Descripción: El objetivo del filtrado es eliminar el ruido y resaltar los eventos de reflexión. Los filtros, por lo general, operan sobre las bases de la frecuencia y la amplitud de las trazas, aunque también s...
A film that does not show the upper border of T1 is inadequate
Caudal traction on the arms may help
If can not, get swimmer’s view or CT
to determine stability
SWIMMER’S VIEW
ADEQUACY Must visualize entire C-spine
Very good for spinal cord, soft tissue and ligamentous injuries
Flexion-Extension Plain Films
Better for occult fractures
MRI
Optional: Oblique and Swimmer’s
CT
AP, lateral and open mouth view
LATERAL CERVICAL SPINE X-RAY
ALIGNMENT • The anterior vertebral line, posterior vertebral line, and spinolaminar line should have a smooth curve with no steps or discontinuities • Malalignment of the posterior vertebral bodies is more significant than that anteriorly, which may be due to rotation
Anterior subluxation of one vertebra on another indicates facet dislocation
< 50% of the width of a vertebral body unilateral facet dislocation
> 50% bilateral facet dislocation
• A step-off of >3.5mm is significant anywhere
5
11/10/2015
DISC
BONES
Disc Spaces
OPEN MOUTH VIEW
Ideally all patients with abnormal neurological examination should be evaluated with MRI scan
Assess spaces between the spinous processes
CT SCAN
Adequacy: all of the dens and lateral borders of C1 & C2
Alignment: lateral masses of C1 and C2
MRI
Should be uniform
Bone: Inspect dens for lucent fracture lines
Thin cut CT scan should be used to evaluate abnormal, suspicious or poorly visualized areas on plain film
The combination of plain film and directed CT scan provides a false negative rate of less than 0.1%
MANAGEMENT OF SCI
Primary Goal
Prevent secondary injury
Immobilization of the spine begins in the initial assessment
Treat the spine as a long bone
Secure joint above and below
Caution with “partial” spine splinting
6
11/10/2015
MANAGEMENT OF SCI
MANAGEMENT OF SCI
Spinal motion restriction: immobilization devices
Look for other injuries: “Life over Limb”
ABCs
Transport to app ropriate SCI center once stabilized
Consider high dose methylprednisolone
Increase FiO2
Assist ventilations as needed with c-spine control
Indications for intubation :
Controversial as r ecent evidence questions benefit
Must be started < 8 hours of injury
Do not use for penetrating trauma
PCO2 > 50
30 mg/kg bolus over 15 minute
VC < 10 mL/kg
After bolus: infusion 5.4mg/kg IV for 23 hours
Acute respiratory failure
GCS <9
Increased RR with hypoxia
IV Access & fluids titrated to BP ~ 90-100 mmHg
PRINCIPLE OF TREATMENT
Spinal alignment
deformity/subluxation/dislocation reduction
Spinal column stability
JEFFERSON FRACTURE Burst fracture of C1 ring
Increased lateral ADI on lateral film if ruptured transverse ligament and displacement of C1 lateral masses on open mouth view
Need CT scan
unstable stabilization
Neurological status
neurological deficit decompression
BURST FRACTURE
CLAY SHOVELER’S FRACTURE
Fracture of C3-C7 from axial loading
Spinal cord injury is common from posterior displacement of fragments into the spinal canal
Flexion fracture of spinous process
C7>C6>T1
7
11/10/2015
FLEXION TEARDROP FRACTURE
BILATERAL FACET DISLOCATION
Flexion injury causing a fracture of the anteroinferior portion of the vertebral body
Subluxation of dislocated vertebra of greater than ½ the AP diameter of the vertebral body below it High incidence of spinal cord injury
because usually associated with posterior ligamentous injury
HANGMAN’S FRACTURE
Flexion injury
Extremely
ODONTOID FRACTURES
Extension injury
Bilateral fractures of C2 pedicles
Complex mechanism of injury
Generally
Type 1 fracture through the tip
(white arrow)
Anterior dislocation of C2 vertebral body (red arrow)
Type 2 fracture through the base
Rare Most common
Type 3 fracture through the base and body of axis
Best prognosis
Odontoid Fracture Type II
Odontoid Fracture Type III
8
11/10/2015
Anatomic Classification
2 or 3 Columns
CLASSIFICATION OF THORACOLUMBAR SPINE
Denis ‘83
FRACTURE
McAfee ‘83
Ferguson & Allen’84 Holdsworth’ 62
Kelley & Whitesides ’68
ANATOMIC CLASSIFICATION
ANATOMIC CLASSIFICATION
2 COLUMN THEORY
3 COLUMN THEORY DENIS 83
HOLDSWORTH 62 Posterior
Anterior
Six types- Nicols +2 1
Reviewed 1,0 00 patients Anterior- vertebral body, ALL, PLL
