Nattawit Kaewkomoot MD.
Outline
● Introduction
● Anatomy and physiology
● Spinal cord injury
● Specific type of spine injury
○ Mechanism (TinTin)
○ Anatomical (ATLS)
● Radiographic Evaluation
● General management
Introduction
Introduction
Traumatic Brain injury Spine injury
Brain injury
25%
Spine injury
5%
Spine injury
75%
Brain injury
95%
Introduction
Spine injury
● Inadequate restriction of spinal motion cause
worsen the patient’s outcome Lumbosacral
15%
● At least 5% of patients with spine injury had Thoracic
15%
delayed onset of neurological symptoms
after reaching emergency department (ED).
These complications are typically due to
ischemia or progression of spinal cord edema
Cervical
55%
● Thoracolumbar junction is a fulcrum
between inflexible thoracic and more mobile lumbar
Thoracolumbar
15%
Introduction
● Spinal protection does not require lying supine on a firm surface and utilizing spinal
patients to spend hours on a long spine board precautions when moving is sufficient.
● Patients, who are comatose à clinician needs appropriate imaging to exclude a spinal injury
If the images are inconclusive, restrict motion of the spine
until testing can be performed
Spine Anatomy
Spine Anatomy
Spine Anatomy
● Cervical canal is wide from the foramen magnum to the lower part of C2.
Upper cervical injury (Above C3)
From apnea by loss of central innervation of phrenic n.
(Below the level of C3)
Die at scene Arival ED with
25% neuro intact
75%
Spine Anatomy
● Thoracic spine mobility is more restricted than cervical spine mobility
(thoracic spine has additional support from the rib cage)
Incidence of thoracic fractures is much lower
• Because of the relatively narrow thoracic canal
When a fracture-dislocation in the thoracic spine occur,
it almost always results in a complete spinal cord injury
Spinal cord Anatomy
Spinal cord Anatomy
Spinal cord Anatomy
Spinal cord Anatomy
Document
Examination
Spinal cord Anatomy
Spinal cord Anatomy
Spinal cord Anatomy
Spinal cord Anatomy
Spinal Cord
injury
Spinal cord Injury
Spinal cord Injury
Spinal cord Injury
Spinal shock > occur immediately after spinal cord injury
- Flaccidity (loss of muscle tone) and
- Loss of reflexes
Recover sign of Spinal shock (24-48 hr)
- Bulbocavernosus reflex
- Sacral sparing test
Type of Spine
injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of spine injury
Type of Spine
injury
Cervical spine fracture
Mechanisms of injury :
Axial loading
Flexion
Extension
Rotation
Lateral bending
Distraction
Cervical spine fracture
Atlanto-Occipital Dislocation
Mechanism : Severe traumatic flexion and distraction
Present : Most die from apnea & brain stem destruction
* may survive if they are promptly resuscitated at the injury scene
* Common cause of death in cases of shaken baby syndrome
Cervical spine fracture
Atlas (C1) Fracture
Mechanism : Axial loading (neutral position)
Present : Most common C1 fx is a burst fx (Jefferson fracture)
Imaging: Open mouth view or CT C-spine
* Usually are not associated with spinal cord injuries
Cervical spine fracture
C1 Rotary Subluxation
Mechanism : Rotation
Present : A persistent rotation of the head (torticollis)
- Occur spontaneously after major or minor trauma
- With an upper respiratory infection
- With rheumatoid arthritis
* Do not force the patient to overcome the rotation
à Restrict motion with him or her in the rotated position
Cervical spine fracture
Odontoid Fractures
Mechanism : Combine
Present :
* 60% of C2 fractures involve the odontoid process
Cervical spine fracture
Posterior Element Fractures (hangman’s fracture)
Mechanism : Extension
Present :
Cervical spine fracture
Fractures and Dislocations (C3 through C7)
Mechanism : -
Present : C5–C6 and is thus most vulnerable to injury
* Facet dislocations associate with neurological inury
Thoracic spine fractures
Classified 4 categories
● Axial loading w flexion àAnterior wedge compression injuries
● Vertical-axial compression àBurst injuries
● Flexion àChance fractures
● Extreme flexion or severe blunt trauma àFracture-dislocations
* Fracture subluxations in thoracic spine commonly result in Complete neurological deficit
Thoracic spine fractures
Chance fractures
Mechanism : Flexion an axis anterior to the vertebral column
Present : Seen following motor vehicle crashes
which patient was restrained by improperly placed lap belt
* Associated with retroperitoneal and abdominal visceral injuries
Thoracolumbar junction fractures (T11 through L1)
Mechanism : Combination of acute hyperflexion and rotation
Present : Fall from a height
Restrained drivers sustain severe flexion w/ high kinetic energy transfer
● Conus medullaris at approximately the level of L1
à Bladder and bowel dysfunction
à Decreased sensation and strength in the lower extremities
* Vulnerable to rotational movement à Extremely careful when logrolling them
Approach
Cervical Spine Restriction
Cervical Spine Restriction
Cervical Spine Restriction
Imaging
● Primary screening modality is Multidetector CT (MDCT)
● Patient with neck pain and normal radiography
Should evaluated by magnetic resonance imaging (MRI)
or flexion-extension x-ray films
● In the presence of neurological deficits, MRI is recommended
Thank you
