Dr. TEDJO RUKMOYO, SpOT,S.SPINE(K), FICSDr. TEDJO RUKMOYO, SpOT,S.SPINE(K), FICS

In U.S. : 11,200– Death before hospital : 4,200– Death in hospital : 1,150– Survive : 50%

In Dr. Sardjito hospital: 5-6 cases / month

Quadriplegia : 50%Paraplegia : 50%

80% < 40 y.o.( 15-35 y.o.)

10% paralysis increase during staying in the hospital

Cerebral concussion : 20% with cervical fracture

CERVICAL VERTEBRAE :

• More often • Especially C 5 - C6• Wider mobility• Spinal canal 30% wider than spinal cord

THORACAL VERTEBRA

• Trauma Not so often• Trauma • Complete paralysis

• Irreversible

VERTEBRAE LUMBAL :

• The most cases fracture T 12- L1• Paraparese Paraplegi

NEUROLOGIC DISTURBANCES :

Death neuron in 4 hoursDysfunction of the spinal cord

• Compression of the spinal cord• Disruption of the vascularization

PREHOSPITAL CAREPREHOSPITAL CARE

1. ABC evaluation, B6 evaluation

2. Vital sign

3. Seeking for painful, consciousness evaluation

4. Cervical palpation – neurologic evaluation

5. Examination the others trauma

6. Splinting stabilization

7. Medication

SPINAL CORD INJURYBowelDistension

PRESSURESORES

BLADDERDYSFUNCTION

URINARYINFECTION

PYELONEPHRITIS

CACHEXIA

WEAKRESPIRATION

ACUTE

DEATH

RESPIRATORYINFECTION

POOR RESISTANCETO INFECTION

SPASM

CONTRACTURES

PSYCOLOGICALFACTORS

PROTEIN LOSSAND ANAEMIA

LOSS OFAPPETITE

SUSPECTED CERVICAL FRACTURESUSPECTED CERVICAL FRACTURE

• Keep unmoving of the head

• Apply cervical collar

• Fixing sand-bag pillow beside the head

• Traction: Glisson, Crutch field traction

• Lifting the patient in a unite: 4 persons

SPINAL SHOCKSPINAL SHOCK

• Paralysis + sensibility disturbances• Areflexia• Micturation and defication disturbances • Unsweating• No perianal sensation• No Bulbocavernous reflex • Lasting < 24 hours

VERTEBRAE FRACTURE WITH PARALYSISVERTEBRAE FRACTURE WITH PARALYSIS

• Paralysis (+) / (-)• Perianal sensation (+)• Moving voluntary finger of the foot (+)• Anal contraction voluntary (+)• Bulbocavernous reflex (+)

After recovery of the spinal shock

INCOMPLETE LESIONINCOMPLETE LESION

COMPLETE LESIONCOMPLETE LESION

• Paralysis : Total• Sensibility (-)• Bulbocavernous reflex (+)• Plantar moving big-toe – stimulation: slowly• Priapismus

After recovery of the spinal shock

Fracture C3 - C4 :Fracture C3 - C4 :

Abdominal respiratory– n. intercostal– Lesion respiratory

distress death

Fracture C7 - T1:Fracture C7 - T1:Horner syndromeHorner syndrome

Ptosis Enopthalmus Anhidrosis Miosis

• Bed rest - spinal board• Collar brace• Infus maintenance• Fasting• Catheter • Gastric distension evaluation – gastric cube• Dexamethason / metil prednisolon inj., if < 8 hours• Vital sign & neurologic Evaluation• If : spinal shock: T, P, HR

Limitation fluid management Sympatomimetic

MANAGEMENTMANAGEMENT

Flexion - Extensionneck sprain

SPINAL STABILITY SPINAL STABILITY PAIN PAIN

- Two column concept:- Anterior – posterior column- Disruption posterior column: unstable

- Three column concept:- Anterior-middle-posterior column- Disruption of two column : instability

- Neurologic dysfunction: instability

1. Operation : Unstable

• Neurologic deficit• Kyphosis > 30o (thoraco-lumbal), cervical > 11o

• Translation vertebrae / Dislocation• 2 columns fracture• Vertebrae body height collapse > 50%• Protrusion to spinal canal > 30%

• Release spinal cord compression• Stabilization : Plate + Screw + Wire, Nail + Wire

TREATMENTTREATMENT

2. Conservative

TREATMENTTREATMENT

• Bed rest • Traction• Collar brace • Minerva cast (cervical)• Body jacket brace / cast (thoraco-lumbal)• Hemi-spica cast (> L3)

• Paralysis after few years

• Painful

• Hyper kyphosis

If must be operated,If must be operated,but not to be operated :but not to be operated :