cervical spine injuries by rakesh(presented on 11.11.10)
TRANSCRIPT
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Cervical Spine InjuriesCervical Spine Injuries
RAKESH VALLITTAYILRAKESH VALLITTAYIL
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BROKEN NECK-CAUSESCar accidents,Falls,Sports,Violent acts (e.g., being shot)
The result can be catastrophic that is spinal cord injury resulting in loss of sensation, paralysis, or death.
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Stable fractures •No spinal deformity or neurologic (nerve) problems.
•Spine can still carry and distribute weight •Transverse ligament is intact
Unstable fractures •Difficult for the spine to carry and distribute weight.
•Progressing and causing further damage. •May also cause spinal deformity
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Imaging Following trauma or complaint of neck pain
Obtain lateral, AP,and odontoid views Upper cervical spine
transoral X-ray of odontoid process Cervico-Thoracic junction
C6/7/T1, „Swimmer“, extension of the arms Statscan If there is any doubt of fracture, obtain
oblique(45 degress) views and consider CT
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Additional diagnosticAdditional diagnostic CT-scanCT-scan
Verified fracture, extent, encroachment, posterior Verified fracture, extent, encroachment, posterior complex (B-type !)complex (B-type !)
Suspicious area of trouble, not shown in conventional Suspicious area of trouble, not shown in conventional X-rayX-ray
MRIMRI Neurologic deficit without fracture – epidural hematomaNeurologic deficit without fracture – epidural hematoma Distraction injuries - posterior complexDistraction injuries - posterior complex Injuries of ligaments or disc (cervical spine), there is Injuries of ligaments or disc (cervical spine), there is
traumatic disc injury!traumatic disc injury! Differentiate old/new fracture (osteoporotic)Differentiate old/new fracture (osteoporotic)
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Alignment Loss of cervical lordotisAlignment Loss of cervical lordotis indicating indicating ligmentous injury or occult ligmentous injury or occult
fracture fracture
Anterior vertebral line (anterior margin of vertebral bodies)Posterior vertebral line (posterior margin of vertebral bodies
Spinolaminar line (posterior margin of spinal canalPosterior spinous line (tips of the
spinous processes)
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Prevertebral soft tissuePrevertebral soft tissue Disc spaces should be equal and symmetric Disc spaces should be equal and symmetric
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C1#.Jefferson FractureC1#.Jefferson Fracture► Axial blow to the vertex of the headAxial blow to the vertex of the head (e.g. diving injury, roof of the (e.g. diving injury, roof of the
vehicle).vehicle).
► fractures occurs at anterior and fractures occurs at anterior and posterior posterior
arches of the vertebraarches of the vertebra► Compression fracture of the bonyCompression fracture of the bony ring of first vertibra ring of first vertibra ► Displacement of lateral masses Displacement of lateral masses
splitting and transverse ligament splitting and transverse ligament tear.tear.
► Best seen on odontoid viewBest seen on odontoid view
► CT is required to define the extent CT is required to define the extent of fractureof fracture
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TREATMENTTREATMENT
StabilityIntact or broken transverse ligament and degree of fracture of the anterior arch
Stable –soft or hard cervical collar ,traction
Unstable- fixation done
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C2# ODENTOID FRACTUREC2# ODENTOID FRACTURE► odontoid fractures -most common upper cervical odontoid fractures -most common upper cervical
fractures.fractures.► Rule of thirds - 1/3- cervical cord Rule of thirds - 1/3- cervical cord 1/3- Dens 1/3- Dens
1/3- Empty 1/3- Empty► Flexion loading Flexion loading ► Majority of patients-results in anterior displacement Majority of patients-results in anterior displacement
of the dens.of the dens.► Extension loading (forward fall onto forhead) Extension loading (forward fall onto forhead) ► In minority of patients-results in posterior In minority of patients-results in posterior
displacement of the dens.displacement of the dens.
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TYPE-I TYPE-I # through superior # through superior
portionportionAvulsion of Alar ligament Avulsion of Alar ligament Tmt: with semirigid collarTmt: with semirigid collar
TYPE-II # through the baseHyperextension or hyperflexion forcesAnterior screw fixation
TYPE-III # that extends into the body of C2Mechanically unstable 12 weeks of immobalization
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C2#.Hangman’s C2#.Hangman’s FractureFracture
Sudden forceful hyperextension centered just under Sudden forceful hyperextension centered just under the chinthe chin
Mainly in deceleration injuries Mainly in deceleration injuries face or chin strike an unyielding objectface or chin strike an unyielding object with the neck in extension with the neck in extension # through the pedicle( pars reticularis)# through the pedicle( pars reticularis) of C2 secondary to hyperextensionof C2 secondary to hyperextension Best seen on lateral viewBest seen on lateral view Traction Traction should not be givenshould not be given Surgery- Surgery- Reducing subluxation and stabilizing.Reducing subluxation and stabilizing. ORIF-oblique wiring and ORIF-oblique wiring and screw fixation.screw fixation.
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Flexion Teardrop Fracture
Most severe fracture of cervical spine
Unstable # Due to extreme flexion &
compressive forces
Commonly results from a dive into a shallow pool of water.
Associated w/ acute anterior cervical cord syndrome
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‘Tear drop fracture’-fixation
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Bilateral Facet Dislocation Due to extreme hyperflexion Complete anterior dislocation of the vertebral body. Associated with a very high risk of cord damage. Best seen on lateral view
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Unilateral Facet DislocationUnilateral Facet Dislocation Due to flexion and rotatoryDue to flexion and rotatory movementsmovements Facet joint dislocation Facet joint dislocation Rupture of the apophyseal joint Rupture of the apophyseal joint ligaments ligaments Best seen on lateral or oblique viewsBest seen on lateral or oblique views
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Anterior Subluxation Due to hyperflexion Distruption of posterior ligamentous complex
Signs: Loss of normal cervical lordosis. Anterior displacement of the vertebral body. Fanning of the interspinous distance.
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Clay Shoveler’s Fracture # of Spinous process C6 to T 1 Best seen on lateral view ‘Ghost sign’on AP view ( double spinous process of C6 or
C7)
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Dynamic flouroscopy Ligamentous or spinal cord injuries No Radiological abnormality. Altered mental status after trauma. No bony involvement
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