A short review with simple classification and management. Suitable for med students but needs some additional reading.

1. SPINAL INJURIES
FOR
FIFTH YEAR MEDICAL
STUDENTS
PROF. WALID S. MAANI
JORDAN UNIVERSITY HOSPITAL AND MEDICAL SCHOOL
12/05/12 SPINAL INJURIES 1
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

2. 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
12/05/12 SPINAL INJURIES 2
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

3. ETIOLOGY
 ROAD TRAFFIC ACCIDENTS
 INDUSTRIAL ACCIDENTS (BUILDING SITES)
 FALLS
 SPORT INJURIES (DIVING)
 PENETRATING INJURIES (KNIVES)
 MISSILE INJURIES
12/05/12 SPINAL INJURIES 3
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

4. CLASSIFICATION
(A) SIMPLE OR MAJOR
 SIMPLE:
 FRACTURE SPINOUS PROCESS
 FRACTURE TRANSVERSE PROCESS
 MAJOR:
 BODY FRACTURES & DISLOCATIONS
12/05/12 SPINAL INJURIES 4
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

5. CLASSIFICATION
(B) STABLE OR UNSTABLE
THE THREE COLUMN THEORY
(C) WITH OR WITHOUT NEUROLOGICAL
DAMAGE
INTACT CORD AND ROOTS
DAMAGED CORD AND OR ROOTS
12/05/12 SPINAL INJURIES 5
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

6. 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
12/05/12 SPINAL INJURIES 6
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

7. 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
12/05/12 SPINAL INJURIES 7
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

8. 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
12/05/12 SPINAL INJURIES 8
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

9. CLINICAL PRESENTATION
COMPLETE TRANS-SECTION OF CORD
 LOSS OF POWER BELOW LEVEL
 LOSS OF SENSATION BELOW LEVEL
 SUPERFICIAL
 DEEP
 POSTERIOR COLUMN
 LOSSOF REFLEXES BELOW LEVEL
 HYPOTONIA BELOW LEVEL
 MUTE PLANTER REFLEX
 RETENTION OF URINE
12/05/12 SPINAL INJURIES 9
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

10. 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
12/05/12 SPINAL INJURIES 10
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

11. 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
12/05/12 SPINAL INJURIES 11
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

12. MANAGEMENT
 CARE IN HANDLING DURING RESCUE
 CARE IN HANDLING DURING TRANSPORT
 CARE IN HANDLING DURING XRAY
12/05/12 SPINAL INJURIES 12
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

13. MANAGEMENT
THE THREE PRINCIPLES APPLY
TRACTION
REDUCTION
FIXATION
12/05/12 SPINAL INJURIES 13
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

14. MANAGEMENT
 CARE FOR
 SKIN
 BLADDER
 BOWEL
 NURSING CARE
 FEEDING
 REHABILITATION
12/05/12 SPINAL INJURIES 14
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

15. 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
12/05/12 SPINAL INJURIES 15
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

16. 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
12/05/12 SPINAL INJURIES 16
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

17. 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
12/05/12 SPINAL INJURIES 17
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

18. MANAGEMENT
(D) UNSTABLE INJURY WITH DEFICIT
COMPLETE LESIONS
REDUCTION AND IMMOBILIZATION
INCOMPLETE LESIONS
REDUCTION AND IMMOBILIZATION
DECOMPRESSION OF THE SPINE AND
IMMOBILIZATION
12/05/12 SPINAL INJURIES 18
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

19. 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
12/05/12 SPINAL INJURIES 19
MEDICAL STUDENTS
UNIVERSITY OF JORDAN

20. MANAGEMENT
REHABILITATION
PHYSIOTHERAPY
PASSIVE
ACTIVE
OCCUPATIONAL THERAPY
IN PATIENT
OUT PATIENT
12/05/12 SPINAL INJURIES 20
MEDICAL STUDENTS
UNIVERSITY OF JORDAN