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

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c-spine trauma the first thing we're

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going to talk about it depends where a

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ligament where it is located

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and what is the function of the

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transverse ligament it provides the c1

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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

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odontoid behind c2

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adi in about a 3.5 millimeter so if that

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ligament is injured c1 and c2 will be

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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

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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

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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

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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

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surgery

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probably doing closed reduction and the

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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

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of the spine which will demonstrate by

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an mi or by flexion extension views

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we'll show you a translation more than

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3.5 or angulation more than 11 degree

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then you need to do surgery

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have the barest fracture of the lower

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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

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also

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then the extension injuries that can

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happen in elderly will give you central

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cord syndrome

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then you have the tear drop fracture the

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teardrop fracture is the most severe

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unstable fracture of the c-spine its

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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

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injury both fracture types involved

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anterior inferior aspect of the

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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