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PCT2 - Spinal

Spinal Cord Injuries Overview

  • Fractures can occur with or without spinal cord damage.
  • Unstable injuries typically involve damage to the posterior column and vertebrae ligaments, increasing the risk of complications.

Mechanisms of Injury

  • Understanding the mechanism of injury is crucial for applying appropriate immobilization restrictions.
  • Key mechanisms include flexion, extension, rotation, and torsion.

Flexion

  • Definition: Head moves forward past its normal range of motion.
  • The cervical spine is the weakest and most vulnerable part due to its flexibility.
  • Flexion injuries can cause both hard and soft tissue trauma.
  • Ligaments can be torn, leading to instability.
  • Wedge Fracture:
    • Vertebrae become compressed, forming a wedge shape.
    • Typically seen in flexion injuries.

Severity of Injury

  • Varies depending on the amount of energy and mechanism of injury.
  • Injuries can range from soft tissue tears to vertebral fractures (e.g., teardrop fractures, wedge fractures).
    • Teardrop Fracture: A piece of the vertebrae separates, resembling a teardrop.

Splinter Fractures

  • High-velocity trauma can cause splinter fractures, where splinters of bone break off the vertebrae.
  • Risk: Splinters are sharp and can slice the spinal cord.
  • Surgeons often remove splinters to prevent further cord damage.
    • Cord fibers have limited regeneration and redundancy.

Hyperflexion

  • Flexion beyond the normal range of motion.
  • Can tear ligaments.

Avulsion Fractures

  • Ligaments can tear a piece of bone off the vertebrae.
  • Avulsion: Separation of tissue from its normal anatomical location.

Ligament Injuries

  • Raise concerns about spinal cord injury (SCI).
  • Severe flexion can result in unstable dislocation of vertical joints, leading to cord damage.

Rotation

  • Another mechanism of injury that can lead to dislocation.

Compression Fractures

  • Most commonly occur in the lumbar spine.
  • Mechanism: Vertical compression, such as landing on the feet after a fall.
  • Often treated with observation and restricted activity to allow the bone to heal.
    • Treatment involves waiting for the area to repopulate with calcium.

Treatment Spectrum

  • Ranges from conservative management to surgical intervention.
  • Halo External Fixation:
    • Used for confirmed cervical fractures.
    • A metal band is placed around the head with screws inserted into the skull to connect to a harness on the chest.
    • Immobilizes the cervical spine post-surgically.
    • Worn for approximately two months to stabilize the fracture.

CPR Considerations

  • Use a backboard or KED (Kendrick Extrication Device) for effective CPR.
  • Scoop stretchers are not suitable for CPR.
  • CPR boards (mini half-backboards) can also be used.