2. epidemiology Occurrence 20-80 per 100,000 2 deaths per 100,000 population due to spinal injury male/female ratio 3/1

3. Etiology (USA) 40% - motor vehicle accidents 20% - falls 15% - industrial 15% - sports and recreation

4. Denis tree-column theory anterior posterior column. middle

5. Mechanisms of spine injury Flexion Flexion-rotation Extention Compression

6. Flexion Flexion-Rotation. Mechanisms of injury

7. Shear. Flexion- Distraction. Extension

8. Classification of injury to the spine 1. Depending on integrity of the skin 1. Closed 2. open, depending on integrity of dural sac a)missile b)nonmissile 2. Clinical forms of injury to the spine 1. contusion 2. Injury to the ligaments and capsules 3. Rupture of intervertebral disk 4. Facet dislocation 5. Complete bilateral facet dislocationn (locked facets) 6. Fracture of vertebra corpus (compressive, burst) 7. Fractures of posterior elements of vertebras (joint, transverse, spinous processes and arch) 8. Fracture-dislocation (unilateral and bilateral) 9. Multiple fractures of vertebra elements 3. Violation of support function 1. Stable 2. Instable

9. Types of injury to the cervical spine Occipital condyle fractures Atlanto-occipital dislocation Fractures of the atlas Jefferson fracture Fracture of posterior arch Axis fractures Fractures of the odontoid process (I-III types) Lateral mass fractures Traumatic spondylolisthesis (hangman's fracture)

10. Atlanto-occipital dislocations

11. Traumatic spondylolisthesis (hangman's fracture)

12. Fracture of odontoid process of C2 (type II)

13. Types of injury to the cervical spine Fractures and dislocations of C3-C7 Compression fractures Burst fractures Teardrop fractures Unilateral facet dislocation Bilateral facet dislocation (locked facets) hyperextension dislocation hyperextension fracture-dislocation laminar fractures Fracture of spinous process

14. Compressive fracture of С5

15. Unilateral facet dislocation of C4-C5

16. dislocation of С4

17. Edge compressive fracture of С7, dislocation С6, compression of spinal cord

18. А-normal Б-subluxation В-dislocation Г- complete dislocation with locked facets

19. Complete dislocation of C5 (bilateral locked facets with severe compression of spinal cord

20. Burst fracture С3-С4 with із severe spinal cord compression

21. Typical injuries to the thoraco- lumbalis and lumbalis spine Wedge compression fractures Burst fractures Seat belt–type injuries Fracture-dislocations

22. Wedge compression fracture

23. Burst fractures

24. Seat belt–type injuries

25. Fracture-dislocations

26. Classification of the injury to the spinal cord Complete syndrome – total loss of motor and sensory function below injury level central cord syndrome – weakness of the upper extremities greater than the lower extremities anterior cord syndrome total loss of motor and lateral column sensory function (pain and temperature), dorsal column function (i.e., proprioception, touch, and position sense) is spared conus medullaris syndrome combination of spinal cord and nerve root involvement Cauda equine syndrome Brown-Sequard syndrome

27. Scheme of blood supply of spinal cord and typical ischemical changes 1-vertebral arteria 2-5-radicular- medular arteries 6-spinal cord А – loose type of blood supply Б,В,Г – variants of magistral types of bood supply

28. Classification of spinal cord injury Frankel (A) complete, (B) sensory only, (C) motor useless, (D) motor useful, (E) recovery.

30. Prehospital care 1. ABC A (airway), cleaning, airway tube if indicated B (breathing) – supplemental oxygen of mask C (circulation) – maintaining normal blood pressure – fluids 2. Immobilization - rigid cervical collar, backboard

31. Emergency room management ABCDE Cont ABC protocol Supplemental oxygen for all Fluids and pressors for maintaining normal blood pressure D - (disability) - assessment of neurological status E – (exposure) - removal of all clothes for throughout examination methylprednisolone - iv bolus of 30 mg per kg followed 5.4 mg per kg per hour continuous infusion during the next 23 hours.

32. Treatment of cervical spine injury Cervical traction Reduction of dislocation Manual reduction Traction Immobilization with orthoses Collars Cervicothoracic, thoracolumbar braces Halo-orthosis Surgical decompression and stabilization

33. Typical indications for surgery Almost all thoraco-lumbar injuries with neurological deficit thoraco-lumbar injuries without neurological deficit in cases of progressive deformation (kifosis) Cervical burst fractures and fractures- dislocation Other cervical injuries after ineffectiveness of conservative treatment (cervical traction, manual reposition, halo-orthoses)

34. Accompanying problems and complication Dysfunction of bladder and bowel Urinary infection Decubitus (trophic ulcers) Spasticity (late) Progressive deformation of the spine

35. Diagnostic procedures Plain X-ray examination (min 2 views) Functional X-ray examination CT Myelography and postmyelography CT MRI CSF dynamic tests

36. Reposition of cervical spine dislocations А- traction Б- bending to the “healthy” side В- rotation to the opposite side

37. Hallo apparatus for stabilization of cervical fractures

38. Tongs of distraction and stabilization of injury to the cervical spine

39. Surgical stabilization Corporodesis C3-C5, anterior approach

40. Surgical stabilization Transpedicular fixation

41. Posterior spondilodesis with bone graft

42. Scheme of anterior spondylodesis

43. Posterior spondilodesis with metal wire