1. Trauma to the Spine
and Spinal Cord

2. epidemiology Occurrence 20-80 per 100,000
2 deaths per 100,000 population due to spinal injury
male/female ratio 3/1

3. Etiology (USA) 40% - motor vehicle accidents 20% - falls
15% - industrial
15% - sports and recreation

4. Denis tree-column theory
anterior posterior
column
middle

5. Mechanisms of spine injury
Flexion
Flexion-rotation
Extention
Compression

6. Mechanisms of injury
Compression
Flexion
Flexion-Rotation.

7. Shear.
Flexion-Distraction.
Extension

8. Classification of injury to the spine
Depending on integrity of the skin
Closed
open, depending on integrity of dural sac
missile
nonmissile
Clinical forms of injury to the spine
contusion
Injury to the ligaments and capsules
Rupture of intervertebral disk
Facet dislocation
Complete bilateral facet dislocationn (locked facets)
Fracture of vertebra corpus (compressive, burst)
Fractures of posterior elements of vertebras (joint, transverse, spinous processes and arch)
Fracture-dislocation (unilateral and bilateral)
Multiple fractures of vertebra elements
Violation of support function
Stable
Instable

9. Types of injury to the cervical spine
Occipital condyle fractures
Atlanto-occipital dislocation
Fractures of the atlas
Jefferson fracture
Fracture of posterior arch
Axis fractures
Fractures of the odontoid process (I-III types)
Lateral mass fractures
Traumatic spondylolisthesis (hangman's fracture)

10. Atlanto-occipital dislocations

11. Traumatic spondylolisthesis (hangman's fracture)

12. Fracture of odontoid process of C2 (type II)

13. Types of injury to the cervical spine
Fractures and dislocations of C3-C7
Compression fractures
Burst fractures
Teardrop fractures
Unilateral facet dislocation
Bilateral facet dislocation (locked facets)
hyperextension dislocation
hyperextension fracture-dislocation
laminar fractures
Fracture of spinous process

14. Compressive fracture of С5

15. Unilateral facet dislocation of C4-C5

16. dislocation of С4

17. Edge compressive fracture of С7, dislocation С6, compression of spinal cord

18. А-normal
Б-subluxation
В-dislocation
Г- complete dislocation with locked facets

19. Complete dislocation of C5 (bilateral locked facets with severe compression of spinal cord

20. Burst fracture С3-С4 with із severe spinal cord compression

21. Typical injuries to the thoraco-lumbalis and lumbalis spine
Wedge compression fractures
Burst fractures
Seat belt–type injuries
Fracture-dislocations

22. Wedge compression fracture

23. Burst fractures

24. Seat belt–type injuries

25. Fracture-dislocations

26. Classification of the injury to the spinal cord
Complete syndrome –
total loss of motor and sensory function below injury level
central cord syndrome –
weakness of the upper extremities greater than the lower extremities
anterior cord syndrome
total loss of motor and lateral column sensory function (pain and temperature), dorsal column function (i.e., proprioception, touch, and position sense) is spared
conus medullaris syndrome
combination of spinal cord and nerve root involvement
Cauda equine syndrome
Brown-Sequard syndrome

27. Scheme of blood supply of spinal cord and typical ischemical changes
1-vertebral
arteria
2-5-radicular-
medular
arteries
6-spinal
cord
А – loose type of blood supply
Б,В,Г – variants of magistral types of bood supply

28. Classification of spinal cord injury
Frankel
(A) complete,
(B) sensory only,
(C) motor useless,
(D) motor useful,
(E) recovery.

30. Prehospital care ABC Immobilization - rigid cervical collar, backboard
A (airway), cleaning, airway tube if indicated
B (breathing) – supplemental oxygen of mask
C (circulation) – maintaining normal blood pressure – fluids
Immobilization - rigid cervical collar, backboard

31. Emergency room management
ABCDE
Cont ABC protocol
Supplemental oxygen for all
Fluids and pressors for maintaining normal blood pressure
D - (disability) - assessment of neurological status
E – (exposure) - removal of all clothes for throughout examination
methylprednisolone - iv bolus of 30 mg per kg followed 5.4 mg per kg per hour continuous infusion during the next 23 hours.

32. Treatment of cervical spine injury
Cervical traction
Reduction of dislocation
Manual reduction
Traction
Immobilization with orthoses
Collars
Cervicothoracic, thoracolumbar braces
Halo-orthosis
Surgical decompression and stabilization

33. Typical indications for surgery
Almost all thoraco-lumbar injuries with neurological deficit
thoraco-lumbar injuries without neurological deficit in cases of progressive deformation (kifosis)
Cervical burst fractures and fractures-dislocation
Other cervical injuries after ineffectiveness of conservative treatment (cervical traction, manual reposition, halo-orthoses)

34. Accompanying problems and complication
Dysfunction of bladder and bowel
Urinary infection
Decubitus (trophic ulcers)
Spasticity (late)
Progressive deformation of the spine

35. Diagnostic procedures
Plain X-ray examination (min 2 views)
Functional X-ray examination CT
Myelography and postmyelography CT
MRI
CSF dynamic tests

36. Reposition of cervical spine dislocations
А- traction
Б- bending to the “healthy” side
В- rotation to the opposite side

37. Hallo apparatus for stabilization of cervical fractures

38. Tongs of distraction and stabilization of injury to the cervical spine

39. Surgical stabilization
Corporodesis C3-C5, anterior approach

40. Surgical stabilization
Transpedicular fixation

41. Posterior spondilodesis with bone graft

42. Scheme of anterior spondylodesis

43. Posterior spondilodesis with metal wire