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

nabil ebraheim
3 Mar 201716:36

Summary

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Outlines

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Mindmap

Keywords

💡c-spine trauma

C-spine trauma refers to injuries to the cervical spine, which includes the top seven vertebrae of the spinal column. These injuries can result from various causes such as accidents or falls and can lead to serious neurological complications. The video script discusses the importance of identifying and treating c-spine trauma, particularly focusing on the stability of the C1 and C2 vertebrae.

💡transverse ligament

The transverse ligament is a crucial component of the cervical spine that provides stability between the first (C1) and second (C2) cervical vertebrae. It prevents abnormal movement between these vertebrae, which is vital for spinal cord safety. The script mentions that injury to this ligament can lead to increased risk of spinal cord injury, highlighting its importance.

💡Jefferson fracture

A Jefferson fracture is a specific type of injury to the C1 vertebra, also known as the atlas. It typically occurs due to axial loading forces and can result in instability of the cervical spine. The script describes how this fracture can affect the transverse ligament and the implications for treatment.

💡atlantoaxial instability

Atlantoaxial instability refers to the lack of proper stability between the atlas (C1) and axis (C2) vertebrae. This can be caused by injuries to the transverse ligament, as mentioned in the script. The instability can lead to excessive movement between these vertebrae, which can be dangerous to the spinal cord.

💡open mouth x-ray

An open mouth x-ray, also known as an odontoid view, is a type of x-ray used to visualize the C1 and C2 vertebrae and the odontoid process. The script discusses how this imaging technique can help assess the stability of the cervical spine and detect fractures, particularly in the context of Jefferson fractures.

💡ADI

ADI stands for Atlanto-Dens Interval, which is a measurement on lateral cervical spine x-rays to assess the space between the odontoid process and the arch of C1. An increased ADI can indicate instability or injury to the transverse ligament, as discussed in the script.

💡CT scan

A CT scan, or computed tomography, is an imaging technique that provides detailed cross-sectional images of the body, including the spine. The script mentions that CT scans are important for diagnosing cervical spine fractures, especially when x-rays may not provide adequate visualization.

💡halo vest

A halo vest is a rigid brace used to immobilize the cervical spine during healing after certain types of fractures or injuries. The script discusses the use of halo vests in the treatment of cervical spine injuries, particularly in cases where there is disruption of the transverse ligament.

💡facet dislocation

Facet dislocation refers to the displacement of the facet joints in the spine, which can occur due to trauma. The script describes how this type of injury can lead to spinal instability and potential neurological damage, often requiring surgical intervention.

💡hangman fracture

A hangman fracture is a specific type of fracture that occurs at the C2 vertebra, often due to hyperextension injuries. The script explains that this fracture can involve the spinal canal and carries a lower risk of spinal cord injury, but still requires careful assessment and treatment.

💡MRI

MRI, or magnetic resonance imaging, is a non-invasive imaging technique that uses magnetic fields to generate detailed images of the body's internal structures, including soft tissues. The script mentions the importance of MRI in assessing cervical spine injuries, particularly to identify ligamentous injuries or disc herniations that may not be visible on x-rays or CT scans.

Highlights

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Transcripts

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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

play13:45

an mi or by flexion extension views

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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

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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

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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

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Related Tags
C-Spine TraumaMedical TreatmentOrthopedicsNeurologicalSurgical OptionsFracture CareSpinal StabilityLigament InjuryCervical FusionHealthcare