SPINE TRAUMATOLOGY
M. Krbec, M. Repko, M. Rouchal,
L. Ryba, R. Chaloupka
Ortopaedic Univ. Dept.
FN Brno-Bohunice
• cervical C
• thoracic T
• lumbar L
• sacrum
• coccyx
• body support
• spinal cord / dura protection
SPINE
Anatomy of
vertebra
• Vertebral body
• Pedicles
• Arch
• Articular
processes
- superior
- inferior
• Transverse
processes
• Spinous process
Denis 3-column theory
Now 2-column theory(Magerl)
C1
C1 = atlas
Arches + articular processes
C2
axis
• Body
• Dens
• Articular
processes
Discus intervertebralis
EXAMINATION
• Case history
• Clinical examination
• X-ray
• Neurological
• CT
• MRI
TYPES OF INJURY
Forces, directions
• Axial pressure
• Bending pressure
• Rotation
• Combination
MECHANISM OF INJURY
• Falls
• Traffic accidents
• Sport
Hematomyelia Central
cord sy
Denis‘ classification
3 three-column concept
A compressive
B burst
C flection-distraction
D rotational forces
(shear, translation)
compression
distraction
A,B with
rotation
AO classification
Magerl et al.
2-column
Frankel (ASIA)
classification
A complete loss of motor end sensory
functions
B no motor preservation, sensory
function only
C useless motor function preserved
D motor function less than normal
E normal neurological status
THERAPY
• conservative
– orthosis, plaster cast
– bed rest
• surgical
– posterior surgery
– anterior surgery
– combined
FIRST AID
• CERVICAL SPINE FIXATION
• TO AVOID MOVEMENT WITH
THORACIC AND LUMBAR SPINE
DURING MANIPULATION
• SPINAL DEPARTMENT
SURGICAL INDICATION
• NEUROLOGICAL LESION
» OPERATION UP TO
» 6 HOURS !
• SPINE INSTABILITY
CONSERVATIVE THERAPY
• Bed rest
• Collars- soft
-Philladelphia
T SPINE T8 - 12
• Jewett orthosis
LS SPINE
• Jewett orthosis L1 - 3
• lumbar belt L4 - S1
CONSERVATIVE THERAPY
HALO -
TRACTION
CONSERVATIVE TREATMENT
-plaster casts
C spine
• halo-cast, halo-vest
• Minerva cast / vest
CONSERVATIVE TREATMENT
-plaster cast
• DECOMPRESSION OF
NEUROGICAL STRUCTURES
• REDUCTION OF DEFORMITY
• HEALING WITH SOLID FUSION
SURGICAL THERAPY
• C spine
–anterior surgery
• T, L spine
–posterior surgery
SURGICAL THERAPY
acute period
BASIC PRINCIPLES OF
SURGICAL THERAPY
• reduction
• lordotisation
• stabilisation
POSTERIOR APPROACH TO THE
T-L SPINE
• Pedicle screws
• Bones
• Rods
• Cross-links
intersomatic
fusion
spongioplasty
POSTERIOR STABILISATION OF THE SPINE
CT scan – TRANSPEDICULAR SCREWS
T-L SPINE – ANTERIOR
SURGICAL APPROACH
• replacing the
vertebral body
• stabilisation
Harms cage
anterior
instrumentation
posterior
instrumentation
Synex
extended impl.
C1,2 – SPINE INJURIES
Rare, big violence on OC a C-SPINE
Occipital fracture
C-1 arch fracture
Odontoid C-2 fracture
Body C-2 fracture
CONSERVATIVE THERAPY
DENS FRACTURE
DENS FRACTURE
HANGMAN‘S C-2 FRACTURE
TRAUMATIC SPONDYLOLISTHESIS OF AXIS
Anterior fusion and plate
CERVICAL SPINE INJURIES
• Comminuted body fractures (burst)
• Injuries of discs and ligaments
– disc and ligamentous disruption
• Combined
- teardrop, fracture dislocations
C- SPINE
• anterior surgery
– body replacement
– disc replacement
– stabilisation
CERVICAL PLATES
• CASPAR • SYNTHES
Posterior surgery
STABILISATION of O-C
SPINE• Synthes
• Star Lock
• CerviFix ……..
POSTOPERATIVE
AFTERTREATMENT
• collar
• Jewett orthosis, lumbar belt
• plaster cast
• 0