SPINE TRAUMATOLOGY M. Krbec, M. Repko, M. Rouchal,

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Presentation transcript:

SPINE TRAUMATOLOGY M. Krbec, M. Repko, M. Rouchal, L. Ryba, R. Chaloupka Ortopaedic Univ. Dept. FN Brno-Bohunice

SPINE cervical C thoracic T lumbar L sacrum coccyx body support spinal cord / dura protection

Anatomy of vertebra Vertebral body Pedicles Arch Articular processes - superior - inferior Transverse processes Spinous process

Now 2-column theory(Magerl) Denis 3-column theory Now 2-column theory(Magerl)

C1 C1 = atlas Arches + articular processes

C2 axis Body Dens Articular processes

Discus intervertebralis discus intervertebralis

EXAMINATION Clinical examination X-ray Neurological CT MRI Case history

TYPES OF INJURY Forces, directions Axial pressure Bending pressure Rotation Combination

MECHANISM OF INJURY Falls Traffic accidents Sport

Hematomyelia

Denis‘ classification 3 three-column concept A compressive B burst C flection-distraction D rotational forces (shear, translation)

AO classification Magerl et al. 2-column compression distraction A,B with rotation

Frankel classification A complete loss of motor end sensory functions B no motor preservation, sensory function only C useless motor function preserved D motor function less than normal E normal neurological status

THERAPY conservative surgical orthosis, plaster cast bed rest posterior surgery anterior surgery combined

FIRST AID CERVICAL SPINE FIXATION TO AVOID MOVEMENT WITH THORACIC AND LUMBAR SPINE DURING MANIPULATION SPINAL DEPARTMENT

SURGICAL INDICATION NEUROLOGICAL LESION SPINE INSTABILITY OPERATION UP TO 6 HOURS ! SPINE INSTABILITY

CONSERVATIVE THERAPY Bed rest Collars- soft -Philladelphia

CONSERVATIVE THERAPY T SPINE T8 - 12 Jewett orthosis LS SPINE lumbar belt L4 - S1

HALO - TRACTION

CONSERVATIVE TREATMENT -plaster casts C spine halo-cast, halo-vest Minerva cast / vest

CONSERVATIVE TREATMENT -plaster cast

SURGICAL THERAPY DECOMPRESSION OF NEUROGICAL STRUCTURES REDUCTION OF DEFORMITY HEALING WITH SOLID FUSION

SURGICAL THERAPY acute period C spine anterior surgery T, L spine posterior surgery

BASIC PRINCIPLES OF SURGICAL THERAPY reduction lordotisation stabilisation

POSTERIOR APPROACH TO THE T-L SPINE Pedicle screws Bones Rods Cross-links

intersomatic fusion spongioplasty

POSTERIOR STABILISATION OF THE SPINE CT scan – TRANSPEDICULAR SCREWS

T-L SPINE – ANTERIOR SURGICAL APPROACH replacing the vertebral body stabilisation

posterior instrumentation Harms cage anterior instrumentation

Synex extended impl.

C1,2 – SPINE INJURIES Rare, big violence on OC a C-SPINE Occipital fracture C-1 arch fracture Odontoid C-2 fracture Body C-2 fracture CONSERVATIVE THERAPY

DENS FRACTURE

DENS FRACTURE

HANGMAN‘S C-2 FRACTURE TRAUMATIC SPONDYLOLISTHESIS OF AXIS

Anterior fusion and plate

CERVICAL SPINE INJURIES Comminuted body fractures (burst) Injuries of discs and ligaments disc and ligamentous disruption Combined - teardrop, fracture dislocations

C- SPINE anterior surgery body replacement disc replacement stabilisation

CERVICAL PLATES SYNTHES CASPAR

POSTERIOR SURGERY Hartshill

STABILISATION O-C ARTICULATION Synthes Star Lock CerviFix ……..

HOOK PLATES disc and ligamentous disruption

POSTOPERATIVE AFTERTREATMENT collar Jewett orthosis, lumbar belt plaster cast

Thank you for attention