NEURO L _ SURGERY | 1- Head injury (1) 2- Spinal injury (15) 3- Peripheral nerve injury (28)Eman.a- 9 inal injuries ripheral none = Pe Pipuries, Classification: 1 ¥ re Teg Me According to Recording to Severity a Mechanism of trrquies fe eee Morshal a ¢ : y over. Chate a) Hild Nodeate closed head open aad “clini pacer Assess | [P.M lonard — Hreamely ayes Sa Bi vel Sunset tin DE ye opeoin Responce 1-4 | Highvelocity Bil iepry |G Verbal Kespene 1-5 e9 RTA |G NMotor Responce 46 Falliag from Ric plane | KGlassqow HMascale: | ly Nakimum score =15 Minieram score =3 Eye Opening Respone. ~ Spontaneous eye opening > score. ~ Opening fo call’ Bscore ~ &e opening bo painfull shimul’> VEore — Oriented pr —ytotime. person, Place 5 ccore —cliseriented @ comfugech-» 4 sore — Tnappoprate word »3score ~ Incomerh ensible Speech + sere — NO Responce + Lscone wa(Ci Rene) te bet Q Movement on command 4 6 © Lecalized the pain CHehyte Remave whats do +5 pau’ Fer him) © withdywal. Reflex 4 = rermal Flexion ~ CMexion in Hip Uknee » Elbow wrist) @ — Awnormal Flexion ocr in pt & decorticotion damge in © Generalized Extension +2 3 cerebyal corkx. - occur a, decerelarated pts damage of All cerebral © pl cant move ot hy Whole £ HemiSphere. Haste poralysts N-8 & Lhe pt move hig RE Limb on Command but cant mae the Left Limb —elis scove = 6 on motor Respance Ble the lefh limb fS Vemebsle duete Local cause =) Hemiplegia . = assqow Coma sce@le s— Hfgher center Kinchion eg cerebral °9" pron oe ie open his eye, Hemisphore a his lini € Incompenhersible speech 2 Sof this pho & 24442 =8 > Sever Head) thqer Ee a Mild Head inguey “7 Q-1L > Wodetes Bor less + Sever 4 6 poncided a5 Comatose pt » Bi she \ eS SRA ese ee TF GCS indicate sever ingque ssesS the prognosis Ning a ite 4 Progr oF suv Pn the pt ize oF pupil» gptic Nerve CATFient) — CCulomotor (Effevent s this pric ie ot) CCulometo (EtFevent) © corneal Reflex “Trigeminal (Afferent) Facial (EMaent) ® Gag Reflex = Ghossaphornqect (MFFerent) Vagus, Cefeent)GO) aculovestloular Reflex : Taégetion of ear byt. Slataie Cold weter move ment of Eye balk to oppesite sthe “ assocfated with Nystagmas . Warm weter-> movement oF Eye ball to same side associated, € Nystynus cerebral damage yr Tenic Movement of €ye teal (e Nyptagmes)re E Intact 5 Brain stem Opposite Side E cctd water & same side & warm water - Broin Slem + No Meement oF Eye ball damge © Oulo cephalic QReflex: prisk Movement of Head. if Eye ball Move +o oppesite side-> normal Lrain stem CNormal Responce) ‘Eye pall Fred —> Move & Heacl + damge, Brain slem-w {n-g- Brotn death: - Btaed dilated pepill ~~ Light ReFlex —» no responce _ceneal ReFlex -» no responce. Gray ReFlex — no responce Ge $=3 Apnea tes} > No Respence - EEG, > Flate line © Apnee Test Tn concentration OF Cor Cpeoz)—7 stimulate Respicatery Center 7 ta doth Remove ventilator For 2 min & See Respen. @ EG if late linea Brain death, ~ we cant Say Brain death untill wedo Apnea test EEG, - Size of pupil» Tsocoria - 3 = ANTsocria_p. Emmegency b/c Indicate Masg prussure ‘at ANISOCOTIO + 0 Same side 4-[W8) Befor doing She previous fest Byain stem Faunchion Must We have to Exclude admninestration of Sedative, aMasce Relaxints or Hypothermiass x x According t. moreholo as ) Phelogy Skull Fruduce Antra cranial Injuries _s an ; Bales Valt bone x ® diffuse Bone of Froclure focal Tnquries Anpenes SKuil A_VALT Bone FRACTURE] =_ May be 4- Linear Frachies L Comminuted Frackire CSATAIAT) 32 ts Maltiple Linear Fructure Radiating Fom the Impacted areas: 3-Depressed Fachué 2 Dangerous. + F the depiession fs Equal or More than thickness & the skill -> Swigical intervention. 5 indicated >| > if depression Lesser than thickness oF SiKill ap| No NEGD FoR Surgery: 5 Coane “ tracture Base OF Skull ¢- may be 4- with or without factal Nerve palsy — ENT Surgery 2- with or without Csk leak Cequrrhea) w_Clinical Feature o& Base of skull = Nasal discharge + Rhinowhed > cs ~ Ear discharge +-OTorrhea + cs BilaterdL periorbital Heemodoma-> RACOON EYES. Ecchymosis Rround Mastotd process->Retromastoid Bleeding per ear raising = 6 fecal. Nerve palsy: @ Battles sign uc & ©+ Investigation: @ DipsttcK ships Fr nasal ischarge fe Glucose (CSF) @ Xevy: te valt frudure —— C Sivealh in # Base cf SX) © CTE Avial & coronal section —» Fadure Site of leak” @ Gysternographys. inzecting the Dye in CSE and de CTscin> You wid See ~ contrast coming out OF Site ff Leakge.. : @ MRL: to sce R there is leat’ 22¥ but NOT +e Localize (re site of \eatae. -_Treatment : GQ Most Cases will eal spentaneush) and leak step @ Prephylaris Antibiotics. @ if Not Resolved For eta Repeated Lumbar pundure ag ylep> tt is Contraindi in case of High Icp Bone oF Any Reson. — Herntotion. f Brain Hssue. through foramen magoum CCoNING) @ Surgical intervension in Some cose Nob Respend a eated as. @ 5) 7 F Come clirectly € facial Neruw palsy > @. Rega this palsy 3° ff Develop pay ee roy ~» ine cause Not Ingary - beat developed oF oedema Yo thept “Reated conservakivelds..@ Fecal Ingary 68 Diffuse Ingjuy -Mild concussion —classical concussion — Aiffuse onal myy (NBh Wee of Intra evantal Hamorrhage : ® Epidural Haemorrhg< & subdural Hasmerhge | © Intra ceretoral Haema tor’ Ich) @ Tntia ventriculee Haemerrhee 7 © sub archncid Haemerrage s ATF cal Intracranial Inj) > Ww idurBl. Heemoteme: =Extradural Haemasoma. ~ Dek Collection oF Blood Belween SKall 2d i Common site? Temperl & Temporoparietal oe —Bleedi sur Cee: cases : Middle Neningeel area sees u pone 78 Bibis Brand ‘3 * cases! Venous» middle meni ea) Vein Or wey fo Venous SinuS — Epidural Haemetoma CMOst coMMen) ~ Subdurdl Haematome ~ Intra Cereloral Haema toma( IcH) Clinical picture = a i Aad * primacy Loss of Conscioussness_s, due to Trauma ital] then pr Recovary after Few Hours —> Pr develope = Becondary neurolegical deterioration > Sever H@dach /Vom' Bluried vision, Hemiparesis - ¥ level of Consévoussness- Rinisocovia & Even coma egywhe Lucid TotenvaL g- ime between Primary loss cf consciousnes: | & Neurological deterioration. Or Time Needed by Haematomea +o Yeach oF Size +o cduse Mass Effechs So tb depen ey lucid interval Venjous—*No CAUSE Small Haematoma:s Stop bleeding & Tn Venous Héemotoma -> Ly loss a Consciousness Gccur- Ly oy Neurolegice! cletorioration NB , NoTecurR. ON Source oF Bleeding [eres Nenous Bleed (9 ® 4 PINISOCoria—y Epsilateral Hemiparesis> CoN TRalederal we Hacmatema at ste of Aivisocoda, eg dy @ 4 Arwisocoria> Epsittercl Vem pariesis3 psi lateral — So he Best Clue to defermine site oF Haematoma. 5 the Qnisocorion, NOT Hemiparesrs ble anisocoria Always developed to Same Side of Haemotoma while Hemi paresis mey Epsilateral or contralateal... SEB— the hemiparesi§ is ConTRAleteral to the damged Boe Se Spciloteral te Fhe Haematoma —> SJ Yolee hecalrzin sgn. 29 Yoematama on RF side push Bein Stem Aggainst “Tentorial & es clamge +o Cereloral peduncle oF leh sité = Ri Side Hemiporesig | » Clinical_picure io equ Haematoma » Haemotoma will Stap the Bleeding & ore the Vessels - « Headacy without NeuvelogrcaL roblene --» tes@ Xray: fudue of temporal. lbene Q CT Scam brain + Bone windows Shew —Seper@ion oF clue flow skill (Hyperdense Bieomes = Midline shift lesion) —Bone window (CT Bone without brain issue) Bettecte See™ frecure tn Skin) IE) ocde Blood in CT 4 Fypertense White ae eclour Qubaate Blood incT » Isedense 40 Brain tissue Chronic Bload 19 CT Hype dense (dark 9 caleur) featment: £ sonal & stationary «Venous Haemotona + Conservetive, HEE OF Lage. & progressive Tinsres Surgery (Craniotomy) creniatomy + Evacuation of Haematomnd + Stopping Bleedi Rouce + Return Backy the Bone Flep & clese the skull (3) F Lage & stable + Sugery Cranictomy bie Ue may cause Sfilepsy che to mass prssure effect... ~—fssgeesis:. iE Dieqnesed @ Heatwent tarly & ray ther Morbiclity & Metlality Me Reach Ze%.. TF Late chiagrosed @ Late rented > mortality Smorbidit Rute GB) Sub-duel Haematoma: ff susacite 4 7 chronic. = Collection OF Blood Between ‘Dura & cerebral Hisguew % Source oF Aleecling, &- Mainly Venous (Fear in Bridgia vein» py to sinus ~- Leeratidn of Brolin tissue.) 5 nbad spregnesis 60-Fo'/. Mortality Bk...AL Route subdural Haemetema - 0 nical. picturex() Broad Coma or may Consclous According to Site oF Hoemotenta @ Brawn Swvelieg High Ticp dueto underlying tissue, lamge. Diagresis <@ Yoray: Skill Fadl @ Sie the haematoma take Shape of clara(SiKle) Biconcave Hyperdense Lesion withe cr without Mass oF fect » with or without Hidline Shiftas CTheatment? (3 Craniotemy and Evacuation of Haewatond © craniectomy + Remove Bone Flaps Evacuation of Haemetoma Y, clot Return Bon Rapegus Qe Brain fer Expansion. to Stimulate cp throuh this Bone window Bulged Brain > high Icp NAF Bulged brain + Soft Lox brain tissue -PEGMSISS hod pregnesis @ Elevation F fHead (Hj > Tvenous Return yf Blood amouat @_ Wyperventillations 5 y poor to 28 Normal pooa = 35-45) _» Cerebro Vesospasny a Bisad compart wen Ww © Dug = @® Mannitol - tt increase osmotic Prassue —> Diuresis + } viscosity SF Blood 4 T cerebral effusion —» y : vodue Hien of CSE doser 1-29 /Kg (444 (fusion! This wet give for mone fhan Bday: tle development of Rebound phenemena - iad ae Odewa¥ we have Mannitol S%- 10% .90% Which aie Are ONE we have to use 2- Better 26% bk Low Flurd Content & Diuretics > 4 csr productions © Stewid + } cerebrel odews @ prphyladic Antiepleplic drags © sedate & Musde Relerant ble ae ceggh ot Shes wil T Ice - In Sever Cases - We heve Y Clemprstors) Q) apenas: tor 850° ~> Hetalcliso ip cerebral tissue > h 82 demand by cerebum— take tt more Xdlerant Jo iSchemia .. (S Nentricule stom 5 (Extema| Nemec cular droin) -» EVD possible Yo dene te is Ai Not — BE in tae Lop > Narrow Lateral ventricle : > cath We punctused © Frontal Lobectory7or Tempordl lobectomy (Let st) Nese cone if there lebe are severly cere contused or Gdemateus this clone woll ateraly : -Lndication: 1. diaqnesis of meninaitis _Bacephali's Tediaanesis oF Subarchnaid Haementye 3-Heaswment oF CSF prassure uRemeve CSE to JY Icp Balngjection 9 cus) Rcortrast medio natcattion 1 High Tep 2 Bleenn Tendency fs)B-_Sub- ocute -subdural Haenmatoma + —_—__—$—— eee, Sender Sus eel haeacdamial Lease SER, Subaats subducal - Diagnosis & Haematome ON CT scant this tsodens Yo brain Hesue Ss to AtiYrentate t From norma) brain Hssue, We havete do CT Scam S CONTRAST —» Show Compressed cleviated Blood Nessds oct Haemotoma + Sfhecemenh an or displacemat of Gy Usa : ~Tisatmet S iE there is Midline shift 7 (Sagery cranictory) iF there is No Midline shiFY 4 conservaiwe Cmidline shif} oN CT Scan :Cmass effect ) ttt. >» Prognesis + Better than the acute lype C- chrenic subdural Haematome . SF SESS More Common in ald age and Plcchohc ble f+ ® cerebral Ptrophy > streatching of Bridging, NAN More able fo “nteed even E Minor Arouma. ® those People more Viable to Repeated Aroama. en head due to More Liability te Fatting own > Clinical pichans - de on the site. More Gmmon in Cereloral hemisphere: L- Headach 2 Aaxic Gai} (Coebral Ateve) 5- HemiparesiS 4- deterioration in (evel oF constionsnes BeSpeech may be affeded a Diogoosis 3) CT scan is lag nostic + Hypoclense fesion dak Incelour” Ear € Mass effect LEE @ Conservative ttt » IF No mass effect © tf there 18 ress effect> midline shift. Sunaical Evacuedion theygh Simple burrhele (Not Craniiotomy ) in Some Cases the Chronic Haewertowa Septatec\ Copsulatd) > Need craniotomy to Evacuate oy Lub Nowaday can evacucte > chronic septate = seine hematowes Through “at burr hele + Fleaible EndeSeopy 7¥ prog nesis Has Excellant prognosis. B) Taha cerebral Heematoma - Traamd Ccontusion) Rarely coused Mest commen sike Ke contusion _, Tempera & Pyontokas8l . Bic itis Lie dived ly on skull , but Moy cceur odany place +. Muthiple cerelsral contusions Wald teqether with a he 2 PB aman Haewatowa . Called clelaye. anvedtt aAcerebral wo 3. Dingoes pe ee ottC “Latracerebr Haematowd i Show Vyperdens interfere € Hypodense area > Salt ePpepper Apperance = not Some Mone hypodense aren Surround ree eiees Treetment : Bed eel tacar iT Laewmatoma 1s Superficial G cause mass elfed —»do Sur ery & evacuate Ho ENO ass effec even sapaPracl 7 denservat e vo If there is No mass efFech 4 i deep Haemakoma —? tenserctive the if there is Mass Effed €D Ffuse Intraceniel ny [ Mild Concussion : pt Has no History oF Loss oF conciousness pt Has Nemological ceFiat¢ clisorinted , Conkased , hemipatesis) Reovery Completely within few Hour to Few lay + Has No amnesid (3) classical Concussion: Jhere is Histoy oF loss of Conciousnacs( Nat Nore than 6 hr) usualy 2o-acstlnk + more than 6 hr-7 diffuse AkoNAl Concussion Pt has Neurological defictl which Recover withia few day te Faw weeks there is AlNnesia especialy Pee from time of “Weuma bud May be Antermgrade or postgrade amnesie (5) Diffuse AXOWAL Inquy + DAL. Less of Consciousness 7 6 he may be Mild > pt Recover From com? within ouhe LL sModerdte > Coma Sauhe Lo gever > come >Whr + si A Brain Stew = Aqzary egCirregslor SP —Kempieis) ore Neurclagial defidt nm mild Moderte type > a wit Improved bud ta Sever it will persist epr may ie, ys CT sean: usually Nomal fer DAL (-ve etscan) » tk: conservating wougarent . Teu Mangmaent 3Sum mety + Neurosurgery : J Head Inqury rio a Nera clagsificatien Accordingto atoning to a to Mechanisy, a M phology oF iyjury Mila Hedeete EV sate Closed : Oper head tales Grama Head ue ve In aye Cat eal ) piers OF Feud, ON. J skal — High ie focal oo i 7 Anqun nya act ) te vO d wd. she. So/> G) -Site:- -* the most pat susctbtable 4o treumd ts Cewical pert Gof oF Spine Ingury thoracic Spine which fs More abe be of Ribs@ less Nobile 8% oF spine Inqu a “Thoracolumbar gundion 2of oF — Topury (Mobile pert) Lumber Spine lo% oF Iopury locral Fe¥ion 2% 5 ingey -Lreidence OY of spine ‘inqury «Fed 15-Bo years fold be °F a5 ak Aron *9 3yed wiv _Type of Freche 2 Genaal, a facture oF vedebral body ON \y 457 x Fractuce Gsublerations 3574 *«ONLy sublexation 8% x Traumatic ise polepseé fracture of € sublaxation€/ Fructane, * Spinel. cord ngany 2Y lo/ Caigee oF Cervical spre aciong - -Bccipital di fon t- Lomediate death be oF . Ritants Desig disor stop Respiration aon [El Atlas Fracture Cot fuctaird): G13, the Most common ONE is Conmniuted Frecdure JefFeiSoN frectune.usual the Hing can be split t iato 25352 4 place a Diagnosis. G aie Mouth Velw: +o fissess displacement + ( peftersan Facdure) Fracture of ther ® oFCL E the displacement More than 69mm (the Transverse. amen} was Ruptured ) g plans X-ray: A- p Co = unslabie a B Ct scan- ~ HEE: Hale qackeh far SMonth > Ensure, healing byCT Scan. Flexion = Xora ‘FHealing farl-y ptrieed posterior Ocipitocervial J Prion, p 3 nis Fracture, as 218% | g Face eo hee Safed Loe NO} one ez cr Posi if 8 CRS) + ~Go0% SF Axis Frackuve. Which is Mostcommonly Missed Fractune GFensves qdonoid 35 Process fe Articulation. ( in Cewical Spine & Consftate io oF all cerwical ijaries lea 2-odontoit ACESS %- Ue on Ante su rior side} No other vertebra has oclontoiel ibis process =deng Missing Body: oF ATIAS Bé tt seperate from | Atlas Sanne Nhs onic » py CHa AT 26 Ai halve = Frudure of pedicle: oF C2 ~d-10% oF cencal inquries ~ Caused by Hyper Extension oF spine a» they are Stype i “pert “Wpe rr bea v Most Stable Most unsteHe one Tn Belwen tet by Halo-jacket tht by Cervical fasion Immobilization Rs parhary th 03 _ Month . 8 Qo, OF Axis Fruchres“ATLANTO -OCCIPITAL INSTABILTTY) 2 GOMMON IN Children: + Spentanously due to en | “Trauma or Even duete ‘Infection. in Neck or haryn resent 8S ‘Instabtlity bo stria se * Clinical pictines. usuall P ty the Fead- which tend bo Leok.-to oF Uslightly up So called: Cock Robins pes tion. Diegnes SiS: Ox rey @ ct&an E pt locking to RE # then bo leFH. © if the position of Axis 1s Fast 3 in Relation to the Rtlas on two {veiw then Fred ATIANTo-AxiAL Rotshon can Dig nosed + BR (4) ca-c# Frackure Lower cervical Spinext: Most COMMON — | c@usecd by Hy per Flex Lower -cerrcal oF spine Féeeinpatl ht ber inguey Caused by: Hyper Flex by Pasa L commpre ve oF Spine Fragments cf Bone “pth tet: stoma | AE pushed citcumfen Cethis pa 3 So: Sal Cord wey [ bel ia erly surgical. Sable Bdloesnet (Qver Exténston. BBP YHR, Meters Bensacy Guriaarye Redal _aiys fandhiowDIAGNOSIS oF Cew- Spine Injuc © HIsToRy — Pre fajury Neurol ical status — Histor of the Event - pes Papel Status & change in neu states 3 EXA MINI RATION = Assessment O ‘peel aoe hanes suspeded if rolegicel \ ere TS ro Clavicular inzury - head ingury funconciousness/ “ Facial injury. High beny fagucy > Fall From hight w hry cer aciclent- Evidence of neutological defiot “Tracheal deuration © Hematoma & swelling in Neck. Abnormal head position J in & Tenderness ® Neuwto logical Fissessrnent: e PWWer Weakness Tene » Reflex change -Putenomic. dyskundhion S Assess iF the cord Lesion Complete or incomplete é- iF the cord Leston Incomplete the sacral Nemes are these most Likely do be spated> Sacral gearing the Sacral pene Toot are the least afhected in © spinel injury probally lole Vhey are prctectel to Extent from vascular affeds g- inyery incompl Sacral sparing @n ke assessel F. a OD PR Examination to assess rectal Sphinder » BX > complete cer inqur an P yey \eTenic > Incemplee © gacral sengahon Tnface—siComplete cord ingury Aloxcent > compel 6. eN-B- F SPINAL ShecK has developecl s- TH will aot be Possible te assess Function Below the Injury untill the spinal shock’ has Resolied ot LeaslS Around 2Ubn 5 86 cluurving this perioel gou cond Assess iF the cord lesioh is completer or in complele « occur Tuntedial Tnsuty. pulse noel 4 H potension Flaccid parlysis Including sphiacters. Abscent ReHexes (v6) = SpivarL “Shock Cord hos Tnvestiq Stion,— serait So +r ‘i +» Lateral ceruical spine a Xray qe Urgeat: “chest Fin” palit ‘lm CAP veiw. Now Urgent: A-pvetus UiBopen mouth view is the t Cenical spine | Sblque views Best to see odentetd process ane Articulation boxu C1-Ca. Ls Theracolumbar Yeiw = RP Open-trouth Ly Lateral Veil INS it Label veiw to cereal spine > Fh cervical spine Must be in the veiw Ct Make Fh ceyical spine vertelsra clear in yrey Ether > pull Arm of pt +waarel His thigh tokeep shoulder ot lower level Expose #th-cerica! vertebra, Wimmer wer VF previous two Technique not make it clearny do cT scanS ( ctsean: Best Fer Bony iggy Fructure) , Spinal canal stenosis as Rete - pulsed Fra ment=~ (3) three dimentional CT scan: CANIALe SAGITAL CT) Show ingury to Bone , Facet , Sub taxation. More Sensitive, to bone angury BM MRI: More sensitive bo spinal corel S soft Fissueinguy e.g (ord compression Or Contusicn . &) Myelogam: iF there is Compression ->the centrest will gS B&B Wor Hoye. @ General Investigation: GBC ESR -CRp money, foreleg a [Ais Always ASSESS 4hAT THERE Ts SPINAL Inyur UNTELL. prove OTHERWISE-- a my [B). Xnnmobilize the Spine unk Inyury has been Exeludée} te Avoid further ingayys _o Sart atte oF Traum’. fix heacl &/ Neck by attaching . CLP there 1s assooi@tad Life threatening condititn eg “Shoo _ pouhave to deal & it Fret. [D) , -Bixation €Strmmebilraation © posterior Piradion of occipit fo upper 3 or Y Cervical verlebra if Fackwe tm ATIas @ JetFersen Fraduce Eternal Fixation « @ C2, Fncture oF _, reba Exernal | Odontoid praecs ecg itieutt |, Sublaxatien 5 (5s Eternal Fix. BE Malunica is TS en conawallon rt +Intemal Fxation@ Anterior Repech lay dense Scred Le posteriow C1-C2 Fratton - Internal Fixation i @® Hangmans fradune: xternal Fratton (Halo gacket) © Frade & sublaxation—» Open reduchon + Intemal F xetion + Removal of dise (Chiscectomy) and Bone Graft instead of clisc > by time Wil Rise ag one unit. LNB Disc prlapse Should be Excluded befor reduckion is attempled. © communitel Fracure Bane Fragment in spinal covt canal: Corpectony: Remove the bedy of verlebra Y pub Bone Galt * yeu have to remove, trode cbove + & Below: bo ALLew civect contack Between tne Groat &Yvertebra Abue & below ws unit later on. N®: the Mos} Common Body facture ts body & C5 Commenest level CS Ce ble it ig Most Meotsile pact iA Flexion & Extension .. E Drugs: Steroid + (methyl predni2ciene) Give i directly in Large de in 45 BheCBo ng/kg) help recov ay = L[pregnosis Ih 5+ if Complete ond lesion: complete newvolagical defiert a Fler 2ubr No change te improve him 21 Ineompletes the earlier mangment the beter prognosis@ = Small number & pt may get progressive deteriorahbn tn neurological status Tngpite 4 Good ‘Lmmncbilization this ocur He oF persistent compression to cord —> inteFering & Blood Supply to Neurelogicél tissue bot be due Extension oF Haematoma os adem in aren of HOH es -N-Bi-Trumaéfccident is ast cause oF death befor Forlers Yoy. while Afler Forleis Puy 45> is Heart disease then Cancer the shoke then Accident. - Alp ’Jrarneter F Spinal cord + Counteur & aligament oF Vertebral body - Bone Fragmen displace ments + Linear & Comminated Fracture © Soft Hesuo . Caan ED) e Axial loading + C1 ¥# Oh Sons A 7 Hyper Flexto + Hyper Extension + Lateral Bending + Rotehen o Otstadion (Hanging) BE Ban. GD Yolo « rhe ley@ Thoracic ane digeatsliinbars fadure, Ls » = Crea) 1. = Usually NOT Common. as thoracic vertelare are supported by Ribs Sshernum (rio cage __» Wedge #* Associated € Oshegporosis ate Mast commons these is stable ~ > tet pon Meee siminebili Zain, _» Ober pattem Fx io thoracic verdebre, usuolly associated € High Energ Maltifaumatic iucy _» then combined & Stermal Ss Acetic rupture. Not UACOMMan, ungtable theracic #% are easly Missed on @ iageoph | Vers can displace ~ ’ | —Thorace Lumbar facture) Tio- Ls thoaclimbar# are Mare commen than thoracic # ble this part oF spine not suppaded by Rib ca > Most common Vertebral 4 Tia BLA bk these are at qurckien bfos stiff thaedic spine ¢/ Mobile lumbar gine. | wr therace-lumbar vertebra are divided into eleurnn: (2) Brnterior cdumn: (Ant Lengel el Sree ~RNE Ip oF vertebral Body RUT Y, of Romulus files (2 Middle column : post pb. of vertelyal kaaclies pod Ja oF Annulas Rbrsis pest Leng tectral Ligamed S (3)_pesterior column: ( Lamminae, pedicle, nous Lignmentam Flavum, Pacet-pint PSs Thier Spins garment A SPiINoUs spinus’ G 7 SP ts : “t liga i. )Co) N°Bs- any Fracture thrcugh more than one column ‘S” unstable-. : eNE Column is $able fracture & No Fracture thoug Need Fixaher . _Type oF Fracture. Tn thoracohwn Regror LL WEDGE Fracture: CANT WEDGE Compress for) ~ Cause: Flexion Trauma x Sable nee (Most comman) fee neur in - tt: the Conservative & then Mobility é Hole JAKET- logical Relive + Bed Rest [2 Burst fracture: — Céuse: Vertical teume usualy itis Commnuited — Diagnosis: Xeray SBedinal segn is widening f distance b/w ~ the palide . Fracture in boey of vertebra &/ Pedicle> unstable x it i may be stable io this fracture atkast &column ave affected = Che: ANT+ MIDDLE > Unstable Ise fragment Ma displaced Gems ress Cord. ws + ane indliceded ugicel Retio pu Ye bpt free Neuralog rc Snkwention! LU ANT Hight of verlebral body Reduce! >50% & Kyphohte Angulation 20-26% (26°) &) Spinal cana Compranize 50% inal Canal Compomizet Neurological deficit» 09> 2uf bs Surgical intervention +. + if pt has Neurolo. ealy defy de surguey Operation’ “Trans pedieulay Stew! 2 Above 22 Belw and de destuction . if SHill Compression clo rpectemy[3) Splitting Fracture i Qa Causes. Flexion & Extraction CDistrachen) Sub}ype:- (through Bony Elements —raSprncus process ¢Y one c Doce fucked oe + Verkbral boc, 6) through the. Ligaments —» . Supra spiinus Osan . Inter spinus t amen} ues Ut — Phen pe o dina + Tnterbértelral. Ligament {e) through bony V/Ligament Clinical picture: clepend ont stor ae Mey bez. Corel > UNNL ‘ Conus Medallanss Coda Sgquine Rests» More Liable to Recovers CLMNO) y Us Associated & IntaAlbdominal Lagi » Spliffing # usualy UNSfable be this ustally occur thou P bry eljemeh Elements a a Bragnoss Xa baie - CTsan - MRI tte: postenor Braker by Frans ~peciculer Scrat Gdlecompressiav- aS Eman GB/2ot0«* Anatomy:- the nervecus system divided into Central Nerous cystem 27 peripheral Nervous system: SONS consist of ‘Brain & Spinal cord & ft two cranial Nena V consist °F the remaining cranial and spina) cord-- CNS have abit be regenedte While prs have _Good Ability to Regener ee > Schwan cell Bagmen} membrane & Ende neural collagen Fibers form Endonayral tube + / Lage number of feet Nerve fibee trite, inetariuun are Qathed in Fascicdes gurrounded Aaneuna by Connechve tissue Sheet called Gaye cet! perineunum. the fasceles are bound together” Ss » Axons and the Whele “bunk” is Surrounded byCT} fasicle. bayer called) Epineurium « -1F dhe heuma cisn the AYoN > Cistal pad te injuc undergo Wallerian a aia P wg Y Up( lysis oF YMyoplasm & Ereqmentetion of Myelin gheaths , Leaving an Enconeurial Aube Sentcthined alsneniel — the AXON In Proximal port have the petental to Rd enerdte, Sito the Endsneunel tubes fF clislel segwent. the Regeneration preseeds an (43 mor Soy) @na eRe R- depend Sn the aFfecked Nero &/ Severity | F inqucy ‘ LAWL Flocerd Isis Motor e/fer Sere vert G FineUN &® pes. C= CURSSTFICHTION OF Nevo Tran) ~ BSED DDONT CIASSIF ICA TION: —— = a + Local block te cendudin 6 Ancrhomical clisctsptiog -sComplele cut of “ef Neruc Impulse in AXON &fhere J Newwe “Hunk Axon Intact, continous) My celine nares « Waerian No Walleriandegeneiatiall Wallerian de accur i ASI por we Block is Result from Binin tel och Localize demyelination) Cause: Cause! Resulb of open of Fibrous in “canned | Resuld from Sever How Tngury as Stabe wound oe ere of Nevo or sireatching injery Aso Uh Energy action eis mild ingur . Nerve + Noxious Dawg ingectien caused by Light posse : Radial Nerua paky | & Tschemia can cause (by Teurnigaet ) orsligh “ePsociaded & EH Hamed} Ib. @eedehin of teria” Gs usually Raonctmesis) fae tt if proper Surgical : aie Lbs Rezovary occur Repoir is arablad Naneed surgery by Aron Regeneration ine (Rronal. Complete a a3 mee fon adrade Alon ener within feu dey fo 09 the gare Endo neirial (lnc Bibe Wycomect € the qualih ly of dearar in the same Endorgan Neue pemect- fRewwici Os this feat of Feliuredolo SB eed (escent INUSIS * Koa tube & other CT Nave lave SIS + Gyoae! been Ssapt Bien € Res oning Neac Bex st Repair. Norm Sensory + Ree Shere Mesto Keqenerade Nema oa cerinecdt € Musclese did Senson organ w Not prdyiesuly ionstiaktHis classify Nerus tapuy int 5 deoree oN the. Gants of Tnateasing Anatomica disruphen of Netve Treant Intact In tact Intad -lntact chmged this’ classiFicahon used 4o dishacion Bjvo Be yth degree oye iF fascides are in sacha (30d clegree) > si NEOUS Covary i: ible but iF fascicles a7@ damgec the Spontanecus ceilany (7) (Rade Geet Seyreal) + Cuse: physiological BlocK at site oF Injar « C/ps Light paresis & Sensery dis} urbance © Dx: EMG: Electrophysiological Shidy -* Block At site of = bed Complete Spontanecds Reccvany? “Trauma fe INO Surgury. (2 (Grade IE anddeste)? aCausei- Axon clisnption, Track Endoneutium “Cipi- Deep Sensory & Pieter deficit o th Aiton Regeneretion CAmmlday) the &acbneyrial Lube actas Gute for Regenerate Axon to the ariainel TTavgetC Excellent Recavary)[2 Grede IE 8¢ degree) _) cause: Axon clisruption | Enconeunal tube disruption NB: there is Intalascioular Bleeding —» Fibrosis > & Regenerating AXoN +o Breceed + No lent Re Va CRecovary depend on bend of Fibrosis ) ah _ & A ~m iF Sever fibsosis?- iF Fibrosis Mild to Moder@les- interfere € eneration 66-804 Regeneradion .. > Recovary oF Funchon 8/c there.is Need Surgical ‘Thleventiin, No Guide fee Resgenerat Axon. i * | Grade Bul dre) ) Cause: Prory. Endonerium/peri erium are disrupted. No Spontaneous Recovary >» Need sucgey. (5\(Grad Ye oth degree Cause: Complete cut off Nerw tank? No chance of Recovany , Need Sage: Molor Loss. | Complete loss | complete loss | completeloss sparioy} Complete loss }compleke lass} (| Fabre Sparel J et Los} QJ) Nerve condudia Abscort 6) Recovary | Rall Complete SmmldayWeakness Power ‘a hishory of “Fraume *@ dinical Examination: Motor Kancion & Senso Rinchon 7 Tow point @ Rutonémnic Ranchi Cro sensitive) L boss siysolng © X-ay: Kir Exclude Fracture oF Bene Related ts Nero darqaey G@IMRI: if there is Evulsion in Nerve root > 6s Si pe aa scele Ce shee 5) dle: hysiolegical studies = Neuro Stologic : 7 ae Draqnostic ti ie : We Must wyait ny wks Afler Nene Loguy befor these Test Catlbe performed ble within 2-3 WK OF damged News has Necmal Elechophys- Srudy as dempblinaton = Wallerian de me Need Lwk-lo day to o@ur.. 3 ENG slegical_ Study <3 SSE +e pe of Electrophy: @ ENG: Seco Nya gra » mustle actten potential ar IS a) Recorded in Resporce fovea : Ackui @ Ep: ( Somatosensory Evoked “potentol) Nerue conduchon Study Tnvdlue Recard ing of Sensor or Mote Nenw Acton gpetenheal &/caladatin vloay far Givi Anatemica] Segments n» Slowly coruction cPBnomalihes)vi (CRUSE CHECHANISH oF PTT) Q Laceradions inguy (Stabe wound) © contuston ingus (blunt trauma) @ commpression ~ ingury + Carpal Tunnel syndrome. - Bete Dik proapse. Compartment syndeme + set ‘Tight plaster. OG Sheakh & Evulsion inqucys Motorcyde Acatdent TY Evbs fale : © Etrem Temprdkme @ither Extrem cold, Glireine heat umn © Lngection ingury > Toxin, chemical. > NeuTitis @ Electricity. rT] TREATHENT OF PINT. reser LS Blunt Inpury Laceabon Tapry co ENG after 2-3wik oF Tagury> dorit do sme No Contusion contusion afer Yana bat eat 2300 Vv cer ble befer it Normal EMG Primary Repair Vv Grenif there is Complete Seconda Neue cut as demylinatien ie ao wallertan deqensatten Caceur within doleday) wait 16 day -2u IK demylLinated Nemes, hlonamal EMG UNHIL odema subside NON demylinaled Nera —> Narmal EMG then Remove Contused part oF) Nene.Blunt Lrjay @ Normal EMG Abnomal ENG ¢ wait & Repeat ENGaFler Smonth walt for Spontarieous Recovagy iF imprved NOT Imprevel Follow up ENG Explore &/ ie afer SMonth — Factor Aifecing Recovany 3~ @Bge : children haat than Adutt Oserieity Clean cut do Best > High energy Inga eqlGuns het) Cdamge of Piles 2 has “worse prognosis) © Level: Oistal Lesion do Better than proxinal i He the distal Lesicn Need less time to Reoverthe Leryth of part distel 4 Lesion ( 43 moidfeq) ° @ Better In pt Gout premedical disease COM Hypertensice) Gin Non smoker better than SMoKer, 6 Type! Motor Nerve to Large Muscle clo Bes} © Other inguries + Sot Hssu€ ven 2 Vascular ingu & Frachute male the progneas bad. ro @ delay: the Gar lie~ repair the BeHees pegnosic,NB) why prognesis In distal Lesion Better @) j Khan proximal ? - proximal Need mone +me to Recover. @. proximal Lesion the Mober & sense Fibere ane present tn 8dme trunks while In soem Motor ae Sepacade-—> Sensory &/ Motor Pp Bray v with ach oe J “ - Follow up: o ENG + More Sensihuc. @ Clinical > Observe proximal Muscle to injue cect it is ‘Ficchorh & calewade time needed ty Become Funcheni CReinneruated) C1 Bmrm/dey) > iF time. Needed Cowesp ond) te the distance Blo the Muscle & site of Tague) > Gyood Prognosis. Clinically Examine Reinnewvated Musde th on the masclé7—» if there ts Reinnewathion Here is Fasiulation of [. 1 Musde 'F Nw Reinnervotion —s Jo fasiclation.ee Commpresion Inyury xTneidences More Common in Q 20% #3) bie the Catpal tunnel In wommen is Narow than man HK predisposing Factor! 0) Obestly ® thyroid disease G Matunion oF fracture in this areq ) Contra cephue pills Acrsmegalh RE minis @ wrist dauma @ Exostesis @ Diaysis Wedbonic. Feral faliare O@E FANTERTOR —» Plexor Retinualum POSTERIOR -» carbal. Bowe ONTENT e Median Nerua, Flexer Tendon OF Finger % Clinical picture: parasthesia( loderal #3), Finger) (luring cengakin © pain Cruignt > day time) — fans 2 Necdis? S weakness & Atrophy oF Thera ase ig @ Falling bye weelkness oF Hand Grip {Har ASSESSMENT: @ —Tasei thesic t apping — ParastMesia + Pain @ Phalt test > Plearon oF wrist 6o/second ve ParmSthesia—Linanosis Geng & © Sp @ CTsScan ax Treatment: Ol Pild | (2) Modedle to Sever &¥ Prthaflammato: nugs % Surgical clecompression ¢F Yep support thearm Median nena. Citherby s- physiotherapy Q classical opening Le anasthesia © Endoscopic ayy BeHer B/e “there is No Fibrosis > NO Recewrance. Insizing Jhe Flexor Rehinaculum