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Cervical Spine injuries by rakesh(presented on 11.11.10)

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Cervical Spine injuries by rakesh(presented on 11.11.10)

  1. 1. Cervical Spine InjuriesCervical Spine Injuries RAKESH VALLITTAYILRAKESH VALLITTAYIL
  2. 2. BROKEN NECK-CAUSES Car 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.
  3. 3. 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
  4. 4. 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
  5. 5. Additional diagnosticAdditional diagnostic  CT-scanCT-scan  Verified fracture, extent, encroachment, posteriorVerified fracture, extent, encroachment, posterior complex (B-type !)complex (B-type !)  Suspicious area of trouble, not shown inSuspicious area of trouble, not shown in conventional X-rayconventional X-ray  MRIMRI  Neurologic deficit without fracture – epiduralNeurologic deficit without fracture – epidural hematomahematoma  Distraction injuries - posterior complexDistraction injuries - posterior complex  Injuries of ligaments or disc (cervical spine), thereInjuries of ligaments or disc (cervical spine), there is traumatic disc injury!is traumatic disc injury!  Differentiate old/new fracture (osteoporotic)Differentiate old/new fracture (osteoporotic)
  6. 6. Alignment Loss of cervical lordotisAlignment Loss of cervical lordotis indicatingindicating ligmentous injury or occult fractureligmentous injury or occult fracture Anterior vertebral line (anterior margin of vertebral bodies) Posterior vertebral line (posterior margin of vertebral bodies Spinolaminar line (posterior margin of spinal canal Posterior spinous line (tips of the spinous processes)
  7. 7. Prevertebral soft tissuePrevertebral soft tissue Disc spaces should be equal and symmetricDisc spaces should be equal and symmetric
  8. 8. 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 andfractures occurs at anterior and posteriorposterior arches of the vertebraarches of the vertebra ► Compression fracture of the bonyCompression fracture of the bony ring of first vertibraring of first vertibra ► Displacement of lateral massesDisplacement of lateral masses splitting and transverse ligamentsplitting and transverse ligament tear.tear. ► Best seen on odontoid viewBest seen on odontoid view ► CT is required to define the extent ofCT is required to define the extent of fracturefracture
  9. 9. TREATMENTTREATMENT Stability Intact or broken transverse ligament and degree of fracture of the anterior arch Stable –soft or hard cervical collar ,traction Unstable- fixation done
  10. 10. C2# ODENTOID FRACTUREC2# ODENTOID FRACTURE ► odontoid fractures -most common upper cervical fractures.odontoid fractures -most common upper cervical fractures. ► Rule of thirds - 1/3- cervical cordRule of thirds - 1/3- cervical cord 1/3- Dens1/3- Dens 1/3- Empty1/3- Empty ► Flexion loadingFlexion loading ► Majority of patients-results in anterior displacement of theMajority of patients-results in anterior displacement of the dens.dens. ► Extension loading (forward fall onto forhead)Extension loading (forward fall onto forhead) ► In minority of patients-results in posterior displacement ofIn minority of patients-results in posterior displacement of the dens.the dens.
  11. 11. TYPE-ITYPE-I # through superior portion# through superior portion Avulsion of Alar ligamentAvulsion of Alar ligament Tmt: with semirigid collarTmt: with semirigid collar TYPE-II # through the base Hyperextension or hyperflexion forces Anterior screw fixation TYPE-III # that extends into the body of C2 Mechanically unstable 12 weeks of immobalization
  12. 12. C2#.Hangman’s FractureC2#.Hangman’s Fracture  Sudden forceful hyperextension centered just under theSudden forceful hyperextension centered just under the chinchin  Mainly in deceleration injuriesMainly in deceleration injuries  face or chin strike an unyielding objectface or chin strike an unyielding object with the neck in extensionwith 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  TractionTraction should not be givenshould not be given  Surgery-Surgery-  Reducing subluxation and stabilizing.Reducing subluxation and stabilizing.  ORIF-oblique wiring andORIF-oblique wiring and screw fixation.screw fixation.
  13. 13. 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
  14. 14. ‘Tear drop fracture’-fixation
  15. 15. 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
  16. 16. Unilateral Facet DislocationUnilateral Facet Dislocation  Due to flexion and rotatoryDue to flexion and rotatory movementsmovements  Facet joint dislocationFacet joint dislocation  Rupture of the apophyseal jointRupture of the apophyseal joint ligamentsligaments  Best seen on lateral or oblique viewsBest seen on lateral or oblique views
  17. 17. 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.
  18. 18. 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)
  19. 19. Dynamic flouroscopy  Ligamentous or spinal cord injuries  No Radiological abnormality.  Altered mental status after trauma.  No bony involvement
  20. 20.  THANK YOUTHANK YOU

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