash injury:
Traumatic injury to the
soft tissue in the cervical
region
Hyperflexion,
hyperextention
No fractures or
dislocations
Most common automobile
injury
Recover 3-6 months
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65. Whiplash Injury
X ray: loss of cervical lordosis due to muscle
spasm
MRI: disc herniation
Cervical collar and graded exercises
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66. Spinal Column Injury
Subaxial (C3-C7) #
Vertical compression
injury:
Loss of normal cervical
lordosis
Burst #
Compression of spinal
cord
Unstable
Requires decompression
and fusion
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67. Spinal Column Injury
Subaxial (C3-C7) #
Compression flexion
injury (teardrop #)
Classical diving injury
Posterior elements
involved in >50%
Displacement of inferior
margin of the body
Unstable
Requires stabilization
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69. Spinal Column Injury
Subaxial (C3-C7) #
extention injury (#
posterior elements)
# lamina, pedicles or
spinous process
With or without
ligamentous injury
Usually stable
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70. Clay Shoveller’s Injury
Fracture of C7 spinous process with
severe voluntary contraction of back
muslces
Painful but harmless
Only analgesia
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71. Spinal Column Injury
Thoracic and lumbar #
Stability (three column
model of Denis)
Injury affecting two or
more column is unstable
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74. Posterior Lig. Injury
Sudden flexion of mid cervical spine
Damage to post. lig. Complex
Upper vertebra tilts forward on one below
& opening interspinous space
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75. Posterior Lig. Injury Cont’d
Treatment
Unstable:
– Angulation of VB with its neighbour >11º
– Anterior translation of a vertebra >3.5mm
– # or dislocation of facet
Treated with post. fixation & fusion
Stable
– Semi – rigid collar x 6wks
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76. Burst Fracture
Axial loading as in diving
or athletic accidents
Comminuted fracture of
vertebral body
Frag. may enter spinal
canal
Halo vest or anterior
decompression if
neurological deficit
present & immobilisation
x 6-8 wks
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77. Cervical Disc Herniation
Severe pain radiating upper limbs
Paresthesia and weakness may be
present
If there is paresis, then decompression is
indicated – ant discectomy & interbody
fusion
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78. Signs and symptoms
The extent of injury is defined by the
American Spinal Injury Association (ASIA)
Impairment Scale (modified from the
Frankel classification), using the following
categories.
A – Complete: no sensory or motor function
preserved in sacral segments S4 – S5
B – Incomplete: sensory, but no motor
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79. C – Incomplete: motor function preserved
below level and power graded < 3
D – Incomplete: motor function preserved
below level and power graded 3 or more
E – Normal: sensory and motor function
normal
80. Spinal Shock vs Neurogenic Shock
Spinal Shock :
Transient reflex depression of cord function below level
of injury
Initially hypertension due to release of catecholamines
Followed by hypotension
Flaccid paralysis
Bowel and bladder involved
Sometimes priaprism develops
Symptoms last several hours to days
81. Neurogenic shock:
Triad of i) hypotension
ii) bradycardia
iii) hypothermia
More commonly in injuries above T6
Secondary to disruption of sympathetic
outflow from T1 – L2
82. Loss of vasomotor tone – pooling of blood
Loss of cardiac sympathetic tone – bradycardia
Blood pressure will not be restored by fluid
infusion alone
Massive fluid administration may lead to
overload and pulmonary edema
Vasopressors may be indicated
Atropine used to treat bradycardia
83. Neurogenic Shock
Hypovolemic Shock
As the Result of Loss of Sympathetic
Outflow
As the Result of Hemorrhage
Hypotension
Hypotension
Bradycardia
Tachycardia
Warm extremities
Cold extremities
Normal urine output
Low urine output
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84. Types of incomplete injuries
i)
Central Cord Syndrome
ii)
Anterior Cord Syndrome
iii)
Posterior Cord Syndrome
iv) Brown – Sequard Syndrome
v)
Cauda Equina Syndrome
85. i)
Central Cord Syndrome :
Typically in older patients
Hyperextension injury
Compression of the cord anteriorly by
osteophytes and posteriorly by
ligamentum flavum
86. Also associated with fracture dislocation
and compression fractures
More centrally situated cervical tracts tend
to be more involved hence
flaccid weakness of arms > legs
Perianal sensation & some lower extremity
movement and sensation may be
preserved
87.
88.
89. ii) Anterior cord Syndrome:
Due to flexion / rotation
Anterior dislocation / compression fracture
of a vertebral body encroaching the
ventral canal
Corticospinal and spinothalamic tracts
are damaged either by direct trauma or
ischemia of blood supply (anterior spinal
arteries)
92. ii) Posterior Cord Syndrome:
Hyperextension injuries with fractures
of the posterior elements of the vertebrae
Clinically:
Proprioception affected – ataxia and
faltering gait
Usually good power and sensation
93. ii) Posterior Cord Syndrome:
Hyperextension injuries with fractures
of the posterior elements of the vertebrae
Clinically:
Proprioception affected – ataxia and
faltering gait
Usually good power and sensation
94. iv) Brown – Sequard Syndrome:
Hemi-section of the cord
Either due to penetrating injuries:
i) stab wounds
ii) gunshot wounds
Fractures of lateral mass of vertebrae
95. Clinically:
Paralysis on affected side (corticospinal)
Loss of proprioception and fine
discrimination (dorsal columns)
Pain and temperature loss on the opposite
side below the lesion (spinothalamic)
96.
97. v) Cauda Equina Syndrome:
Due to bony compression or disc protrusions
in lumbar or sacral region
Clinically
Non specific symptoms – back pain
- bowel and bladder dysfunction
- leg numbness and weakness
- saddle parasthesia
98. INVESTIGATIONS
Good ante-posterior and lateral X-rays
centring on the involved segment provide
reasonable information about the injury.
Sometimes, special imaging techniques
are required e.g., Tomogram, C.T. scan,
M.R.I,
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99. Plain X-rays:
(i) confirmation of diagnosis
(ii) assessment of mechanism of injury and
(iii) assessment of the stability of the spine.
The following features may be noted on plain Xrays
• Change in the general alignment of the spine
i.e., antero-posterior bending (kyphosis) or sideways
bending (scoliosis).
• Reduction in t h e height of a vertebra.
• Antero-posterior or sideways displacement of one
vertebra over another.
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• Fracture of a vertebral body. • Fracture of t h e
99
100. C.T. scan and M.R.I
C.T. scan h a s proved to be a very helpful
investigation. One can see the damaged
structures more clearly, and make note of
any bony fragment in the canal.
M.R.I. is the best modality of imaging an
injured spine.
In addition to showing better, the details
of injured bones and soft-tissues,it shows
very well the anatomy of t he cord.
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101. Tomogram:
A tomogram helps in better delineation of
a doubtful area. Myelogram has no role in
the management of acute spinal injuries.
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103. The treatment of spinal injuries can be
divided into three phases, as in other
injuries:
Phase I: Emergency care at the scene of
accident or in emergency department.
Phase II: Definitive care in emergency
department or in the ward.
Phase III: Rehabilitation
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104. Phase I - At the scene of accident
An acute pain in the back following an injury is to
be considered a spinal injury unless proved
otherwise.
Also, all suspected spinal injuries are to be
considered unstable unless their stability is
confirmed on s u b s e q u e n t investigation.
NB: A patient with a spinal injury has to be given
the utmost care right at the scene of accident;
the basic principle being to avoid any movement
at the injured segment.
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105. While moving a person with a suspected cervical
spine injury, one person should hold the neck in
traction by keeping the head pulled.
The rest of the body is supported at the
shoulder, pelvis and legs by three other people.
Whenever required, the whole body is to be
moved in one piece so t h a t no movement
occurs at the spine.
The same precaution is observed in a case with
suspected dorso-lumbar injury.
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106. In the emergency department
The patient should not be moved from the
trolley on which he is first received until
stability of t he spine is confirmed
A quick general examination of t h e
patient is carried out in order to detect any
other associated injuries to the chest,
abdomen, pelvis, limbs etc.
The spine i s examined for any
tenderness, crepitus or haematoma.
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107. PHASE II - DEFINITIVE CARE
Definitive care of a patient with spinal injury
depends upon the stability of the spine and the
presence of a neurological deficit.
The aim of treatment is:
(i) to avoid any deterioration of the neurological
status;
(ii) to achieve stability of the spine by conservative or
operative methods
(iii) to rehabilitate the paralysed patient to the best
possible extent.
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108. Treatment of cervical spine
injuries
Cervical spine injuries are often associated
with head injuries, the effect of which may
mask the spinal lesion.
Therefore, it is necessary to get an X-ray of
the cervical spine in any serious case of
head injury.
The aim of treatment is to achieve proper
alignment of vertebrae, and maintain it in that
position till the vertebral column stabilises.
This can be achieved in most cases by
conservative methods. In some cases, an 108
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operation may be required for-reducing or stabilising the spine.
109. Reduction
is achieved by skull traction applied
through skull calipers—Crutchfield tongs
A weight of up to 10 kg is applied and
check X-rays taken every 12 hours
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111. Operation:
This may be required for:
(i) irreducible subluxation because of
'locking' of the articular processes or
(ii) persistent instability.
The operation consists of inter-body fusion
(anterior fusion) or fusion of the spinous
processes and laminae (posterior fusion).
Internal fixation may be required.
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112. Treatment of thoracic and
lumbar spine injuries
Operative methods:
Whenever necessary the following
operative methods are performed
• Harrington instrumentation — bilateral.
• Luque instrumentation.
• Hartshill rectangle fixation.
• Pedicle screw fixation.
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113. References:
1. Andrew T Raftery, et al. Applied Basic Science for
Basic Surgical Training. Second edition 2008;8:219223
2. Essential Orthopaedics 3rd EDITION-Maheshwari
3. Handbook of Fractures 3rd Edition
4. Dr.Ferdinand Massaga-UDOM,classnotes
5. Spinal cord injuries-JC King
6. Muhas presentation