Operative Treatment For Cervical Spine Fractures Dr T
- Slides: 57
Operative Treatment For Cervical Spine Fractures Dr. T. G. Hogan
Occipito-cervical Dissociation
Basion-Dens-Interval <12 mm. >12 mm. Suggests Vertical Instability Basion Occipitocervical Basion Instability Axis Basion-Axial-Interval < 12 mm >12 mm. Suggests Anterior Instability <0 mm. Suggests Posterior Instability Int <12 BDI < 12
Occipitocervical Dislocation • Mechanism Unclear – Rotation & Distraction • Neurological Deficits Confusing – High Tetraplegia – Cruciate Paralysis – Wallenberg’s Syndrome • Ligamentous Injuries = Unstable • Avoid Traction
Atlas Fractures: Extension • Anterior Arch – Hyper-extension – Avulsion of Longus Colli – R/O Other Injuries – 65% (Landells) • Stewart G, Radiology 1977
Atlas Fractures: Extension • Posterior Arch Fractures • Occipital Pain & Numbness • Stable • R/O Other Injuries (Odontoid #)
Jefferson Fractures • Four Part Burst • Axial Load • 6. 9 mm Overhang – Spence KF, JBJS, 1970 • 8. 1 mm Overhang – Heller JG, J Spinal Disord, 1993
Lateral Mass Fractures of C-1 • Free-Floating Lateral Mass of C-1 • Often Comminuted – Segal & Stauffer, JBJS, 1987
Treatment & Results C-1 #’s • Good Results Reported with – Halo Traction + Vest – Rigid or Simple Orthoses • Late Pain: – Ant/Post Arch – Jefferson – Lateral Mass 50% 70% 33% • Landells, Van. Peteghem, Spine 1987
Anderson & D’Alonzo Classification (JBJS, 1974) • Type III
Odontoid fractures Type 1 Type 2 Type 3
Type II Odontoid • Halo-Thoracic Brace • Non-union Rate 14 -32 -75% • Risk Factors: – Failure to Treat – 5 mm Displacement – >10 deg. Angulation – Posterior Displacement – Elderly
Type II Odontoid • Direct Screw Fixation • • Preserves C 1 -2 Motion No Bone Graft Required Avoid Non-Unions Avoid Reverse Oblique # – Aebi, Spine 1989
Type II Odontoid • Posterior Fusion – Primary – for Non or Delayed Union • Trans-articular Facet Screws • 96% Fusion Rate • Restricted Rotation
C 2 Magerl screw fixation • Good stability • • Does not need – odontoid – C 1 arch – C 2 arch Challenging
Odontoid stabilisation Osteosynthesis: odontoid screw fixation Arthrodesis: Magerl screw fixation - challenging – Good stability – Does not need odontoid, C 1 arch or C 2 arch
Traumatic Spondylolisthesis C-2 (Levine & Edwards, JBJS, 1985)
Traumatic Spondylolisthesis C-2 (Levine & Edwards, JBJS, 1985)
Traumatic Spondylolisthesis C-2 (Levine & Edwards, JBJS, 1985)
Traumatic Spondylolisthesis C-2 (Levine & Edwards, JBJS, 1985) Dislocated
Subaxial C-Spine
Flexion-compression. . . 3 2 1 4 5
Checklist Approach • Applies to trauma and degenerative disease • The more points the more unstable • 5 points does not mean surgery occasionally <5 need Sx >5 don’t need Sx • Currently investigated by CSRS • Different considerations for different levels • 2 -column VS 3 -column
Sensitivity Settings
C 2 -T 1 • • • Usually for trauma, but applies to all Ant. /post. Element failure Stretch test (1. 7 mm, >7. 5 degrees) X-Ray (>3. 5 mm, 11 degrees) Flex/ext x-ray (>3. 5 mm, 20 degrees) Pavlov’s ratio (<0. 8) sagittal diameter <13 Narrow disc Cord damage Root damage Dangerous loading anticipated
Cervical Measurements
Mr. Roeth. C-4 Fracture
Mr. Roeth. C-4 Fracture
CSLP Ant. & Post Instability
Mr. R. Co. C 5 & 6 Fractures
Mr. R. Co. C 5 & 6 Fractures
Mr G H C 4 -5 Facet Dislocation
Mr G H C 4 -5 Facet Dislocation
Cervical trauma Case presentations
Cervical trauma Case 1
Patient JM, 16 yrs • Fell boarding 2/52 ago – – – C 6 “winded” continued 2/7 hemoptysis 4/7 saw GP neck xrayed • Full ROM • Not tender C 6
Patient JM, 16 yrs C 6 Spot lateral C 7
Patient JM, 16 yrs C 6 C 7 Extension C 6 C 7 Flexion
Patient JM, 16 yrs C 6 C 7 CT reformats
• New or old injury? –Snowboarding 2 wks ago? –Dirtbike 2 yrs ago? • Observe only? –Advice and precautions –Risks • Stabilise? –Anterior or posterior –Risks
Patient EC, 72 f Initial Xray C 5
Patient EC, 72 f C 5 Left CT Right
Patient EC, 72 f C 5 Postreduction T 2 MRI
EC C 5 Postop
Cervical trauma Case 3
Patient M, 65 yrs Initial CT
Patient M, 65 yrs Initial CT Left Right
Patient M, 65 yrs Intraoperative Postop
Initial CT Patient M, 65 yrs
Patient BB, 32 yrs
10 lbs 15 lbs 20 lbs BB 25 lbs + 1 day
BB
3 months 6 months BB
- Reflexology tips
- Slidetodoc.com
- Dr sukhpal singh
- Ao classification of fractures
- Acetabular fractures
- Primary bone vs secondary bone
- Fracture en bois vert
- Olecranon fractures irving
- Open fracture treatment
- Classification fracture supracondylienne
- Acetabular ossification
- Panfacial fractures sequencing
- Radial fractures glass
- Weber classification
- Types of fractures with pictures
- Fracture de voillemier définition
- Types of glass fractures
- Daniel tibia
- Concentric fracture glass
- Tubular shaft of a long bone
- Types of fractures with pictures
- Water seal chamber
- Hernia nursing care plan
- Transhepatic cholangiography
- What are the 3 phases of perioperative nursing
- Caesarean section ppt
- Informative expressive operative
- Informative, expressive and operative text types
- Pre operative care
- Leva operative
- Pen grasp in dentistry
- Operative functions of hrm
- Operative clauses mun
- Perioperative nursing meaning
- Holger kallehauge
- Preoperative patient education ppt
- Crtd sap
- Preambulatory clauses examples
- Smear layer definicion
- Terratogenesis
- Pre- post- peri-
- Comfed
- Post operative nursing care
- Preoperative nursing definition
- Strategische restrukturierung
- Scope of operative dentistry
- Straight fissure bur uses
- Operative clause example
- Human resource management process
- Rake angle in dentistry
- Nursing interventions for hoarding disorder
- Post operative fever
- Post operative nursing care
- Piggy back wedging
- Nursing care plan for cataract surgery
- Operative clause words
- Ordinary hatchet
- Co operative relationship between investor and entrepreneur