this presentation includes spinal fractures and spinal injury s with their classification.. information taken from J.Maheshwari and google.com

2. STRUCTURE : the vc consists of 33 vertebrae
( 7 cervical, 12 dorsal , 5 lumbar, 5 sacral and
4 coccygeal)
Posterior ligament complex :
•Thick capsule
•Ligamentum flavum
•Interspnious ligament
•Supra-spinous ligament
•Inter-transverse ligament

5. A stable injury is one where further displacement
between two vertebral bodies does not occur because
of the intact “mechanical linkages”.
A unstable injury is one where further displacement can
occur because of serious disruption of the structures
responsible for stability.

9. On the basis of mechanism of injury
1.Flexion injury
2.Flexion –rotation injury
3.Extension injury
4.Flexion-distraction injury
5.Direct injury
6.Indirect injury due to the violent
muscle violent muscle contraction.

10. Commonest type of injury
Examples :
1. Heavy blow across the shoulder by heavy object.
2. Fall from height on the heels or buttocks.
Results : in the cervical spine , flexion force can result in :
• A sprain in the ligaments and muscles of the back of the neck
• Compression fracture of the vertebral body , C6 to C7
• Dislocation of one vertebra over another(commonest over C5
overC6 )
• In the dorso-lumbar spine , can result in:
• Wedge compression (L1 is commonest , L2 and D12)
• Its is stable injury if compression of vertebra is less than 50
percent of its posterior height

12. Worst type of injury(because it is unstable , high neurological
damage)
Examples :
1. Heavy blow onto one shoulder causing the trunk to the flexion
and rotation to the opp side.
2. A blow or fall on the postero-lateral aspect of the head
Results : in the cervical spine , flexion force can result in :
• #-dislocation of cervical vertebra.
• Dislocation of facet joints on one or both sides.
• In the dorso-lumbar spine , can result in:
Here one vertebra is twisted-off in front of the below it. While the
dislocating the upper vertebra takes a slice of the body of the
lower vertebra with it.There is a extensive damage to the nerual
arch and PLL , hence unstable injury.

14. Common spinal injury.(Unstable injury)
Examples :
1. A blow on the top of the head by some object falling on
the head
2. A fall from the height in erect position.
Results :
in the cervical spine :
• Burst #( compression on the cord : neurological deficit)
In the dorso-lumbar spine:
• Rarely occurs

16. Commonest cervical injury.(Unstable injury)
Examples :
1. Motor vehicle accident : the forehead striking against
the windscreen forcing the neck into hyperextension.
2. Shallow water diving : the head hitting the ground ,
extending neck.
Results :
chip # of the anterior rim of the vertebra.

18. Seat belt injury
Examples :with the sudden stopping of
the car , the upper part of the body is
forced forward by inertia while the
lower part is tied to seat by seat belt.
The flexion force thus generated has a
component of distraction.
Results : horizontal #(posterior
elements)
Also called chance #.

20. Rare type of injury
Examples :
1. Bullet injury
2. Lathi blow hitting the
spinous processes
Results:
Any part of the body can be
damaged by smashed bullet.
But spinous processes # by
lathi

21. Rare injury
Examples :
Sudden violent contraction of
the psoas .
Results:
# of transverse processes(can be
associated with a huge
retroperitoneal haematoma ).

22. •PAIN : in the back following a serve
violence of the spine.
•Neurological deficit :
•Patients complaints of inability to
move the part
•Loss of sensation
•History of violenece

23. •GENERAL examination (any hypovolaemic
shock and associated injuries to head , chest and
injuries)
•NEUROLOGICAL examination (level of motor
paralysis, loss of sensation, -nce of reflexes)
•Examination of the spine : done by a surgeon

26. •X-ray
•CT SCAN
•MRI (confirm investigations)
•Tomogram

31. The aim of treatment is:
(i) to avoid any deterioration of the
neurological status
(ii) to achieve stability of the spine by
conservative or operative methods
(iii) to rehabilitate
the paralysed patient to the best possible
extent.

32. Reduction is achieved by skull traction applied
through skull calipers – Crutchfield tongs A weight of up to 10 kg is applied and
check X-rays taken every 12 hours. Also a close watch is kept on the patient’s
neurological status, because it is possible to damage the spinal cord or the
medulla by injudicious traction.
When it is confirmed on X-rays that reduction has been achieved, light traction
is continued for 6 weeks. This is followed by immobilisation of the neck in a
moulded PoP cast or a plastic collar. In about 3-4 months, a bony bridge forms
between the subluxed vertebrae, and the spine stabilises. The collar can then
be discarded.
Operation: This may be particularly required for:
(i) irreducible subluxation because of ‘locking’ of the articular processes or
(ii) persistent instability. The operation consists of inter-body fusion
(anterior fusion) or fusion of the spinous processes and laminae (posterior
fusion). Internal fixation may be required.

35. 1. # OFTHE ATLAS.
2. ATLANTO-AXIAL #-DISLOCATION
3. CLAY SHOVELLER’S #
4. DISPLACEMENT OF IV DISC

36. Stable injuries: Most of these need a period of bed
rest and analgesics followed by mobilisation. Initial
mobilisation may be by some external support, like a
brace etc.During the period of bed rest, one must take
special care of possible complications such as bed
sores, chest infection, urinary tract infection etc.
Unstable injuries:These are either associated with a
neurological deficit . Open reduction and surgical
stabilisation gives the best choice of recovery but
conventionally, these cases have been treatednon-
operatively with: (i) bed rest for 6 weeks; (ii)bracing till
spine stabilises; and (iii) care of the back.

37. Operative intervention:This is particularly required under the following circumstances:
a) Partial neurological deficit with CT or MRI
proven compromise of the spinal canal.
b)Worsening of the neurological deficit.
c) Multiple injured patient.
Operative methods: Whenever necessary the following operative methods are performed
• Harrington instrumentation – bilateral
• Luque instrumentation
• Hartshill rectangle fixation
• Pedicle screw fixation
• Moss Miami system
Flow chart-31.2 shows a practical plan of treatment of injuries to dorso-lumbar spine.