spinal injuries Prof G S Patnaik

1. Spinal Injuries: An Overview

2. Spinal Cord Injury
 Epidemiology
 30-40 million per year
 10,000 new cases per year
 Etiology
 Motor vehicle accident: 44.5%
 Falls: 18.1%
 Violence: 16.6% (and increasing)
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3. Pre Hospital Care
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4. Spinal Cord Injury
 Economic Consequences
 Between $7.3 billion and $8.3 billion per year
 A person with a high cervical injury at age 25 incurs
lifetime costs of more than $3 million
 Rehabilitation Treatment
 Systematic, intensive, coordinated team approach
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5. Spinal trauma should be suspected in
 All unconscious patients
 High energy trauma
 Evidence of neurological deficit
 Multiple injuries
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6.  Proper extraction
 Intubation
 Immobilization
 Cervical collar, sand bag, tape,
 ? Neck position
 ?pediatrics
While Transporting ……
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7. Why do we miss Spinal Injuries !!
A low level of suspicion
Failure to take proper radiographs
Poly trauma
Failure to interpret the x ray
Intoxication
Decrease level of consciousness
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8. History
 Mechanism of injury
 Position of the patient when found
 Transient motor or sensory loss
 Paradoxical breathing
 Seat belt
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9. Inspection
 All clothing should be carefully removed
 Any bleeding , abrasion or lacerations
 Limb asymmetry
 Voluntary limb movement
 Chest expansion
 Please document the findings..
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10. Palpation
To Remove Cervical collar carefully
1. Tenderness
2. Interspinous widening
3. Malialignement of spinous process
4. Step off
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11. Neurological Evaluation
1. Sensory evaluation
2. Motor evaluation
3. Reflexes
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12. Cresmatic reflex
 Stroking inner thigh & observing the
scrotum movement
 Absence means UMNL
 Unilateral absence suggest LMNL
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13. Bulbocavernosus reflex
 Pull glans or press
clitoris  anal
contraction (int.
sphincter) around
gloved finger
 Absence is indicator
of spinal shock
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14. RADIOLOGICAL
ASSESMENT
 PLAIN FILM
 AP & LATERAL
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15. CT SCAN
 Injury suspected on plain films
 Better visualize fracture (specificity and
sensitivity)
 Unable to adequately assess on plain films
 Fracture or soft tissue injury in the plane of the CT
can be missed
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16.  Invaluable for assessing cord and soft tissues
 R/O associated disc herniation ( facet dislocations)
 Hemorrhage vs edema in soft tissues ????
 Ligamentous tears and facet capsule disruptions visualized with
fat suppression
 May allow prognostic assessment of final motor function
 Intrasubstance hematoma
MRI SCAN
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17. T1 T2 GRE
MRI
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18. Compression Fracture
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19. Burst Fracture
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20. Fracture Dislocation
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21. Flexion Distraction
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22. Imaging
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23. Non-Operative Management
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24. Surgical intervention
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25. Surgical Intervention contd…
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26. Rehabilitation…..
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27. To Conclude…….
 Spinal injuries are serious, dangerous and have
far reaching consequences
 Prevention must be the top priority
 Legislation, Seat belt , Helmet
 Proper Ambulanve and paramedic services
 Emergency room assesment
 Specialized Treatment
TEAMWORK
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