Professional Documents
Culture Documents
Spinal Injury1 2 PPT PDF
Spinal Injury1 2 PPT PDF
&
Spinal Cord
Injury
Outline
Goal of spine trauma care
Pre-hospital management
Clinical and neurologic assessment
Acute spinal cord injury
Term, type and clinical characteristic
Common cervical spine fracture and
dislocation
Goal of spine trauma care
Protect further injury during evaluation and
management
Facilitate rehabilitation
Suspected Spinal Injury
High speed crash
Unconscious
Multiple injuries
Neurological deficit
Spinal pain/tenderness
Pre-hospital management
Protect spine at all times during the
management of patients with multiple injuries
Log-rolling
Pre-hospital management
Cervical spine immobilization
Neutral position
Philadelphia hard collar
Transportation of spinal cord-injured
patients
Emergency Medical Systems (EMS)
Paramedical staff
Primary trauma center
Spinal injury center
Clinical assessment
Advance Trauma Life Support (ATLS)
guidelines
Primary and secondary surveys
Adequate airway and ventilation are the
most important factors
Supplemental oxygenation
Early intubation is critical to limit secondary
injury from hypoxia
Physical examination
Information
Mechanism
energy, energy
Direction of Impact
Associated Injuries
Is the patient awake or
unexaminable?
Whats the difference ?
Awake
ask/answer question OW!
pain/tenderness
motor/sensory exam
Not awake
you can ask (but they wont answer)
cant assess tenderness
no motor/sensory exam
------
Unexaminable
No exam
Physical examination
Neurological assessment
Motor, sensation and reflexes
PR
Neurogenic Hypovolemic
Preserved
propioception and
deep touch
Brown-Sequard syndrome
Loss of ipsilateral
motor and
propioception
Loss of contralateral
pain and
temperature
Central cord syndrome
Weakness :
upper > lower
Variable sensory
loss
Sacral sparing
Radiographic imaging
Who needs an x- ray of the spine ?
NEXUS Criteria:
1. Absence of tenderness in the posterior midline
2. Absence of a neurological deficit
3. Normal level of alertness (GCS score = 15)
4. No evidence of intoxication (drugs or alcohol)
5. No distracting injury/pain
NEXUS
NO
Any low-risk factor that allows safe
YES
assessment of range of motion?
Simple rear-end MVC, or NO
Sitting position in ER, or Radiography
Ambulatory at any time, or
Delayed onset of neck pain, or
Absence of midline C-spine tenderness
YES
Able to actively rotate neck? UNABLE
45 degrees left and right
ABLE
No Radiography
National Emergency X
Radiography Utilization Study
(NEXUS)
&
The Canadian C-spine rule
Both have:
Excellent negative predictive value for
excluding patients identified as low risk
Clearance of Cervical Spine Injury in
Conscious, Symptomatic Patients
Plain films
AP, lateral and open mouth view
Optional: Oblique and Swimmers
CT
Better for occult fractures
MRI
Very good for spinal cord, soft tissue and
ligamentous injuries
Adequacy, Alignment
Bone abnormality, Base of skull
Cartilage
Disc space
Soft tissue
Adequacy
Malalignment of the
posterior vertebral bodies is
more significant than that
anteriorly, which may be
due to rotation
A step-off of >3.5mm is
significant anywhere
Lateral Cervical Spine X-Ray
Disc Spaces
Should be uniform
Assess spaces
between the
spinous processes
Soft tissue
Nasopharyngeal space
(C1)
10 mm (adult)
Retropharyngeal space
(C2-C4)
5-7 mm
Retrotracheal space
(C5-C7)
14 mm (children)
22 mm (adults)
AP C-spine Films
Spinous processes
should line up
Disc space should be
uniform
Vertebral body height
should be uniform.
Check for oblique
fractures.
Open mouth view
Primary Goal
Prevent secondary injury
Spinal alignment
deformity/subluxation/dislocation reduction
Neurological status
neurological deficit decompression
Jefferson Fracture
Burst fracture of C1 ring
Unstable fracture
Need CT scan
Burst Fracture
Unstable
Clay Shovelers Fracture
Flexion fracture of
spinous process
C7>C6>T1
Stable fracture
Flexion Teardrop Fracture
Unstable because
usually associated with
posterior ligamentous
injury
Bilateral Facet Dislocation
Flexion injury
Subluxation of dislocated
vertebra of greater than
the AP diameter of the
vertebral body below it
High incidence of spinal
cord injury
Extremely unstable
Hangmans Fracture
Extension injury
Bilateral fractures of
C2 pedicles
(white arrow)
Anterior dislocation of
C2 vertebral body
(red arrow)
Unstable
Odontoid Fractures