Cervical Spine Trauma - Everything You Need To Know - Dr. Nabil Ebraheim

nabil ebraheim
3 Mar 201716:36

Summary

TLDRهذا الملخص يناقش الإصابةات في العظم الرأسي للرقبة، ويسلط الضوء على دور ال Ligament ال平均水平 في الاستقرار، ومدى أهمية التشخيص المبكر. يناقش النص الإصابةات المختلفة مثل Jefferson fracture، وأنواع الكسر العظمي، وكيفية التشخيص والمعالجة، بما في ذلك العمليات الجراحية والتقنيات ال nonsurgical. يشدد على أهمية التشخيص ال precoup والتشخيص قبل الإجراء، والعناية بالمرضى الكبار، والتشخيص التشخيصي للإصابةات العصبية.

Takeaways

  • 🔒 تplay a central role in providing stability at the C1-C2 level of the spine.
  • 🚑 Jefferson fracture is a type of C1 or atlas fracture that can compromise the transverse ligament.
  • 🔍 Open mouth X-ray can help diagnose fractures by showing the lateral mass overhang, which indicates stability or instability of the fracture.
  • 🏥 Non-operative treatment is common for stable fractures, while operative treatment like C1-C2 fusion may be necessary for unstable injuries.
  • 👵 Halo vest is a non-operative treatment option, but it carries risks in the elderly population, such as pneumonia.
  • 🧑‍⚕️ Surgical intervention is often required for fractures with transverse ligament disruption or when non-operative treatments fail.
  • 🦴 Hangman's fracture involves the C2 pedicles and is typically associated with a lower risk of spinal cord injury.
  • 📈 MRI is crucial for assessing ligamentous injuries and ruling out additional spinal issues before surgery.
  • 🛑 Facet dislocations often require immediate closed reduction and may necessitate surgical fixation if reduction fails or there's a neurological deficit.
  • ⚠️ Be aware of the 'naked' or 'empty' facet sign on X-rays, which can indicate a dislocation and potential for severe instability.

Q & A

  • ما هي الوظيفة الرئيسية للـ transverse ligament في الossa العظمية؟

    -يوفر transverse ligament الاستقرار في الossa العظمية C1، C2، مما يمنع الحركة غير الطبيعية بين C1 و C2.

  • ماذا تعني ABI في النص؟

    -يعني ABI 'Atlas Biomedial Interval'، وهو يشير إلى المسافة بين الossa العظمية C1 والossa العظمية C2، ويعكس الاستقرار في هذا الجزء من العمود الفقري.

  • ما هي الإصابة العظمية التي يمكن أن تسبب إصابة transverse ligament؟

    -الإصابة العظمية التي يمكن أن تسبب إصابة transverse ligament هي Jefferson fracture، وهي كسر في الossa العظمية C1 أو الossa العظمية العظمية.

  • كيف يمكن م量的ة الإصابة في الossa العظمية C1-C2 باستخدام التصوير المفتوح؟

    -يمكن م量的ة الإصابة باستخدام التصوير المفتوح من خلال م量的ة lateral mass overhang، إذا كان أقل من 6.9 فهذا يعني أن الإصابة مستقر، أما إذا كان أكثر من 6.9 فهذا يعني وجود تآكل في transverse ligament.

  • ما هي العامل الرئيسي الذي يحدد ما إذا كان المعالجة غير الجراحية مناسبة للكسر؟

    -العامل الرئيسي هو وجود تآكل في transverse ligament، إذا كان الADI (Atlanto-Dental Interval) أكثر من 3.5، هناك إصابة في transverse ligament، مما يتطلب علاج جراحي.

  • لماذا يعتبر التصوير الComputed Tomography (CT) مهمًا في المعالجة؟

    -يساعد الCT في اكتشاف كسور أخرى قد تصاحب الكسر الرئيسي، ويساعد أيضا في التأكد من عدم وجود تآكل في transverse ligament.

  • ما هي الأنواع الرئيسية للكسر في الossa العظمية C1-C2؟

    -هناك عدة أنواع من الكسر، مثل Jefferson fracture، وbody fracture، وdisruption في transverse ligament.

  • لماذا يجب تجنب الاستخدام من halo في المرضى الكبار؟

    -لأن المرضى الكبار قد يموتون بسبب الالتهاب الرئوي، لذا يعتبر halo ممنوعًا في هذه الفئة العمرية.

  • ما هو الإجراء الجراحي الشائع في حالات إصابة transverse ligament؟

    -الإجراء الجراحي الشائع هو C1-C2 fusion، حيث يتم ربط الossa العظمية C1 والossa العظمية C2 معًا لضمان الاستقرار.

  • ماذا تعني الجملة 'do not use halo and elderly they will die from pneumonia'؟

    -تعني أن استخدام halo في المرضى الكبار قد يؤدي إلى مخاطر مثل الإصابة بالالتهاب الرئوي، مما قد يؤدي إلى الوفاة.

  • كيف يمكن م量的ة الإصابة في الossa العظمية C2؟

    -يمكن م量的ة الإصابة باستخدام الCT scan، حيث إذا كان هناك avulsion في الossa العظمية C2، يمكن استخدام halo.

Outlines

00:00

🩺 C-Spine Trauma and Transverse Ligament Injuries

The paragraph discusses c-spine trauma, focusing on the role and function of the transverse ligament in providing stability between C1 and C2 vertebrae. It explains the significance of this ligament in preventing abnormal movement and the potential increase in the anterior spinal interval (ASI) if it's injured. The discussion covers Jefferson fractures of C1 or atlas fractures, their impact on neck rotation, and how certain fractures can be stable or unstable based on the lateral mass overhang and ASI measurements. The paragraph also touches on the use of open mouth x-rays and CT scans for diagnosis, treatment options ranging from non-operative to surgical interventions like C1-C2 fusion, and considerations for elderly patients, including the risks associated with halo immobilization.

05:07

🦴 Management of C-Spine Fractures

This section delves into the management of various c-spine fractures, emphasizing the importance of factors like displacement, patient age, and comorbidities in determining treatment approaches. It outlines different types of fractures, such as hangman fractures and facet dislocations, and their respective treatments. The paragraph stresses the need for immediate closed reduction in certain cases and the potential need for surgical intervention, especially when there's a risk of non-union or neurological deficit. It also highlights the importance of understanding the anatomy of facet joints and the implications of dislocations for diagnosis and treatment.

10:07

🏥 Surgical and Non-Surgical Treatments for C-Spine Injuries

The paragraph discusses the surgical and non-surgical options for treating c-spine injuries, including the use of MRI for diagnosis and the decision-making process for surgery. It covers different fracture types, such as facet fractures and the distinction between superior and inferior facets in normal and dislocated states. The discussion also includes the importance of identifying 'naked' facets and the implications of ligamentous injuries on treatment. Additionally, it addresses the management of specific injuries like burst fractures, central cord syndrome, and teardrop fractures, emphasizing the need for surgery in unstable fractures and the potential for neurological deficits.

15:08

🛡 Complications and Rare Injuries in C-Spine

This final paragraph addresses rare but serious c-spine injuries such as occipital cervical dislocation and occipital condyle fractures. It discusses the treatment options, which often involve occipital cervical fusion, and the importance of identifying these conditions through imaging studies. The paragraph concludes with a hopeful note, suggesting that the information provided is intended to be helpful for understanding the complexities of c-spine trauma management.

Keywords

💡c-spine trauma

c-spine trauma هو الإصابة المتعلق بجزء العظمي العلوي من العمود الرأسي، يشمل هذا المصطلح الإصابات المتعلقة بـ C1 و C2، وهي الفقرات العظمية العليا في العمود الرأسي. في النص، تتم مناقشة الإصابةات المختلفة والطرق الطبية لمعالجة هذه الإصابات، مثل Jefferson fracture.

💡transverse ligament

ال韧带 العمودية هو عضلة توفر استقرارًا لل两块颈椎 C1 و C2، مما يحمي النخاع العصبي. في النص، يُذكر أن الإصابة في هذا الligament قد يؤدي إلى حركيات غير طبيعية بين两块颈椎 C1 و C2، مما قد يتسبب في زيادة خطر الإصابة العصبية.

💡Jefferson fracture

جسر جيفرس هو نوع من الكسر العظمي الذي يصيب C1 أو العظم الذراع العلوي، ويتم مناقشة هذا النوع من الكسر في النص، وكيفية تشخيصه والعلاج به، بما في ذلك التشخيص بالأشعة المفتوحة والعلاج غير الجراحي.

💡atlantoaxial instability

عدم الاستقرار بين两块颈椎 C1 و C2 يشير إلى مشكلة في الروابط بين两块颈椎 هذه، مما قد يؤدي إلى حركيات غير مرغوب فيها وإصابة النخاع العصبي. في النص، يُناقش كيف يمكن مراقبة عدم الاستقرار من خلال التصوير ال放射ي.

💡odontoid fracture

الكسر العظمي للأسنان العظمي هو كسر في الجزء العلوي من C2، ويُعتبر هذا النوع من الكسر قديمًا وازدياد الخطر على الإصابة العصبية. في النص، يُذكر أن التشخيص والعلاج لهذا النوع من الكسر قد يتطلب إجراء CT scan.

💡ADI

ADI هو اختصار لـ Atlanto-Dental Interval، وهو مقياس يستخدم لقياس المسافة بين两块颈椎 C1 و C2، مما يساعد في التشخيص المبكر لأي حالات من عدم الاستقرار أو الكسر. في النص، يُذكر أن زيادة ADI قد تشير إلى كسر أو إصابة في الligament الtransverse.

💡cervical spine fusion

دمج عمود الظهر هو عملية جراحية تتم لربط两块椎骨 معًا لمنع الحركة بينهما، مما يساعد في المعالجة لحالات الإصابة التي تؤدي إلى عدم الاستقرار. في النص، يُذكر أن الدمج قد يتم في حالات مثل كسر ال韧带 الtransverse.

💡facet dislocation

الإنزال الوجهي هو نوع من الإصابة حيث تتم تحريك ال两块椎骨 بشكل غير طبيعي بسبب الكسر أو الإصابة في الروابط. يُناقش هذا النوع من الإصابة في النص، وكيفية تشخيصه والعلاج به، بما في ذلك الإجراء الجراحي.

💡hangman fracture

الكسر المتعلق بالرجل هو كسر في ال两块椎骨 C2، ويحدث عادةً عند الضغط الخلفي. يُناقش هذا النوع من الكسر في النص، وكيفية التشخيص والعلاج به، بما في ذلك المعالجة الجراحية وال保守的.

💡MRI

MRI هو اختصار لـ Magnetic Resonance Imaging، وهي تقنية تصوير تستخدم لرؤية الهيكل الداخلي للجسم. في النص، يُذكر أن MRI قد تتم قبل أو بعد المعالجة الجراحية لتحديد الإصابة العصبية أو وجود كسر آخر.

Highlights

Transverse ligament provides C1-C2 stability and prevents abnormal movement.

Injury to the transverse ligament can increase the chance of spinal cord injury.

Jefferson fracture is a type of C1 or atlas fracture that can affect the transverse ligament.

C1-C2 fracture controls 50% of neck rotation and can be stable or unstable.

Open mouth x-ray can indicate stability of a fracture by measuring lateral mass overhang.

Lateral view x-ray and ADI measurement are crucial for diagnosing transverse ligament injury.

CT-scan is recommended for diagnosing fractures at the occipital cervical junction.

Halo vest or cervical collar may be used for non-operative treatment of certain fractures.

C1-C2 fusion surgery is necessary for unstable injuries involving the transverse ligament.

Elderly patients with spinal cord injury have increased mortality, and halo is contraindicated.

Atlantoaxial rotatory subluxation can be treated with a halo for avulsion fractures.

Dens fracture type A is an avulsion of the tip and can be treated with orthosis.

Non-union rates for dens fractures are high, especially with displacement or in older patients.

Hangman's fracture involves the pedicles of C2 and has a lower risk for spinal cord injury.

Peyote fracture treatment depends on the degree of displacement and may require halo or surgery.

Facet dislocations are often associated with neurological deficit and require surgery.

Naked facet sign indicates a dislocation and usually requires fusion surgery.

MRI is essential for diagnosing ligamentous injuries and ruling out disc herniation.

Extension injuries in the elderly can lead to central cord syndrome.

Teardrop fracture is a severe and unstable injury usually caused by flexion and compression.

Occipital cervical dislocation is a rare but fatal injury, often treated by fusion.

Occipital condyles fracture is usually an incidental finding and may require fusion based on extension x-rays.

Transcripts

play00:06

c-spine trauma the first thing we're

play00:09

going to talk about it depends where a

play00:11

ligament where it is located

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and what is the function of the

play00:16

transverse ligament it provides the c1

play00:20

c2 stability the seat is behind dog

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employed and it anchor it doesn't tied

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to the range of c1 so it prevents an

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abnormal movement between c1 and c2

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because the spinal cord is behind the

play00:40

odontoid behind c2

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adi in about a 3.5 millimeter so if that

play00:52

ligament is injured c1 and c2 will be

play00:56

free to move and you'll have an increase

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of the ABI

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traumatic injury of the transverse

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ligament is probably rare but please

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take a condition where the transverse

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ligament injury can be a problem

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this Jefferson fracture c1 or atlas

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fracture two eggs a load

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see one is an egg c1c2 control 50% of

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rotation of the neck you can have a body

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fracture which is fracture of part of

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dying or multiple fractures in there

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usually that is a stable injury and you

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can have the fracture in addition to

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disruption of the transverse ligament

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mouth vo open mouth x-ray and you find

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the lateral mass overhang is less than

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6.9 then that fracture is stable and the

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treatment is usually non-operative

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treatment but if the lateral mass

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overhang more than 6.9 then there is

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disruption of the transverse ligament

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you will see that overhang in the urban

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mouth x-rays but if you look at the

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lateral view and the ADI is more than

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three point five then there is an injury

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to the transverse ligament and if it is

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more than five then there is an injury

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to the apical and Eylure ligament in

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addition to the transverse ligament

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you

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ct-scan nearly in the treatment of

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choice because this fracture can be

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missed due to inadequate x-rays of the

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occipital cervical Junction also this

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fracture is associated with other

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fractures so the CT scan would help us

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in finding other fractions discretion

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opens the canal so the risk of

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neurological deficit is not that high

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to decide if that fracture has

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transverse ligament disruption or not

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completed by a hard cervical or closes

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or by a halo never a halo and elderly

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I think halo will be good for transverse

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ligament avulsion fractures will you see

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body avulsion on the CT scan use a halo

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did observe the patient if you don't

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want to do c1 and c2 fusion

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however if there is injury to the

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transverse ligament you would do c1 c2

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fusion because that injury is unstable

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just remember to reactivate patients

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with the spinal cord injury for upper

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c-spine fractures will have an increased

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mortality and halo is contraindicated in

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the geriatric population

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you put a halo watch out the summer

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orbital and sobra trochlear nerve root

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injury

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you

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another one is a Detroit fracture tab

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one is an avulsion of the tip

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you will give the patient orthosis

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by two dozen toilet process itself

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the non-union rate is high up to 80%

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especially if you have more than five

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millimeters of displacement or the

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patient is older than 50 years

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other factors are delay in treatment

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posterior displacement of the fracture

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and diabetes

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do not use halo and elderly they will

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die from pneumonia

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how do you treat that to fraction in a

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young patient you will take it by a halo

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it is displaced and there are risk

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factors for non-union then you would do

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surgery

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what kind of surgery you will do you

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don't old school and young patient wire

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onto the screw because runup reserve c1

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and c2 motion because it controls 50% of

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the rotation you don't have use that in

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somebody younger so somebody is older

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then you can use c1 and c2 fusion

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so how do you teach I to if the patient

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is old or soldiers or you do surgery for

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a fusion of c1 and c2 if there is an

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indication for surgery and if there is a

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clearance for surgery

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how about peyote fracture where it goes

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into the body you tainted by agent

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orthosis or halo

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hangman fracture the fracture that

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involved the pedicles of c2 so the

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spinal canal is wider and there will be

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low risk for spinal cord injury

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types one of them is the non-displaced

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which is type 1 the fracture is vertical

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and no angulation and no translation and

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you did that by cervical or process

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type to the some angulation and

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translation so you will treat it by

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traction and extension and put the

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patient in a halo for about three months

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type that's bad bye - a witch will have

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severe angulation with letter

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translation because the ligament the

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posterior longitudinal ligament is

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disrupted you cannot eat that by

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traction because you will pull the

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spinal cord apart so you would eat it by

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extension tenth halo in compression for

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about six to twelve weeks and you may

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need to fuse

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five three this is a surgical time this

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is a fraction of the Perkins in addition

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to facet dislocation it has some

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neurological deficit Association and the

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treatment is surgery carbon reduction

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and posterior spine fusion

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facet dislocations the association of a

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naked - and facet involvement is very

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high watch out that you don't have a

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herniated disc in addition to the bony

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injury that's double trouble so when you

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have unilateral facet dislocation

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usually there is less than 50%

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translation on x-rays and it may affect

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a nerve root

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if you are bilateral facet dislocation

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will be more than 50% translation and

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probably spinal cord injury ligament

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injury don't heal it means to be fused

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it needs surgery

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so the treatment of facet dislocation is

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immediate closed reduction didn't get

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them I didn't do the surgery but if the

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patient has a mental status change then

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you will do the MRI first and

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immediately followed by urban reduction

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and surgical fixation so when Diego and

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tearily

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will go and Tilly if there is a disc

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herniation the incidence is about 10 to

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30 percent in cervical facet dislocation

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so if you try to do a reduction the disc

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fragment may stay in the canal causing

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spinal cord injury

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so when do you go for serially if

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reduction of the rustication failed and

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there is no discrimination when do you

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do combined and clearly and posteriorly

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we got to go and Tilly to remove a desk

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and we got to go for silly because the

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dislocation cannot be reduced by a

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closed method or by an open anterior

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technique

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three important points for facet

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dislocations number one get the mi

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before surgery make sure you don't have

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a disk herniation number two ligament

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injury don't heal it needs fusion it

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will need surgery number three know the

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arrangement of the fact that the

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superior facet and inferior facet in the

play11:01

normal and in the block or dislocated

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facets because they will confuse you

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especially in the exam know the naked

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facet or the empty facet train yourself

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to see that because you'll have an arrow

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at one of them and they ask you which

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facet at the the superior the inferior

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visit the level above or the level below

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what is a naked fraction it is the city

play11:35

appearance of an uncovered vertebral

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particular fashion when the facet joint

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is dislocated to usually indicate

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flexion distraction injury with CBA

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ligamentous disruption and spinal

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instability

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now would need to talk about the MRI if

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the patient is awake you will do close

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reduction before you get the mi because

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if something bad happened like

play12:08

deterioration of the neurological status

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we will know about it by conversing with

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the elect awake patient and then you can

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leave the castien if it happened so you

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use the spine and then you get the mi

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in what situation you get MRI first

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before you do close reduction if the

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patient is not alert not awake drunk not

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cooperating or if you can do that close

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reduction then before you take the

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patient to surgery you need to get the

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MRI you need to see the second problem

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so now we got the MRI after the close

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reduction or before the close reduction

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then we're going to take the patient to

play13:01

surgery

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probably doing closed reduction and the

play13:06

patient is alert awake cooperative then

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you get neurological deficit then you

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need two legs the reduction get an MI

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and you're going to go to service

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then you can have the facet fracture

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usually the superior fashion this

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classic injuries usually Oh care from

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flexion distraction force plus minus

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rotation

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another entity is the ligamentous injury

play13:41

of the spine which will demonstrate by

play13:45

an mi or by flexion extension views

play13:48

we'll show you a translation more than

play13:51

3.5 or angulation more than 11 degree

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then you need to do surgery

play13:59

have the barest fracture of the lower

play14:02

c-spine from axial compression usually

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they have neurological deficit and the

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treatment is usually until decompression

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and fusion unless you have posterior

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ligamentous injury then we will fix that

play14:18

also

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then the extension injuries that can

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happen in elderly will give you central

play14:25

cord syndrome

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then you have the tear drop fracture the

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teardrop fracture is the most severe

play14:35

unstable fracture of the c-spine its

play14:39

usual care from flexion and compression

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which is different from the extension

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teardrop fracture which usually will

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care at c2 which is usually a stable

play14:51

injury both fracture types involved

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anterior inferior aspect of the

play14:57

vertebral body

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deflection type injury is usually

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associated with a spinal cord injury the

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posterior part of the vertebral body

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will be displaced into the spinal canal

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the posterior ligaments will be

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disrupted and will allow separation of

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the spinous processes the flexion pipe

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fracture is usually unstable and it will

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need surgery

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then you have the occipital cervical

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dislocation which is a fatal injury but

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rare and usually treated by occipital

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cervical fusion occipital condyles

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fracture

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it is rare injury it's usually

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incidental finding seen on a head CT

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scan one third of occipital condylar

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fracture of cares would

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atlanto-occipital dislocation treatment

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occipital cervical fusion based on

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legend extension x-rays

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much I hope that was helpful

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you

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