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Spinal Trauma

Spine Trauma


Presentation

  • Cushing performed laminectomies within 24 hours on patients with immediate presentations-both complete and incomplete spinal cord lesions.[ncbi.nlm.nih.gov]
  • Further, they advise “utilization of backboards for spinal immobilization during transport should be judicious, so that potential benefits outweigh risks.” 1 Spinal immobilization should not be used at all in patients with penetrating trauma who do not present[mdedge.com]
Pain
  • […] as well as for patients with severe pain and inability to function who have not gotten better after at least three to six months of non-surgical treatment.[ana-neurosurgery.com]
  • All four patients demonstrated spontaneous relief of pain within 2 weeks after injury. The pain was modified by transcutaneous stimulation in one case and by l-dopa in another case.[ncbi.nlm.nih.gov]
  • Generally, central herniation produces local neck pain while lateral herniation produces upper extremity pain.[chiro.org]
  • It is performed in patients who have persistent tailbone pain due to injury, fall or contact sports and when all other conservative treatments are a failure.[newwestsportsmedicine.com]
  • Symptoms can consist of pain, swelling, trouble moving and walking. Testing & Diagnosis Physicians will conduct a thorough family and medical history followed by a complete and accurate diagnosis.[advocatechildrenshospital.com]
Falling
  • Spine trauma is damage to the spine caused from a sudden traumatic injury caused by an accidental fall or any other physical injury.[newwestsportsmedicine.com]
  • Car accidents are a common cause of spinal injury, as are sports injuries and falls.[spineuniverse.com]
  • This is largely due to a trauma injury that produces great force, such as a motor vehicle accident or hard fall, both of which are the leading causes of this injury.[ana-neurosurgery.com]
  • The most common spinal cord injuries in children occur when the spine or neck is bent or compressed, as in the following: Birth injuries, typically affecting the spinal cord in the neck area Diving accidents Falls Infection that causes an abscess on the[childrens.com]
  • People find hundreds of ways to injure their low back: car accidents, sports injuries, workplace injuries, falls, and violence. Doctors divide lumbar spine injuries into two broad categories, low and high energy.[understandspinesurgery.com]
Back Pain
  • The goal of the surgery is to fuse and repair the fracture, eliminate back pain, and restore posture and ease of movement. The most common surgical procedures for spinal compression fractures are lumbar fusion and vertebroplasty/kyphoplasty.[athensbrainandspine.com]
  • This type of collision or a fall while in the shower can cause low back pain, but the types of injuries seen are very different from a high speed collision in which the passenger is ejected from the car.[understandspinesurgery.com]
  • This resulted in the use of spinal immobilization on the majority of trauma patients, regardless of mechanism of injury or presenting symptoms. 5,6 One review estimated that over 50% of trauma patients with no complaint of neck or back pain were transported[mdedge.com]
  • Falls and major injuries are risk factors for thoracolumbar injuries: cognitive impairment and multiple injuries impede the detection of back pain and tenderness. J Trauma . 1995; 38: 692–695. Sheridan R, Peralta R, Rhea J, Ptak T, Novelline R.[east.org]
  • A fracture-dislocation causes instability and severe back pain. As in other spinal fractures, a fracture-dislocation can result in bone fragments causing pinching and damage to the spinal nerves or spinal cord.[ana-neurosurgery.com]
Neck Pain
  • Neck pain and signs or symptoms of spinal cord injury should prompt investigation when there is a history of severe trauma.[journals.lww.com]
  • Those with: Neck pain or neurological symptoms Altered level of consciousness Significant blunt injury above the level of the clavicles As always, what is considered ‘significant’ is contentious.[lifeinthefastlane.com]
  • Required one of the following: neck pain, or no neck pain all of (injury above clavicles, non ambulatory and dangerous mechanism). Ian Stiells group generated a decision rule with sensitivity of 99.7% and specificity of 50.7 %.[canadiem.org]
  • Patients were eligible for enrollment if they were alert (GCS of 15), if they had stable vitals signs, and if they had either neck pain after injury or had no neck pain but visible injury above the clavicles after a dangerous mechanism of injury.[anesthesiology.pubs.asahq.org]
  • Generally, central herniation produces local neck pain while lateral herniation produces upper extremity pain.[chiro.org]
Low Back Pain
  • This type of collision or a fall while in the shower can cause low back pain, but the types of injuries seen are very different from a high speed collision in which the passenger is ejected from the car.[understandspinesurgery.com]
  • We excluded those with non‐specific low back pain and radicular pain secondary to primary pathological conditions other than congenital or degenerative LSS.[cochranelibrary.com]
  • The patient is instructed to breathe normally, flex forward at the waist (when low-back pain is absent), and then bring the arms back and up in an arc from the anterior to the posterior as far as can be comfortably managed.[chiro.org]
  • It can cause low back pain, weakness or paralysis in the lower limbs, loss of sensation, bowel and bladder dysfunction, and loss of reflexes. Unlike in conus medullaris syndrome, symptoms often occur on only one side of the body.[en.wikipedia.org]
Urinary Retention
  • We get most of our patients with deformed spine with concomitant complications of SCI such as pressure sores, urinary retention and infection, deep vein thrombosis.[ncbi.nlm.nih.gov]
  • EFAST) — Nasogastric tube insertion — spinal patients are at risk of gastric distention — Indwelling catheter insertion — prevent urinary retention and bladder overdistention due to spinal inury; monitor urine output given the risk of hemorrhagic and[lifeinthefastlane.com]
Paresis
  • It presents with spastic paresis , hyperreflexia , and continued sensory loss. Acute stabilization, a thorough neurological examination , and imaging is required for adequate diagnosis.[amboss.com]
  • Lesions at the C5 level or higher lead to diaphragmatic paresis or paralysis, as the phrenic nerve arises from the C3-5 levels.[lifeinthefastlane.com]
Altered Mental Status
  • The reliability of nonreconstructed computerized tomographic scans of the abdomen and pelvis in detecting thoracolumbar spine injuries in blunt trauma patient with altered mental status. J Bone Joint Surg Am . 2009; 91: 2342–2349.[east.org]
  • For patients with a head injury who are comatose or who have altered mental status and who have normal plain films, 21% of level II and 10% of level I centers advocated removal of the cervical collar without further testing beyond a five-view series.[anesthesiology.pubs.asahq.org]

Workup

  • Although neurologically intact on initial workup, she developed precipitous quadriplegia and apnea in a delayed fashion. Tonsillar herniation with medullary compression and cerebellar infarction was diagnosed on magnetic resonance imaging.[ncbi.nlm.nih.gov]

Treatment

  • Treatments Treatments plans will be based off of the overall health, age and severity of the fracture.[advocatechildrenshospital.com]
  • From diagnosis to rehabilitation, neurosurgeons at Kaweah Delta will be with you every step of the way through your brain or spinal trauma treatment. Schedule a consultation with your primary care doctor.[kaweahdelta.org]
  • Surgery is recommended when other treatments are a failure or inappropriate. Surgery for spinal condition depends on the type and severity of injury.[newwestsportsmedicine.com]
  • The causes can range from assault to car wrecks to falling down, and the types of treatment for spinal trauma are as varied as the causes.[athensbrainandspine.com]
  • Treatment Options for Spinal Trauma Spinal trauma requires immediate treatment, usually at the site of the injury, to prevent additional injury to the spinal cord.[neurosurgeonsofnewjersey.com]

Prognosis

  • There are several types of traumatic spinal cord injury 3-5 : spinal cord swelling spinal cord contusion/edema cord edema only: most favourable prognosis cord edema and contusion: intermediate prognosis cord contusion only: worse prognosis intramedullary[radiopaedia.org]
  • The prognosis is guarded for recumbent horses and cattle. In animals that have lost deep pain perception caudal to the lesion, the prognosis for return of neurologic function is poor. Resources In This Article[merckvetmanual.com]
  • These cases illustrate Cushing's dedication to and rapport with his patients, even in the face of a dismal prognosis.[ncbi.nlm.nih.gov]
  • […] when compared with clinical predictors, but confirmed that the presence of hemorrhage was associated with a worse prognosis.[appliedradiology.com]
  • Emergency magnetic resonance imaging of cervical spinal cord injuries: clinical correlation and prognosis. Neurosurgery. 1999;44:785-92. Andreoli C, Colaiacomo MC, Rojas BM, Biasi D, Casciani E, Gualdi G.[msjonline.org]

Etiology

  • Subluxation may also be an asymptomatic complicating factor to those etiologic factors mentioned above.[chiro.org]
  • J Trauma 1987; 27:980–6Reid, DC Henderson, R Saboe, L Miller, JDR Davis JW, Phreaner DL, Hoyt DB, MacKersie RC: The etiology of missed cervical spine injuries.[anesthesiology.pubs.asahq.org]
  • Etiology and clinical course of missed spine fractures. J Trauma . 1987; 27: 980–986. Levi AD, Hurlbert RJ, Anderson P, et al.. Neurological deterioration secondary to unrecognized spinal instability following trauma—a multicentre study.[east.org]

Epidemiology

  • Spinal cord injury in Manitoba: a provincial epidemiological study. J Spinal Cord Med. 2011;34(1):6-10. Cripps RA, Lee BB, Wing P, Weerts E, Mackay J, Brown D.[msjonline.org]
  • We need to collect epidemiological data to know the magnitude of the problem with average number of patients per lakh of the population, their demographic details, mode of trauma, mode of transportation, type of treatment given.[ncbi.nlm.nih.gov]
  • Epidemiology The type and location of injury varies with age of the patient. Osenbach and Menezes 20 reported on 179 children from birth to age 16 years treated for vertebral column and/or spinal cord injury during an 18-year period.[journals.lww.com]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Clinical Epidemiology . 6 : 309–31. doi : 10.2147/CLEP.S68889 . PMC 4179833 . PMID 25278785 . Devivo MJ (May 2012). "Epidemiology of traumatic spinal cord injury: trends and future implications".[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Perhaps such techniques would allow more insights into the ongoing pathophysiologic changes present in the acute and chronically injured spine.[ajnr.org]
  • The second group, treatments targeting the pathophysiology of spinal injuries, encompasses timing of surgery in spinal trauma, hypothermia, lumbar drainage, and diffusion MRI.[academic.oup.com]
  • Time-dependent effect long-term pathophysiology.[anesthesiology.pubs.asahq.org]
  • Tator CH (1996) Experimental and clinical studies of the pathophysiology and managment of acute spinal cord injury. J Spinal Cord Med 19: 206–214 57.[springermedizin.de]
  • Respiratory assessment As with all clinical practice, background anatomical, pathophysiological and disease knowledge inform the clinical assessment of patients.[breathe.ersjournals.com]

Prevention

  • Treatment Options for Spinal Trauma Spinal trauma requires immediate treatment, usually at the site of the injury, to prevent additional injury to the spinal cord.[neurosurgeonsofnewjersey.com]
  • Emergency Medicine . 2016 April;48(4):152-157 Prehospital spinal immobilization has long been the standard of care (SOC) to prevent spinal cord injury in trauma patients, but utilizing the best data currently available, some professional societies recently[mdedge.com]
  • These are all preventable injuries and can be avoided if people are educated and safety norms are practiced mandatorily.[ncbi.nlm.nih.gov]
  • In the case of spinal trauma, immediate treatment is necessary to prevent any additional damage to the spinal cord. Surgery may be necessary to relieve any pressure in your spine or stabilize fractured vertebrae.[kaweahdelta.org]
  • It is an emergency which can require urgent surgical intervention to prevent long-term neurological complications of spinal cord injury.[radiopaedia.org]

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