Spinal Trauma.ppt

Spinal Trauma Outline Incidence Types Clinical signs Radiological signs Spinal shock Management Incidence 10 - 15 per million 18 - 35 years Male - 3:1 RTA 51% - cars Domestic 16% Industrial 11% Sports 16% - diving incidents Self harm 5% Types Cervical 40% Thoracic 10% Lumbar 3% Dorso lumbar 35% Any 14% Anatomy Spinal cord ends below lower border of L1 Cauda equina is below L1 Mid dorsal spinal cord neural canal space are of same diameter hence prone for complete lesion Mechanical injury - early ischaemia, cord edema - cord necrosis Neurological recovery unpredictable in cauda equina ie. peripheral nerves Cervical spine anatomy Anterior column - Anterior longitudinal ligament+ Anterior annular ligament and anterior half of VB. Middle column – Posterior long. Lig. + Posterior annular ligament +Posterior half of VB. Posterior Column – Lig flavum + superior Interspinous lig + intertransverse capsular lig + neural arch + pedicle spinous process. Significance Unstable if middle column + either Anterior or Posterior column is damaged Rupture of interspinous ligament is : - associated with avulsion of spinous process - Unstable spine - Further flexion increases neurological injury Level of Spinal injury Neurological level is at the most lowest segment with normal motor sensory function Difficult to determine : - as most muscle efferents receive fibres from more than one level - Closed cord lesions may extend over several cms. - Dermatomes have imprecise boundaries. Cord level C2 – C7 = add +1 for cord level T1 – T6 = add +2 T7 – T9 = add +3 T10 = L1, L2 level T11 = L3, L4 level L1 = sacro coccygeal segments Degrees of injury Complete - flaccid paralysis + total loss of sensory motor functions Incomplete - mixed loss - Anterior sc syndrome - Posterior sc syndrome - Central cord syndrome - Brown sequard’s syndrome - Cauda equina syndrome Anterior spinal cord syndrome Flexion rotational force to spine Due to c