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SPINAL INJURIES
DR MURIITHI

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ANATOMICAL
CONSIDERATIONS
 SPINAL CORD SHORTER THAN SPINAL COLUMN
 CORD ENDS AT LOWER BORDER OF Ll
 ADULT SPINOUS PROCESSES, VERTEBREA AND
CORD SEGMENTS DO NOT LIE AT SAME LEVEL
 CERVICAL ARTICULAR FACETS (HORIZONTAL)
 DORSAL ARTICULAR FACETS (OBLIQUE)
 LUMBAR ARTICULAR FACETS (VERTICAL)
 CERVICAL SPINE VERY MOBILE
 THORACIC CANAL IS VERY NARROW

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ETIOLOGY
 ROAD TRAFFIC ACCIDENTS
 INDUSTRIAL ACCIDENTS (BUILDING SITES)
 FALLS
 SPORT INJURIES (DIVING)
 PENETRATING INJURIES (KNIVES)
 MISSILE INJURIES

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CLASSIFICATION
(A) SIMPLE OR MAJOR
 SIMPLE:
 FRACTURE SPINOUS PROCESS
 FRACTURE TRANSVERSE PROCESS
 MAJOR:
 BODY FRACTURES & DISLOCATIONS

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CLASSIFICATION
(B) STABLE OR UNSTABLE
THE THREE COLUMN THEORY
(C) WITH OR WITHOUT NEUROLOGICAL
DAMAGE
INTACT CORD AND ROOTS
DAMAGED CORD AND OR ROOTS

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THE THREE COLUMN
THEORY
 ANTERIOR COLUMN
ANTERIOR HALF OF VERTEBRAL BODY WITH ANTERIOR
HALF OF DISC AND ANULUS FIBROSUS AND ANTERIOR
LONGITUDINAL LIGAMENT (ALL)
 MIDDLE COLUMN
POSTERIOR HALF OF VERTEBRAL BODY WITH
POSTERIOR HALF OF DISC AND ANULUS FIBROSUS AND
POSTERIOR LONGITUDINAL LIGAMENT (PLL)
 POSTERIOR COLUMN
POSTERIOR BONY COMPLEX
POSTERIOR LIGAMENTOUS COMPLEX

ASIA CLASSIFICATION
A-complete;both sensory and motor
functions not preserved.

B-incomplete,Sensory preserved,motor
not preserved

C-incomplete;sensory and motor
preserved but muscle power less than
grade 3

D-incomplete;sensory and motor
preserved,motor power≥3
E-normal 7
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CLINICAL PRESENTATION
 HISTORY OF TRAUMA
 SYMPTOMS
 PAIN ON MOVEMENT OR AT SITE OF INJURY
 DISTURBED SENSATION
 INABILITY TO MOVE A LIMB OR PART OF IT
 RETENTION OF URINE OR INCONTINENCE
 SIGNS
 DEPEND ON TYPE, LEVEL AND EXTENT
 TENDERNESS OVER FRACTURE

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CLINICAL PRESENTATION
 SIGNS RELATED TO CORD DAMAGE
 SENSORY LOSS BELOW LEVEL
 MOTOR LOSS BELOW LEVEL
 HYPOTONIA BELOW LEVEL
 AREFLEXIA BELOW LEVEL
 SIGNS RELATED TO ROOT DAMAGE
 SENSORY LOSS IN DERMATOME/S
 MOTOR LOSS IN MUSCLE/GROUP
 HYPOTONIA OF MUSCLE/S
 REFLEX LOSS IN DERMATOME

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CLINICAL PRESENTATION
COMPLETE TRANS-SECTION OF CORD
 LOSS OF POWER BELOW LEVEL
 LOSS OF SENSATION BELOW LEVEL
 SUPERFICIAL
 DEEP
 POSTERIOR COLUMN
 LOSS OF REFLEXES BELOW LEVEL
 HYPOTONIA BELOW LEVEL
 MUTE PLANTER REFLEX
 RETENTION OF URINE

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CLINICAL PRESENTATION
BROWNE-SEQUARD SYNDROME
(HEMI-SECTION OF THE CORD)
 CONTRALATERAL (SPINOTHALAMIC)
 LOSS OF PAIN
 LOSS OF THERMAL SENSATION
 IPSILATERAL (CORTICOSPINAL & POSTERIOR
COLUMN)
 LOSS OF MOTOR POWER
 LOSS OF PROPRIOCEPTION

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IMAGING
 PLAIN X-RAYS
 ANTERO-POSTERIOR AND LATERAL
 DYNAMIC VIEWS
 OPEN MOUTH VIEWS FOR ODONTOID
 SKULL XRAY WITH CERVICAL FRACTURES
 COMPUTERIZED TOMOGRAPHY
 BONE WINDOWS
 RECONSTRUCTION
 ?MRI
 OTHER SYSTEMS AS REQUIRED

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MANAGEMENT
 CARE IN HANDLING DURING RESCUE
 CARE IN HANDLING DURING TRANSPORT
 CARE IN HANDLING DURING XRAY

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MANAGEMENT
THE THREE PRINCIPLES APPLY
TRACTION
REDUCTION
FIXATION

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MANAGEMENT
 CARE FOR
 SKIN
 BLADDER
 BOWEL
 NURSING CARE
 FEEDING
 REHABILITATION

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MANAGEMENT
(A) STABLE INJURY WITHOUT DEFICIT
 FRACTURE SPINOUS PROCESS
 FRACTURE TRANSVERSE PROCESS
 WEDGE BODY FRACTURE LESS THAN
50%
SYMPTOMATIC TREATMENT
BED REST
ANALGESIA
PHYSIOTHERAPY AND MOBILIZATION

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MANAGEMENT
(B) UNSTABLE INJURY WITHOUT DEFICIT
 FRACTURE DISLOCATION OF CERVICAL
SPINE
 WEDGE FRACTURE MORE THAN 50%
 FRACTURE INVOLVING TWO COLUMNS
REDUCTION THEN IMMOBILIZATION
TRACTION WITH TONGS
TRACTION WITH HALO
MANIPULATION OF LOCKED FACETS
OPEN REDUCTION
PLASTER OF PARIS
FIXATION BY PLATES OR BONE GRAFTS

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MANAGEMENT
(C) STABLE INJURY WITH DEFICIT
 TEMPORARY DISLOCATION, DISPLACEMENT
 INJURY TO SPONDYLOTIC SPINE
 BONE OR DISC FRAGMENT INJURY
COMPLETE INJURY
CONSERVATIVE
INCOMPLETE INJURY
CONSERVATIVE
SURGICAL
PRESENCE OF COMPRESSING AGENT
IMPROVEMENT THEN DETERIORATION

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MANAGEMENT
(D) UNSTABLE INJURY WITH DEFICIT
COMPLETE LESIONS
REDUCTION AND IMMOBILIZATION
INCOMPLETE LESIONS
REDUCTION AND IMMOBILIZATION
DECOMPRESSION OF THE SPINE AND
IMMOBILIZATION

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MANAGEMENT
(E) SPINAL CORD INJURY WITHOUT
RADIOGRAPHIC ABNORMALITY
(SCIWORA)
 CHILDREN
 NOTHING COULD BE SEEN ON X-RAYS
 NOTHING ON CT SCANS
 MAY BE AN HYPERINTENSE SIGNAL ON
MRI

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MANAGEMENT
REHABILITATION
PHYSIOTHERAPY
PASSIVE
ACTIVE
OCCUPATIONAL THERAPY
IN PATIENT
OUT PATIENT