ANATOMY OF SPINE
? 7 cervical vertebrae
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? 12 thoracic vertebrae? 5 lumbar vertebrae
? 5 fused sacral vertebrae
? 3-4 smal bones comprising the coccyx
q Spinal cord ends as conus medul aris at
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level of first lumbar vertebra lumbar and
sacral nerve roots exit below this and
form the cauda equina
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ANATOMY OF SPINE
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ANATOMY OF SPINE
NEUROANATOMY
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1&2 Posterior Columns: convey Ipsilateral information
about two Point discrimination, proprioception And
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vibratory sense5 Lateral Spinothalamic Tract: carries Pain and
Temperature Information From contralateral extremity
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4 Lateral Corticospinal Tract: Carries Motor Information
from Contralateral Brain to Ipsilateral Extremity
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MECHANISMS OF INJURY? Compression
? Flexion Injury
? Extension Injury
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? RotationCOMPRESSION INJURY
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? Vertebral body fracture? Disc herniation
? Epidural hematoma
? Displacement of posterior wal of the vertebral body
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JEFFERSON FRACTURE? A comminuted fracture of the ring of C1.
? Compression of base of skul against C1
? Results in cracking the ring of C1
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? Best seen on open mouth x-rayATLANTOAXIAL AND DENS
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FRACTURES? The result of hyperflexion or hyperextension injuries
8% of Dens Fractures associated with C1 fractures
C2 Fractures
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Dens Fracture :? Hyperflexion Injury
Hangman Fracture :
? Hyperextension Injury
? Traumatic spondylolisthesis of the axis
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? Bilateral fractures through the pars interarticularis of the axisFLEXION TEARDROP FRACTURE
Hyperflexion of the subaxial cervical spine
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Retropulsion of the larger portion of a vertebralbody into the spinal canal, detached from an
anterior fragment (teardrop)
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Often associated with an anterior cord
syndrome.
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CLAY-SHOVELER'S
FRACTURE
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? Avulsion fracture of the spinous process of C6,C7, or T1.
? It is not typical y associated with neurologic
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injury.
THORACOLUMBAR TRAUMA
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q Mechanism of injury? Compression
? Distraction
? Rotation
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CHANCE FRACTURE
? Failure of al three columns due to flexion-distraction
? Fal s from a height
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? Strikes part of the torso on an immovable object? Injury pattern most likely to cause SCI
THE THREE-COLUMN CONCEPT OF SPINAL
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ANATOMY? The anterior column: ALL + anterior portion of the vertebral body + anterior portion of the
disk.
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? The middle column: posterior portion of the vertebral body + the posterior portion of the disk
+ PLL
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? The posterior column: the pedicles facet joints + laminae + supraspinous ligament,interspinous ligament + facet joint capsule + ligamentum flavum.
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STABLE Vs UNSTABLE FRACTURE? When the integrity of the middle and either the anterior or
the posterior column is affected, the spine is likely to be
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unstable.
qThe columns can be affected by:
? Fracture
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? Ligamentous disruption? Gunshot wounds
Because of the nature of the injury, can affect more than one
column and the spine can stil remain stable.
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SCI can occur without obvious radiographic findings.
CLINICAL SYNDROMES AFTER INCOMPLETE
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SPINAL CORD INJURY? Central Cord Syndrome
? Brown-Sequard Syndrome
? Anterior Cord Syndrome
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? Conus Medul aris Syndrome? Cauda Equina Syndrome
CENTRAL CORD SYNDROME
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? Motor>Sensory Loss
? Upper>Lower Extremity Loss
? Distal >Proximal Muscle Weakness
? Classical y occurs with hyperextension
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injuries of the cervical spineBROWN-SEQUARD LESION
q A burst fracture with posterior displacement
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of bone fragments compresses one side of the spinalcord.
? Loss of Ipsilateral Proprioception, Light Touch and
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Motor Function? Loss of Contralateral Pain and Temperature
Sensation
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? Due to hemisection of the cord due to penetratinginjury
? Incomplete lesions most common
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ANTERIOR CORD SYNDROME
q A large disk herniation compresses
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the anterior aspect of the spinal cord,leaving the dorsal columns intact.
? Loss of Motor function, Pain and
Temperature Sensation
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? Preservation of Light touch, Vibratory Sensationand Proprioception
CONUS MEDULLARIS SYNDROME
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A burst fracture of with posterior displacement of bonefragments compresses the conus medul aris.
Injury to sacral cord, lumbar nerve roots causing
? Areflexic bladder
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? Loss of control of bowels? Knee jerk relexes preserved, ankle jerk absent
? Signs similar to cauda equina syndrome except
more likely to be bilateral
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CAUDA EQUINA SYNDROME
q A central disk herniation at L4-L5 level
compresses the cauda equina.
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? Injury to nerve roots and not spinal cord itself
? Muscle weakness and decreased sensation
in affected dermatomes
? Decreased bowel and bladder control
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CLASSIFICATION OF SPINAL CORD
INJURY
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Patients are classified according to the ASIA Impairment Scale (AIS)q Combined efforts from
vASIA: American Spinal Injury Association
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vISCOS: International Spinal Cord SocietyCOMPONENTS OF THE TEST
Three Main Parts to the Exam:
? Strength Testing
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? Light Touch Sensation? Pinprick Sensation
Lowest Level of motor control:
? Voluntary Anal Contraction
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? Lowest Level of Sensation:? Deep Anal Pressure
NEUROLOGIC EXAM: DERMATOMES
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? C5- Deltoid? T12 ? Symphysis Pubis
? C6 ? Thumb
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? L4 ? Medial aspect of leg
? C7 ? Middle Finger
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? L5 - Space between first and secondtoes
? C8 - Little Finger
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? S1 ? Lateral border of the foot
? T4 ? Nipple
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? S3 ? Ischial Tuberosity? T8 ? Xiphoid
? S4-5 ? Perianal region
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? T10 - Umbilicus
MYOTOMES
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? C5 ? Deltoid
? L2 - Hip flexion
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? C6 ? Wrist Extensors? L3 - Knee Extension
? C7 ? Elbow Extensor
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? L4 - Ankle dorsiflexion
? C8 ? Finger flexors
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? L5 - Toe extension? T1 ? Little finger abduction
? S1 ? Plantar flexion
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Thank You
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