Traumatic Spinal Injury

(TSI)
DR .WAQAS ARSHAD BAJWA
PG SURGERY
 Overview
 Function of spine.
 Defintion of spinal injury. Diagnosis.
 Antatomy of human spine. Managment
 Classification of spinal injury.  Prognosis
 Epidemiology. Rehablitaions
 Pathophysiology of spinal injury.  Conclusions
 Clinical features of spinal injury.
 Functions of spine
Protection to spinal cord & associated nerves
• To allow for movements
• To support over body frame in up right position
• To allow for flexibity
• To provide a structural foundation to shoulder and pelvic gridle
• Act as shock absorbers
• Provide a structural base for ribs attachments
 TSI
• Injury to spinal column ( Bony column/ Spinal cord) or both of them
that result in loss of fuctions such as sensory ,motor and autonomic
 Anatomy of human spine
Spinal column anatomy
•Series of motion segments .
• Upper cervical spine anatomy is designed to facilitate motion .
The cervicothoracic and thoracolumbar junctions are transitional
zones.
.
 Spinal Stability
• Spinal stability is the ability of the spine to withstand
• physiological loads with acceptable pain
• avoiding progressive deformity or neurological deficiet
 Spinal Neuroanatomy
• The spinal cord extends from the foramen magnum to the L1/
L2 level, where it ends as the conus medullaris in adults (lower in
children)
• Below this level lies the cauda equina illustrates a cross-section of the
spinal cord.
 Types
1) Spinal column injury Bony injury
(Bony) 1) Compression fractures
2) Spinal cord injury 2) Burst fractures
3) Combined 3) Flexion-distraction
Fractures
3) Fracture-dislocation
Complete and incomplete spinal injury
 Epidemiology
• incidence is 15–40 cases per million
• leading cause RTA.
• Males > females
 Risk factors

• Degenerative disease of spine. • klippel feil syndrome

• Spinal cord stenosis • Arnold chiari malformation
• Ankolysiong spondylitis • Metastatic CA
• Down syndrome • Osteomylitis
• RA
Mechanism of injury
PATHOPHYSIOLOGY OF SPINAL
CORD INJURY
• The primary injury
This is the direct insult to the neural elements and occurs at
the time of the initial injury
The secondary injury
Haemorrhage, oedema and ischaemia result in a biochemical cascade
that causes the secondary injury.
 Clinical features
• Pain • Loss of autonomic activity
• Breathing difficulty • loss of bowel control
• Senstivity to stimuli • loss of bladder control
• Muscle spasm • sexual dysfunction
• Loss of sensation • Paralysis
• Loss of reflex function
PATIENT ASSESSMENT
• The unconscious patient
Definitive clearance of the spine may not be
possible in the initial stage.
 PHYSICAL EXAMINATION
• Initial assessment :
The primary survey always takes precedence,
followed by a careful systems examination paying particular attention
to the abdomen and chest. Spinal cord injury may mask signs of intra-
abdominal injury
Spinal examination :
. Inspection
. Palpation
. spinal log roll .
. A rectal examination .
 Neurological examination

.Motor function is assessed.

.Sensory function .
. Rectal examination
 Level of neurological impairment
• The ASIA Neurological Impairment Scale is based on the
Frankel classification of spinal cord injury:
● A: complete spinal cord injury;
● B: sensation present, motor absent;
● C: sensation present, motor present but not useful (MRC
grade <3/5);
● D: sensation present, motor useful (MRC grade ≥3/5);
● E: normal function
 Investigations
• LABs : Routine work up
Radiological
X-ray, CT-Scan & MRI
 Basic management principles
• Spinal realignment
Stabilisation
Decompression of the neural element
Corticosteroids
 Specific Spinal Injury
Upper cervical spine (skull–C2)
Occipital condyle fracture
Occipitoatlantal dislocation
Atlas fracture (Jefferson fracture)
• Atlantoaxial instability :.
Odontoid fractures :
 Subaxial cervical spine (C3–C7)
.
Thoracolumbar spinal fractures (T11–L2)
 Complications associated with
spinal cord injury
• Bed sores
• Pain and spasticity
• Autonomic dysreflexia
• Neurological deterioration
• Thromboembolic events
• Osteoporosis, heterotopic ossification and contractures
 REHABILITATION AND PATIENT
OUTCOME
• The goal of spinal cord injury .
• . There is a focus on goal-setting.
• The level of neurological impairment .
 Prognosis of spinal cord injury
• Below normal following SCI.
• The median life expectancy is 33 years .
 Conclusions
• Pre hospital & Post hospital care.
• Surgical interventios improve recovery period ,quality of life and
rehab reduce mortality and morbility
• SI is neglected poorly managed
• Pre hospital care of suspected SI patients should be improved