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Hyperextension Casting

August 31, 2010 By Dr Arun Pal Singh Leave a Comment

Hyperextgension casting is a non operative method to treat thoracolumbar spine injuries where a casthyperextension-cast is applied in position of hyperextension.

Popularity: 3% [?]

Filed Under: Definitions, E-H, Spine Injuries, Thoracic-Lumbar Spine Tagged With: hyperextension position, non operative treatement, spinal injury treatment

Fracture L3 Vertebra – Lateral Radiograph

August 29, 2010 By Dr Arun Pal Singh 3 Comments

29 years lady was sitting in auto rickshaw which was struck by a car from behind. THe woman was thrown out of the auto rickshaw and the auto rickshaw fell on the lady.

She was brought to casualty of our hospital and found have injured her pelvis and spine along with paraplegia.

The xray in picture is lateral view of the spine and shows fracture of L3 vertebra.

MRI of the spine revealed a retropulsed fragment as well. She was operated upon and the spine was stabilized using pedicle screw system.

Popularity: 5% [?]

Filed Under: Spine Injuries, Thoracic-Lumbar Spine Tagged With: L3 fracture, pedicle screw system stablization, pelvic injury, spine trauma

Surgery In Thoracolumbar Injuries – Timing and Approches

August 26, 2010 By Dr Arun Pal Singh Leave a Comment

There is controversy in literature about timing of surgery for thoracolumbar injuries. There is no conclusive evidence that early surgical decompression and stabilization improves neurological recovery, or that a delay in surgery would cause compromised neurological recovery.

However, it is agreed upon that if the neurological deficit is progressive, an emergency decompression is indicated.

Otherwise there are two schools of thought. One advocates early decompression and stabilization. The benefits highlighted are lesser complication rate and shorter duration of hospital stay. [Read more...]

Popularity: 4% [?]

Filed Under: Spine Injuries, Thoracic-Lumbar Spine Tagged With: surgery in lumbar spine injury, surgery in thoracic spine injury, thoraqcolumbar injuries, timing of decompression

Treatment Options In Thoracolumbar Spine Injuries – When To Operate and When To Not?

August 25, 2010 By Dr Arun Pal Singh Leave a Comment

In case of spinal cord injury there is a continuous debate in the literature about operative versus non operative treatment and there are strong adovcates on either side. Because of complex nature of spinal injuries and multiple factors affecting prognosis there are options of treatment available which needs to be individualized in every case.

Broadly speaking, there are two kinds of treatments – non operative and operative.

Before we discuss them further a look into pathophysiology of the cord injury is necessary to grasp the concepts. [Read more...]

Popularity: 6% [?]

Filed Under: Spine Injuries, Thoracic-Lumbar Spine Tagged With: conservative management of thoracic spine injuries, lumbar spine injuries, surgery in lumbar spine injuries, thoracic spine trauma, thoracolumbar spine injuries, treatment options in thoracolumbar spine injuries

Thoracolumbar Injuries – Susceptibility Of Spinal Cord To Injury

August 23, 2010 By Dr Arun Pal Singh Leave a Comment

In continuation with spinal canal of cervical spine, spinal canal in thoracic and lumbar spine consists of vertebral body, intervertebral disc, posterior longitudinal ligament anteriorly, pedicles, medial aspect of facet joints on either side laterally and ligamentum flavum & laminae posteriorly.

Injury can cause compromise of the spinal canal and the most common cause is posterior bony retropulsion from a burst fracture of the vertebral body.

Dislocations and fracture dislocations of vertebrae leading to translation between adjacent vertebrae can also cause reduction in canal space. Anterirorly displaced fractures of posterior elements [laminae] can also compromise the canal space.

Postraumatic hematoma formation, disc herniations are other causes of compression following injury.

Lumbar canal stenosis is frequent non traumatic cause of reduction of canal space and neural compromise.

Conus medularis is most distal aspect of the spinal cord and its location varies between T12 and L3. Spinal canal dimensions relative to  spinal cord dimensions are smallest in the T2-T10 region and for this reason the neurologic injury is more commmon after trauma in this region.

Complete spinal cord injury is six times more common than incomplete injury with high-energy trauma to the midthoracic spine .

In addition to smaller canal space,  another factor which is responsible for susceptibility is the lesser vascular supply to the spinal cord. The region between T2 and T10  derives its proximal blood supply from antegrade vessels in the upper thoracic spine and distally from retrograde flow from the artery of Adamkiewicz. [Read more...]

Popularity: 6% [?]

Filed Under: Spine Injuries, Thoracic-Lumbar Spine Tagged With: lumbar injuries, neural injuries in spine fractures, spinal cord injuries, spinal fractures, spinal trauma, thoracic injuries

Fractures to the Axis Vertebra

August 3, 2010 By Dr Arun Pal Singh Leave a Comment

The axis vertebra has unique anatomy and despite  fractures to the odontoid or pars interarticularis, is subject to a variety of injuries similar to those found in the lower cervical spine. Several basic fracture types are recognized and can be divided  into distinct categories

Type I

The fractures resemble an extension-type teardrop fracture of the inferior anterior end plate. These fractures are usually stable.

Type II

Fractures are characterized by hear fracture line through the C-2 vertebral body that runs horizontally.

Type III

It is a burst fracture of  C-2 vertebral body.

Type IV

These fractures are sagittal cleavage fractures are usually be highly unstable.

Treatment

Stable fractures can be treated by conservative means but unstable fractures would require operative treatment.

Popularity: 10% [?]

Filed Under: Cervical Spine, Spine Injuries Tagged With: Axis body fractures, C2 fractures, fractures C2

Cervical Injuries of the Ankylosed and Spondylotic Spine

July 31, 2010 By Dr Arun Pal Singh Leave a Comment

Patients with ankylosed and spondylotic spine can suffer cervical injury even after minor trauma. Therefore, the patients who present with neck pain or neurologic deficit after major or minor trauma should be considered to have a cervical spine injury until proven otherwise.

Degenerative spondylotic changes, such as vertebral body osteophytes, fixed subluxations, and facet hypertrophy can make plain films difficult to interpret. Therefore unless the injury is severe, the plain x-rays may not be helpful in detecting a level of injury. [Read more...]

Popularity: 9% [?]

Filed Under: Cervical Spine, Spine Injuries Tagged With: ankylosing spondylitis and cervical injury, cervical injury, cervical stiffness

Thoracolumbar Injury Classification and Injury Severity Score

July 15, 2010 By Dr Arun Pal Singh Leave a Comment

This score was proposed by Vaccaro et al  to assist in the determination of when operative treatment of the thoracolumbar spine is appropriate.This score needs still further validation.

Score is developed from an algorithm in which points are collected in a sequential evaluation of the injury.

The items considered in order are [Read more...]

Popularity: 5% [?]

Filed Under: Spine Injuries, Thoracic-Lumbar Spine Tagged With: injuries to lumbar spine, severe injury to spine, severity of thoracolumbar injuries, thoracolumbar injuries

Thoraco Lumbar Spine Injuries Overview

July 13, 2010 By Dr Arun Pal Singh 1 Comment

Injuries to thoracic and lumbar spine have been mentioned in the history very frequently and date almost as back as 3000 BC. With increase in trauma following increasing in motor vehicles

Reports of trauma to the thoracolumbar spine with associated neurologic injury were described as early as 3000 BC in the Edwin Smith Papyrus. With the introduction of motorized vehicles and greater exposure to high-energy blunt trauma, the occurrence of thoracolumbar fractures and dislocations has increased substantially.

Recent studies suggest that motorcycle accidents are greatest culprits.

Thoracic and lumbar injuries  are responsible for 90% of all spinal injuries. [Read more...]

Popularity: 6% [?]

Filed Under: Spine, Spine Injuries, Thoracic-Lumbar Spine Tagged With: lumbar spine injuries, spinal trauma, Spine Injuries, thoracic spine injuries, thoracolumbar injuries

Mechanics of Injury In Thoracolumbar Fractures

July 6, 2010 By Dr Arun Pal Singh Leave a Comment

Normal Mechanics of Thoracic and Lumbar Spine

Lumbar spine is much more flexible than thoracic spine and the thoracolumbar junction represents a biomechanical transition zone between the rigid thoracic spine and flexible lumbar spine.  The thoracic spine is rigid by virtue of presence of the rib cage, thoracic musculature, and facet joint configuration.

Normally the thoracic spine has a normal kyphosis whereas lumbar spine has lordosis normally.  The thoracolumbar junction represents the  area of change in sagittal alignment between the kyphotic thoracic segment and a lordotic lumbar region. [Read more...]

Popularity: 5% [?]

Filed Under: Spine Injuries, Thoracic-Lumbar Spine Tagged With: biomechanics of spine injuries, lumbar injuries, spinal trauma, Spine Injuries, thoracic injuries
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