Cervical Fractures and Cervical spine injuries - Dr.KK
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Transcript of Cervical Fractures and Cervical spine injuries - Dr.KK
Cervical Spine Injuries
CERVICAL SPINE
CERVICAL SPINE
• Seven Cervical Vertebrae
• Eight pairs of Cervical spinal nerves
Cervical Spine Injuries
Main Cause of the disease
TRAUMA
RTA – leading cause
Mode of injury
• Road side accidents (RSA)
• Fall from height
• Accidental injury due to carrying heavy
weight over head
• Sports injuries
• Trivial Trauma in Pre-existing Spondylotic
spine
Mode of injury
Mechanism of Injury
• NO STUDY TILL DATE WHICH CORELATES
SEVERITY OF INJURY WITH
MODE OF TRAUMA / INJURY
Cervical Spine Injuries
Cervical spine injuries
with cord injury
without cord injury
Cervical Spine Injuries
• PRESENTING COMPLAINTS
• Pain
• Quadriplegia
Myotome and Dermatome Testing
Nerve Root Level
Sensory Testing Motor Testing Reflex Testing
C1-C2 Front of face Neck flexion N/A
C3 Lateral face and skull Lateral flexion N/a
C4 Supraclavicular Shoulder shrug N/A
C5 Lateral shoulder/upper arm Shoulder abduction Bicipital (musculocutaneous)
C6 Lateral lower arm and hand (thumb and index finger)
Elbow flexion and wrist extension
Brachialradial (musculocutaneous)
C7 Palmar aspect of hand – middle 3 fingers
Elbow extension and wrist flexion
Triceps (radial)
C8 Medial lower arm and hand Finger flexion and thumb extension
N/A
T1 Medial elbow and upper arm Finger abduction N/A
DERMATOME DISTRIBUTION
INVESTIGATIONS
• Radiological• X-rays AP, Lat , Swimmers view ,
odontoid view
• CT Scan
• MRI must for patients with neurological loss
DIGNOSTIC – PRE OPERATIVE
X-RAYSLateral view
• Top of T1 visible in idle lat view • Three smooth arcs maintained• Vertebral bodies of uniform height• Odontoid intact and closely applied to C1
AP view• Spinous processes straight and spaced equally• Intervertebral spaces roughly equal
Odontoid view• Odontoid intact• Equal spaces on either side of odontoid• Lateral margins of C1 and C2 align
DIGNOSTIC – PRE OPERATIVE
CT SCAN MRI
SIGNS OF INSTABILITY
• AP translation > 3.5mm• spinous process widening on lateral• rotation of facets on lateral
• facet joint widening• malalignment of spinous process on
AP view• lateral tilting of vertebral body on AP
view
LAT VIEW – X RAY
LAT VIEW – X RAY
Prevertebral soft tissue
Nasopharyngeal spaceRetropharyngeal space Retrotracheal space
AP and Odontoid View
Initial Treatment• CAB • Immobilization rigid cervical
orthosis- Philadelphia collar
Spine Board
cervical traction with Halo or Gardner wells tongs.
Initial Treatment
NO
YES
Treatment - Conservative
Halo traction Gardner wells tongs
Surgical Treatment
• Stabilisation
• Anterior• Posterior• Combined/ Global
fusion
Surgical Treatment
Surgical Treatment
Surgical Treatment
Surgical Treatment
Ferguson and Allen Classification
• Classification is Based on position of neck at time of injury and dominant force
• Compression and Flexion• Vertical Compression• Distraction Flexion• Compression Extension• Compression Distraction• Lateral Flexion
Occipito-atlantal Dislocation
hyperextension distraction
and rotation of craniovertebral junction
severe neurological injuries from complete C1 quadriplegia to incomplete syndromes
Surgical Treatment
ATLAS FRACTURE
• Axial compression injuries• neurological injury rare• 3 types
Jefferson fracture- direct compression and lateral masses forced apart
asymmetric load fracture ant or post to mass and displaces it
posterior arch fractures with an extension moment through it
Jefferson Fracture
• Compression fracture of the bony ring of C1
• Odontoid view
• Displacement of the lateral masses of vertebrae C1 beyond the margins of the body of vertebra C2.
Jefferson Fracture
Odontoid Fracture [Axis]
• 15 % all cervical fractures
• usually hyperflexion with anterior displacement
• assoc injuries to C1 common• neurological deficit in 15-25% cases
Odontoid Fracture
• Best seen on the lateral view
• Types– I – Fx through superior portion of dens– II – Fx through the base of the dens– III – Fx that extends into the body of C2
Odontoid Fracture
Odontoid Fracture
Odontoid Fracture
Type 1 - Philadelphia collar for 6-8 weeks
Type 2 undisplaced - halo immobilization displaced - Primary C1-C2 fusion after
reduction in traction [most recommend if displacement > 4-5mm]
Type 3 Halo vest immobilization after reduction in
traction ( 3-4 months)
C2 Hangman’s FractureFx through the pars reticularis of C2 secondary to
hyperextension
Hangman’s C2 FractureTraumatic spondylolithesis
• Type 1 isolated minimally displaced fracture of ring with no
angulation
• Type 2 more unstable flesion type/extension type or listhetic type displaced > 3mm and angulation of C2-C3 disk space ALL, PLL Disc can be interrupted
• Type 3 rare , anterior dislocation of C2 facets on C3 with 2
extension fracturing neural arch
Three types of Hangman’s fracture
TREATMENT
• Type 1Conservative - rigid cervical orthosis
• Type 2– closed reduction with traction– halo vest immobilization
• Type 3– Surgical management - C2 -C3 fusion
Clay Shoveler’s Fracture
• Fracture of a spinous process C6-T1
• Signs: – Spinous process
fracture on lateral view.
– Ghost sign on AP view
(i.e. double spinous process of C6 or C7 resulting from displaced fractured spinous
Burst Fracture
• Fracture of C3-C7 • axial compression.
• CT is required for all patients to evaluate extent of injury.
Wedge Fracture
• Compression fracture resulting from flexion.
Buckled anterior cortex.
Loss of height of anterior vertebral body.
Anterosuperior fracture of vertebral body.
DISLOCATIONS
Bilateral Facet Dislocation Unilateral Facet Dislocation
Cervical spine injuries with Vertebral artery occlusion
Prevention is Better than Cure
When meditating over a disease, I
never think of finding a remedy for it,
but instead, a means of preventing it ”
Louis Pasteur
Thanks
Cervical Spine Injuries
…….. Known is a drop….…………………..unknown is an ocean………..
Dr. Kalaivanan Kanniyan Assistant Professor – OrthopaedicsArthroplasty and Adult Reconstruction UnitSMCH, Saveetha University, chennai, Tamil
Nadu, India.