UNCOMPLICATED

AND
COMPLICATED
SPINAL INJURY
Uncomplicated spinal injury

Uncomplicated called these spinal lesions that are

not accompanied by damage to the spinal cord
and its roots. Among them, the most unfavorable
prognostic is dislocated and fractured vertebrae.
Late diagnosis of these injuries can be a cause of
secondary damage both the vertebrae and the
contents of the dural sac - the spinal cord and its
roots. Remember that the diagnosis of back injury,
ligament damage can be established only after
completely excluded the diagnosis of vertebral
damage.
 Dislocation and fracture of the vertebral
bodies

Damage to the vertebral bodies tend to

occur in the indirect mechanism of injury: the
axial load on the spine, sudden or excessive
flexing his or (more rarely) extension.
Sometimes it can combine two or even three
types of load. For example, when the so-
called whiplash injury mechanism combines
sharp flexion and extension of the cervical
spine when hit by a car, braking and other.
The mechanism of injury in spinal fracture
1,2 – lumbar; 3,4 - cervical spine

1 2 The mechanism of injury in

spinal fracture
1,2 – lumbar; 3,4 - cervical
spine

2 3
 In adults, the most damaged vertebrae
in the transition zone of one of the
physiological curvature of the other, i.е
тhe lower cervical and upper thoracic,
lower thoracic and upper lumbar
vertebrae.
Dislocation of the more common
cervical spine, while in the thoracic and
lumbar fractures predominate and
fracture-dislocations.
 Spinal injury Stability defined
integrity posterior ligamentous complex,
which includes interspinous, and yellow
over the spinous ligaments and
intervertebral joints. Damage
accompanied by complete destruction of
the posterior ligamentous complex, called
unstable, others - stable. In unstable
injuries tend to anteroposterior
displacement of the vertebrae with the
threat of compression of the contents of
the dural sac. With stable turn this trend
there.
• instability injuries include sprains and fractures, dislocation
of vertebrae, fractured wedge body compression in the
anterior half of its height and more, as well as flexion-
rotation fracture
• Stable fractures of the vertebral body - peel angle, wedge
compression is less than half the height of the vertebral
body and the so-called explosive fractures
• «explosive» fracture occurs when the axial load without
bending and straightening of the spine. This vertebral
endplates break. Nucleus pulposus adjacent vertebrae
embedded in the vertebral body and tearing it from the
inside on the principle of water hammer into several
fragments. Stable damage occur more frequently unstable.
 Unstable fractures of the spine

Stable vertebral body fractures

 Diagnostics. The most common complaint
of patients in the early stages after injury is a
pain in the injured spine. The intensity of pain
depends not only on the severity of bone
damage, but also from soft tissue injury, the
patient's general condition, individual sensitivity
threshold, and others. In cases where spinal
damage accompanies injury to other organs, the
patient can not draw the attention of the doctor
to pains in the spine and injuries go unnoticed.
In these cases, the correct diagnosis contribute
to a detailed medical history and a careful
clinical examination.
 X-ray study begins with an overview of X-
ray in two projections: anteroposterior and
lateral. In the future, if necessary, make the
sighting shots, and X-ray tomography of the
spine in the oblique projections, allowing more
detail to identify pathological changes in both
the vertebral body and the back of his
department: arches, articular and spinous
processes. The most constant symptom of
vertebral body fracture is a wedge-shaped
deformation of it, which is visible on the
radiograph in lateral projection.
 Treatment of fractures of the
lower thoracic and lumbar vertebrae.
When providing first aid with a suspected
fracture of the spine should be remembered
that the movement of the spine, especially
bending it, may lead to further damage to
the spine and spinal cord. Such patients
should be transported on special stretchers
with the shield or on improvised structures
that exclude spinal flexion.
 Of the many methods of conservative
treatment of vertebral fractures most widely-
stage reduction is followed by the imposition of
the corset, functional method and the gradual
repositioning followed by the imposition of the
corset.
Immediate reposition followed by the
imposition of the corset is shown with
considerable (about half of vertebral body
height and more) wedge compression of the
vertebral body.
 The principle of the method.
Straightening broken vertebra forced
straightening the spine, followed by the
imposition of a corset to fracture consolidation.
Simultaneously reposition is performed under
general anesthesia or local anesthesia. The
simplest method is the anesthesia by Belair,
when Interspinous span over a broken vertebra
at a depth of 2 - 4 cm administered 20 ml of
0.5% solution of novocaine. Local anesthesia
supplemented by subcutaneous administration
of analgesics.
 Reposition the spine straightening may be
performed on the tables of different heights
according to the method of Watson - Jones -
Belair or pulling up the leg of the patient lying
face down (Davis' method). However, a more
suitable reposition the universal orthopedic
table.
In this case, spinal traction bath is
provided by changing the curvature of the
resilient strips when approaching the table
pedestals.
 Reposition compression
fractures of the lower
thoracic and lumbar
vertebrae Watson - Jones
- Belair.
 Corset is applied at the position of the spine
extension immediately after the simultaneous reduction
and radiological control. In this case change the position
of the patient should not be. The plaster corset with
compression fractures of the spine has some
peculiarities. The main goal of his - to prevent bending of
the spine, located in extension. The corset should have
three support points: the sternum, symphysis and
lumbar spine in the region of maximum lordosis. You
must strive to ensure that the back remains open for
opportunities. This will facilitate the later impact on the
region of the back of physiotherapy and hygienic
procedures will make it possible to massage the back
muscles.
From the first days spend physiotherapy, massage,
exercise therapy. Go to the corset allow 3 weeks after
repositioning. Read the corset after 4 - 6 months.

Traction on the shield

 Operational posterior fixation of the spine is
indicated for uncomplicated flexion fractures of the
vertebral bodies.
The principle of the method. After fracture
reduction is carried out fixing the spinous
processes, arches or transverse processes of the
damaged spinal segment. Thus, the load is
transferred to the rear intact spine and damaged
vertebral body is discharged the entire period of
fracture healing. External spine immobilization is
not applicable. Straightened the broken vertebra is
produced in the preoperative period by one-stage
or progressive reduction.
Method of spinal posterior fixation by
Yumashev.

Fixing plates spine

Senile spine fracture

Called senile vertebral fractures in elderly

persons on the background characteristic
of osteoporosis. Damage occurs in the
thoracic or lumbar spine at little effort
during the thrust or bending of the spine.
Thus there is a wedge-shaped vertebral
body compression or separation of its
front corner. Senile fracture refers to a
stable group.
 Diagnosis The clinical picture is
characterized by vague pains in the damage
zone. Often pain localized in the side of the
fracture. This is due to concomitant injury of
degenerated intervertebral discs and
ligaments of the spine apparatus. However,
a careful examination can identify most of
the symptoms typical for fractures of the
vertebral bodies of the lumbar and thoracic
spine.
 Treatment. Straightening broken vertebra
fracture in senile do not produce. Treatment is
carried out by the functional method on a horizontal
bed with a shield.
Movement of the patient in the bed is not limited as
long as they are not associated with spinal flexion.
From the first days of physical therapy teach classes
according to age and comorbidities, medication for
osteoporosis, back massage and legs. After lifting
the patient in an upright position (3 - 5 weeks) is
shown wearing a lightweight soft corset like "grace"
or the backboard for up to 3 months.
 Complicated spinal injury

In a closed injury of the spine there are

varying degrees of spinal cord injury and
roots of the cauda equina, from
microscopic changes to bruises, crushing
and anatomical interruption. Thus brain
edema may reach such an extent that the
brain fills the lumen of the dural channel.
 Clinic complicated spinal injury

Functional interruption of the spinal cord syndrome with

complicated spinal injury is characterized in the acute period
(depending on the level of damage) quadriplegia or paraplegia with a
low tone, anesthesia conduction type of priapism, a violation of the
functions of the pelvic organs and the autonomic functions
(perspiration, skin temperature, hemodynamics and others.). In clinical
practice, the initial period, characterized by the following symptoms,
referred to as "spinal shock" term. The duration of this period in the
case of reversible neurological pathology is highly variable and can
sometimes be several weeks or even months. The majority of patients
with spinal cord injury picture reaches its maximum severity at the time
of spinal injury, indicating that the value of a sudden change in the
configuration of the spinal canal at the level of damage. With all the
injuries below the cervical and lumbar-sacral above segments flaccid
paraplegia later becomes spastic. In the absence of rising cystic
degeneration with injuries below the cervical hands remain intact.
 In different periods of traumatic spinal cord
disease, depending on the morphological changes in it,
and the flow of cerebrospinal fluid circulation disorders,
the development of cystic degeneration, the clinical
picture may change and manifest a variety of
neurological syndromes of spinal cord dysfunction on the
cross section is the defeat:
1) complete cross defeat syndrome (functional spinal
cord break);
2) syndrome of defeat half the diameter of the spinal
cord (ventral, dorsal or lateral);
3) Centro-medullary lesions syndrome. Each of these
syndromes characterized by a certain set of symptoms,
which in turn are closely intertwined, in various stages of
moving from one to another.
 Violation vesical functions. One of the most
frequent manifestations of traumatic spinal cord
injury is a violation of urination, often complicated by
infection due to the stagnation of intravesical urine.
This in turn leads to reflux complicate pielitah and
general sepsis or urosepsis. Difficulties with urination
associated with violation of the normal mechanisms
of regulation of detrusor contraction and relaxation of
the sphincter. Tactics early overlay suprapubic vesical
fistula in patients with urinary disorders with any
severity of spinal cord injury in time of peace be
considered vicious.
 Against the background of a prolonged
antibiotic therapy can be intermittent bladder
catheterization. Catheterization is usually carried
out 3 - 4 to 6 times a day depending on the speed
of filling of the bladder. Even in cases of
permanent catheterization (6 - 8 months), the
majority of patients with the right manipulations
with careful observance of the rules of aseptic and
antiseptic not observed any signs of vesical
infection.
 Bedsores. One of the most frequent
complications in patients with spinal cord injuries
are decubitus developing in 20 - 53% of cases. As a
gateway infections are a source of pressure sores
and septic complications 20 - 30% of death cause.
Decubitus are lost through a large number of
protein fractions (40 - 50 g), which increases further
aggravates the condition of patients. Proper skin
care, early massage, use suspending devices in
acute and early periods of spinal cord injuries may
prevent the development of pressure ulcers.
 Principles of surgical treatment of complicated spinal injury

Patterns of injuries of the cervical spine should be considered when choosing the
surgical method.

1. Any injury of the cervical spine in the sagittal plane, accompanied by damage to
the musculo-ligamentous apparatus, must be regarded as unstable, which in the
acute or long-term period of traumatic spinal cord disease may exacerbate its
morphological changes, which clinically manifested by progressive cystic with the
development of focal symptoms .

2. When dislocation, fracture-dislocation, and penetrating a compression fracture of

the vertebral body compression primary factor is biased or deformed vertebrae of
the spinal canal segment and also the bone fragments of vertebrae that make the
front of the spinal cord compression.

3. In the interim period, these factors contribute to trauma anterior spinal and
radicular arteries, which can lead to disruption of spinal cord ischemic vascularization
and formation of cavities.
 Absolute contraindications to emergency anterior
decompression of spinal injury in complicated cases should be
considered when patients:

1. admission to hospital are lesions of the brain stem symptoms,

combined with
2. functional interruption of the spinal cord;
3. clinically detected a pronounced center-medullary syndrome in
the absence of clear indications of radiological damage to the
cervical spine ( "clinic without radiology"), which usually
accompanies the mechanism of injury.

A relative contraindication for emergency surgery is rapid (within

hours) neurological symptoms regressed.
 THANK YOU
FOR ATTENTION
!!!