spine injuries

1. SPINAL INJURY
SRIRAM MOHANAKUMAR
GROUP 6
6TH YEAR
TSMU

2. INTRODUCTION
• Spinal Cord Injury (SCI) is damage to the spinal cord that results in a
loss of function below the level of the lesion, including paralysis,
sensory loss, bowel/bladder/sexual dysfunction. A fracture or
dislocation of a vertebra can cause bone fragments to pinch and
damage the spinal nerves or spinal cord.
• Most spinal fractures occur from car accidents, falls, gunshot, or
sports. Injuries can range from relatively mild ligament and muscle
strains, to fractures and dislocations of the bony vertebrae, to spinal
cord damage.
• Many fractures heal with conservative treatment.
• however severe fractures may require surgery to realign the bones.

3. ANATOMY

5. A dermatome pattern shows which spinal nerves are
responsible for sensory and motor control of specific
areas of the body. The spinal nerves innervate specific
areas and form a striped pattern across the body called
dermatomes we can use this pattern to diagnose the
location of a spinal problem based on the area of pain or
muscle weakness. For example leg pain (sciatica) usually
indicates a problem near the L4-S3 nerves.

6. What are spinal fractures?
• Spinal injuries can range from
relatively mild ligament and muscle
strains (such as whiplash), to
fractures and dislocations of the
bony vertebrae, to debilitating
spinal cord injuries. Spinal fractures
and dislocations can pinch,
compress, and even tear the spinal
cord. Treatment of spinal fractures
depends on the type of fracture
and the degree of instability.

7. Whiplash
• Whiplash is a common injury to the neck caused by hyperextension or
rapid back and forth motion of the head - most often in a car
accident. The jerking motion strains the muscles and ligaments of the
neck and may cause the discs to bulge. Whiplash can lead to
headaches, stiff muscles, or neck pain. It is important to examine a
spine injury carefully. Whiplash is different than a spinal fracture or
spinal cord injury and the symptoms usually improve with
conservative treatment.

8. Spinal instability
• Spinal instability is the excessive
motion between vertebrae caused
by stretched or torn ligaments and
broken bone. Abnormal slipping
and rubbing motions can cause
pain and damage the spinal
nerves or spinal cord. Stable
fractures can usually be treated
with bracing and rest. Unstable
fractures usually require surgery
to realign the bones and prevent
spinal cord or nerve injury.

9. • Fractures can occur anywhere along the spine. Five to ten percent
occur in the cervical (neck) region. Sixty four percent occur in the
thoracolumbar (low back) region, often at T12-L1.
• There are numerous classifications for fractures. In general, spine
fractures fall into three categories:
FRACTURES
DISLOCATIONS
FRACTURE DISLOCATIONS

10. FRACTURES
• when more pressure is put
on a bone than it can stand,
it will break. The most
common type of spine
fracture is a vertebral body
compression fracture .
Sudden downward force
shatters and collapses the
body of the vertebrae. If the
force is great enough, it may
send bone fragments into
the spinal canal, called a
burst fracture. (Left) Normal spine. In a compression fracture (right), sudden
downward force shatters the body of the vertebra (arrow).

11. DISLOCATIONS
• when the ligaments and/or
discs connecting two
vertebrae together are
stretched or torn, the bones
may come out of alignment
For example, when the rapid
forward motion of the upper
body against a seat belt pulls
apart the vertebra and
stretches the ligaments. A
dislocated vertebra can cause
instability and spinal cord
compression. They usually
require stabilization surgery
or a brace.
In a dislocation, the ligaments are stretched or torn (arrows)
allowing the vertebra to come out of alignment.

12. FRACTURE DISLOCATIONS
• occur when bone is broken
and the ligaments are torn
These fractures are usually
unstable, tend to be very
debilitating, and are often
surgically repaired.
In a fracture-dislocation, both the bone and ligaments are
disrupted (arrows).

13. What are the symptoms?
• Symptoms of a spinal fracture vary
depending on the severity and location
of the injury.
• They include back or neck pain,
numbness, tingling, muscle spasm,
weakness, bowel/bladder changes, and
paralysis. Paralysis is a loss of movement
in the arms or legs and may indicate a
spinal cord injury.
• Not all fractures cause spinal cord injury
and rarely is the spinal cord completely
severed.

14. What are the causes?
• Car accidents (45%), falls
(20%), sports (15%), acts of
violence (15%), and
miscellaneous activities (5%)
are the primary causes of
spinal fractures.
• Diseases such as osteoporosis
and spine tumors also
contribute to fractures.

15. Who is affected?
• 80% of patients are aged 18-25
years
• Men are 4 times more likely to
have a traumatic spinal fracture
than women

16. How is a diagnosis made?
• X-RAY test uses x-rays to view the bony vertebrae in your spine and can tell
your doctor if any of them show fractures. Special flexion and extension x-rays
may be taken to detect any abnormal movement.
• Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray
beam and a computer to make 2-dimensional images of your spine. It may or
may not be performed with a dye (contrast agent) injected into your
bloodstream. It is especially useful for viewing changes in bony structures.
• Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a
magnetic field and radiofrequency waves to give a detailed view of the soft
tissues of your spine. Unlike an X-ray, nerves and discs are clearly visible. It
may or may not be performed with a dye (contrast agent) injected into your
bloodstream. MRI is useful in evaluating soft tissue damage to the ligaments
and discs, and assessing spinal cord injury.

17. What treatments are available?
• Treatment of a fracture begins with pain management and
stabilization to prevent further injury.
• Other body injuries (e.g., to the chest) may be present and need
treatment as well. Depending on the type of fracture and its stability,
bracing and/or surgery may be necessary.
• Surgical procedures used to treat spinal fractures are:
Vertebroplasty
Kyphoplasty
Spinal fusion surgery

18. • Vertebroplasty and kyphoplasty are similar medical spinal procedures
in which bone cement is injected through a small hole in the skin
(percutaneously) into a fractured vertebra with the goal of
relieving back pain caused by vertebral compression fractures.
• Vertebroplasty is typically performed by a spine surgeon
or interventional radiologist. Patients are given local anesthesia and
light sedation for the procedure, though it can be performed using only
local anesthetic for patients with medical problems who cannot
tolerate sedatives well.

19. • During the procedure, bone cement is injected
with a biopsy needle into the collapsed or
fractured vertebra.
• The needle is placed with fluoroscopic x-
ray guidance. The cement (most commonly
Poly(methyl methacrylate) , although more
modern cements are used as well) quickly
hardens and forms a support structure within
the vertebra that provide stabilization and
strength.
• The needle makes a small puncture in the
patient's skin that is easily covered with a
small bandage after the procedure.

20. Spinal Fusion Surgery
• Spinal fusion surgery is sometimes used for spinal compression fractures to
eliminate motion between two vertebrae and relieve pain. The procedure
connects two or more vertebrae together, holds them in the correct position,
and keeps them from moving until they have a chance to grow together, or
fuse.
• Metal screws are placed through a small tube of bone and into the vertebrae.
The screws are attached to metal plates or metal rods that are bolted
together in the back of the spine. The hardware holds the vertebrae in place.
This stops movement, allowing the vertebrae to fuse. Bone is grafted into the
spaces between vertebrae.

21. • Recovery from spinal fusion
surgery takes longer than with
other types of spinal surgery.
Patients often have a three- or
four-day hospital stay, with a
possible stay on a rehabilitation
unit. Patients typically wear a
brace immediately after
surgery. Rehabilitation is often
necessary to rebuild strength
and functioning. Activity level is
gradually increased. Depending
on the patient's age and health
status, getting back to normal
functioning can happen within
two months or up to six
months later

22. Nonsurgical Treatment for Spinal Compression
Fractures
• Pain from a spinal compression fracture allowed to heal naturally can
last as long as three months. But the pain usually improves
significantly in a matter of days or weeks.
• Pain management may include analgesic pain medicines, bed rest,
back bracing, and physical activity.
• Narcotic pain medications and muscle relaxants are often prescribed
for short periods of time, since there is risk of addiction.
Antidepressants can also help relieve nerve-related pain.

23. • A back brace provides external
support to limit the motion of
fractured vertebrae -- much like
applying a cast on a broken wrist.
The rigid style of a back brace
limits spine-related motion
significantly, which may help
reduce pain.
• Bone-strengthening drugs such as
bisphosphonates (such as Actonel,
Boniva, and Fosamax) help
stabilize or restore bone loss. This
is a critical part of treatment to
help prevent further compression
fractures.