Spine
fracture
Dakheel A. Al-Dakheel, MBBS, SSC(Ortho)
Orthopaedic surgery department
King Fahd Hospital of the University
Khobar, KSA
NOTE : THIS PRESENTATION
DOES NOT REPLACE
ATTENDANCE OR
INFORMATION GIVEN IN THE
LECTURE.IT IS INTENDED AS
A HIGHLIGHT FOR THE TOPIC
Thoraco-lumbar fracture
Incidence:
• Neurological deficit may occur in 10–25% of patients with spinal
trauma
• Incidence of spinal injury in the US is between 4 and 5.3 per
hundred thousand of population
• The common causes of spinal trauma include
Road traffic accidents - 45%
Falls - 20%
Sports -15%
• The male to female ratio is 4:1.
• The overall survival rate for patients with spinal injuries is 86%
at 10 years
• Incidence of noncontiguous, multilevel vertebral injuries is
approximately 20%
Mechanism of injury
• MVA
• Falls
• Gunshot
• Sport
50%
25%
15%
10%
• Most of patient with spine injury have an
associated injuries
• 80% multiple injuries
• 26% head & face injury
• 16% major chest injury
• 10% major abdominal injury
• 8% long bone/ pelvic fractures
Incidence of missed spinal
fracture
• The prevalence of delay in diagnosis of
trauma
• cervical spine is 22-33%
• thoracolumbar spine is 5%.
• 22% in tertiary centre.
• The main causes are :• a low level of suspicion
• failure to take proper radiographs
• poly trauma
• failure to interpret the x ray
• intoxication
• decrease level of consciousness
Multiple Spinal Fracture
• Calenoff,
Chessare,&
Rogers reported
an incidence of
4.5%
Demographics
• SCI is predominantly a disease of young men.
• Average age at injury is 29.7 years.
• Median age is 25 years
• 82% male.
• Occurrence increase with increase daylight.
Medical problems in SCI
• The leading cause of death in acute
phase is respiratory failure & pneumonia.
• Pulmonary problems also the leading
cause of readmission in the 1st year.
Leading cause of death in
SCI
•
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Respiratory disease
Accident, poisoning, violence
Circulatory disease
Infections
Genitourinary disease
Neoplasm
20.5%
9.7%
8.8%
8.8%
4.0%
3.9%
Approach to
Spine Trauma
•
•
Pre Hospital Care
The aim is to retrieve the patient from
the site of injury safely and rapidly
• Transfer to a suitable facility.
• spinal trauma should be suspected in
1. all unconscious patients
2. High energy trauma
3. Evidence of neurological deficit
4. Multiple injuries
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Proper extraction
Intubation
Immobilization
Cervical collar, sand bag, tape,
? Neck position
• ?pediatrics
Emergency Assessment
•ATLS
• Evaluating spinal injury begins in the
secondary survey
• History is taken & head to toe examination
• Obtain history from
• Patient
• Family members
• Paramedical personnel
History
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Mechanism of injury
Position of the patient when found
Transient motor or sensory loss
Paradoxical breathing
Seat belt
Inspection
•
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All clothing should be carefully removed
Any bleeding , abrasion or lacerations
Limb asymmetry
Voluntary limb movement
Chest expansion
Palpation
•
1.
2.
3.
4.
Cervical collar removed carefully
Tenderness
Interspinous widening
Malialignement of spinouse process
Step off
Neurological Evaluation
•
1.
2.
3.
Neurological examination
Sensory evaluation
Motor evaluation
Reflexes
Spinal reflexes
Cresmatic reflex
• Stocking inner thigh & observing the scrotum
movement
• Absence means UMNL
• Unilateral absence suggest LMNL
Sacral Sparing
1.
2.
3.
•
Perianal/perineal sensation
Rectal tone
Big toe flexion
Implies partial structural continuity of
white matter long tracts
• May be only evidence of incomplete
injuryhigher chance of recovery
• Essential to check and document
Bulbocavernosus reflex
• Pull glans or press
clitoris  anal
contraction (int.
sphincter) around
gloved finger
• Absence is indicator
of spinal shock
Skeletal Trauma
RADIOLOGICAL ASSESMENT
• PLAIN FILM
• AP & LATERAL
CT
•
•
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Injury suspected on plain films
Better visualize fracture (specificity and sensitivity)
Unable to adequately assess on plain films
Fracture or soft tissue injury in the plane of the CT
can be missed
MRI
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Invaluable for assessing cord and soft tissues
R/O associated disc herniation ( facet dislocations)
Hemorrhage vs edema in soft tissues ????
Ligamentous tears and facet capsule disruptions
visualized with fat suppression
• May allow prognostic assessment of final motor
function
• Intrasubstance hematoma
MRI
T1
T2
GRE
Classification of
ThoracoLumbar spine
Fracture
Compression Fracture
Burst Fracture
Fracture Dislocation
Flexion Distraction
Imaging
Non-Operative Management
Surgical intervention
Complications of spine fracture
• Neurological injury
• Instability ( pain & deformity)
• Complication of surgery
THANK YOU