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Gunshot Injuries Of Thoracolumbar Spine

February 21, 2011 by Leave a Comment

Gunshot injuries are quite distinct from other thoracolumbar injuries.  The mechanism of injury in these is different than other spine injuries.

Here a missile passes through the spine rather than the spine being forcibly accelerated or decelerated that results in structural failure.

The extent and type of neurologic deficits from gunshot injuries to the thoracolumbar spine vary. [Read more...]

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Operative Treatment Of Thoracolumbar Burst Fractures

December 17, 2010 by Leave a Comment

Surgical treatment of the burst fractures involves decompression and stabilization. The spine can be approached through anterior and posterior approach. Both the routes have their own advantages and disadvantages.

Indications For Surgery In Thoracolumbar Burst Fractures

  • A progressive neurologic deficit
  • Presence of a posterior ligament complex injury
  • Neurologic deficit with or without an unstable fracture
  • Rapidly increasing kyphotic deformity.
  • Fractures in multiply injured patients
  • Those who are candidates for conservative treatment but refuse it or conservative treatment cannot be employed because of body habitus.

Posterior Surgery

Advantages

  • Avoids the morbidity of anterior exposure in patients who potentially have concomitant pulmonary or abdominal injuries.
  • Shorter operative times
  • Decreased blood loss
  • Functional outcomes are similar to those following anterior surgery

Disadvantages

Through posterior approach posterior instrumentation is done [Instrument used to fix the spine is posterior]. Posterior instrumentation alone cannot reconstitute anterior column support. Therefore the construct is somewhat weaker than anterior instrumentation when subjected to compressive forces. [Read more...]

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Thoraco Lumbar Spine Injuries Overview

July 13, 2010 by 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...]

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Mechanics of Injury In Thoracolumbar Fractures

July 6, 2010 by 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...]

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Thoracolumbar Spine Injuries – Initial Evaluation and Emergency Care

June 23, 2010 by Leave a Comment

There is a high incidence of concomitant adjacent spinal injuries which  warrant a  strict precautions for the entire spine when encountered at the injury site.

As a protocol a cervical collar should be applied and patient should be put on  a flat spine board should be standard protocol during in-field evaluation and transport.

Spinal shock may be recognized by hypotension [decrease in blood pressure] and bradycardia [decrease in heart rate]. An absent bulbocavernosus reflex in a trauma victim can indicate spinal shock. The prognosis for the potential of neurologic recovery cannot be determined until spinal shock has resolved. [Read more...]

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What Is Log Rolling Manaeuver

September 6, 2009 by Leave a Comment

Log rolling maneuver is used in patients of spinal injury. After a person suffers from a spinal injury, they need to be put on a stretcher.

The main aim of log rolling is to avoid movement at the injured spine while the patient is moved. The procedure requires three or more people in order to preform this maneuver in a safe manner.

The usual positions are [Read more...]

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Radioimaging In Spine Injuries – Xray, CT, MRI

August 14, 2009 by 2 Comments

After clinical evaluation, radioimging is a very important part of spine assessment. Radiographs or xrays are the first imaging modality used. They are handy, easy, does not require special care and reports are almost instant. Their finding  can guide  the approach to further diagnostic investigation. however radiographs do not provide complete information due to their inherent limitations of two dimensional views. Theref0re computed tomogram is necessary and adds to  information in approximately half of all cases.

Radiographs (Xray)

Following xrays are essential in a patient who has multiple injuries

  • Chest x-ray anteroposterior view
  • Pelvis x-ray anteroposterior view
  • Lateral cervical spine x-ray.

Rest of the imaging for spine is done after patient has been stabilized. [Read more...]

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Initial Care of Patient With Spine Injury

August 1, 2009 by Leave a Comment

All trauma patient must be provided protection and immobilization of the spine until spinal injury has been ruled out or treated definitively.
This general principle and implications are  commonly referred to as spine precautions. These precautions include

  • All trauma patients should be maintained in the supine position at strict bed rest with the bed flat;
  • Transfers should be done with a spine board
  • Patients with cervical injury must be stabilized with hard cervical collar
  • Log-rolling should be don to turn the patients

Further course of events depend upon the clinical qand radiological assessment of the injury. [Read more...]

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