Spine Trauma

Dr. Agus Guntoro SpBS

Definition
Any injury that has occurred to any of the
following structures:
Bony

elements
Soft tissues
Neurological structures

Anatomy
The Spine
Composed of 33
vertebrae
7 cervical
12 thoracic
5 lumbar
5 sacral + 4
coccyx (fused)
Act to support the
trunk and transfer
muscular load

Anatomy

Anatomy

Facet Joints

Ligaments

Intervertebral Disc

ETIOLOGY OF SPINAL CORD INJURY

TRAUMATIC

50%

motor vechicle accidents

20-30% Falls
12-21% gun shots
6-7% sport related activities
NONTRAUMATIC
Intraspinal

tumors
Infections & inflammatory diseases
Intraspinal abscesses
Iatrogenic complications of surgical or diagnostic
procedures

General Principles
of Trauma
Primary Survey
Airway (with C-spine protection)
Breathing and ventilation
Circulation (with hemorrhage control)
Disability - neurologic status
Exposure and environment
Resuscitation
Other studies and monitors
Secondary survey

Vertebral Injuries
Injuries to the spine must be excluded after
trauma:
55% involve the cervical spine
15% involve the thoracic spine
15% involve the thoracolumbar region
15% involve the lumbosacral region

TWO IMPORTANT FACTORS IN

SPINAL TRAUMA
1. Instability of the vertebral
column
2. Actual or potential neurological
injury

SPINAL INSTABILITY
Definition:

Loss of normal relationship between

anatomic structures with a resulting alteration of
natural function:
Spine

can no longer carry normal loads

Permanent deformity may occur resulting in severe
pain
Potential for catastrophic neurological injury
Instability
Fracture

results from:

of vertebral body, lamina, and/or pedicles

Dislocation of anatomic components caused by
disruption of soft tissues
Fracture and dislocation may occur together

Classification of Fractures

Major and Minor

Major = fracture of vertebral body, pedicles,
lamina
Minor = fracture of transverse, spinous, articular
processes

Classification of Fractures
Stable

and Unstable

Stable
Spine

can withstand physical loads

No significant displacement or deformity to
bone or soft tissue

Unstable
Spine

may not be able to carry normal loads

Most likely have significant deformity and pain
Potential for catastrophic neurologic injury

Denis Classification Method

Based on 3-column theory of the spine:
Anterior = ALL and anterior 2/3 of vertebral
body/disc
Middle = posterior 1/3 of vertebral body/disc
and PLL
Posterior = pedicles, lamina, facets, post.
ligaments

NEUROLOGIC INJURY

Definition: trauma to
spinal cord, cauda equina,
nerve roots
Can result from bone,
bone fragments, or disc
material compressing on
neuro. structures
All structures innervated
by the affected neuro.
structure may lose all or
partial function

Scoring of Neurologic Injury

Frankel Score
A

= Complete loss of motor and sensory

function
B = Only sensory function remains
C = Motor function is present but of no
practical use (i.e., can move legs but not
walk)
D = Motor function impaired (i.e.can walk
but not with normal gait)
E = No neuro impairment noted

GENERAL PRINCIPLES OF MANAGEMENT

Imobilisation
Stabilized

medically
Maintain spinal alignment
Decompression
Spinal stabilisation
Rehabilitation

IMMOBILISATION
From the scene of accident to
emergency room
Stabilise the neck in neutral position
Prevent rotation !
Lay supine on a firm and even
surface
Transfer of patient using the fourmen lift or use a Robinsons
orthopaedic stretcher

MEDICAL STABILISATION

Especially in a tetraparetic or tetraplegic

Normalised vital signs
Maintain adequate circulation and tissue
perfusion
Monitor urine production
Monitor blood gas analysis
Neurogenic shock ?

MEDICAL STABILISATION

Insert NGT gastric decompression and

prevention of stress ulcer
Insert urinary catheter to monitor fluid
output and to decrease the hypotonic
bladder
Mega dose of methylprednisolone (???)

Neurogenic Shock

Loss of symphatetic tone on

the periphery
Increase blood vessel capacity
Venous swelling on lower
extremities
Hypotension and bradycardia
Hypothermia

Neurogenic Shock Treatment

Adequate fluid ( do not

overload )
Trendelenburg position
Atropine 0.4 mg
Cardiopressors to increase
peripheral vascular tone and
cardiac output

SPINAL ALIGNMENT

In fractures Gardner tongs traction

In dislocation Gardner tongs traction
with increasing weight every 10-15 until
reduction
If closed realignment procedures fail
open reduction and stabilisation
Anteriorly or posteriorly

DECOMPRESSION

Realignment means..decompression !!
If closed measures fail..open
decompression and reduction
Anterior decompression or posterior
decompression ?

SPINAL (SURGICAL) STABILISATION

REHABILITATION

Should be initiated upon admission

Optimalisation of neurologic functions
Bladder training
Bowel training
Etc