Spine Fractures

 

INTRODUCTION:

Spine is the principal load bearing structure of the head and torso.

Cervical spine provides head with limited mobility and protects proximal part of spinal cord. Injuries of the cervical spine are dangerous and if associated with neurological damage the results can be devastating.

Jefferson pointed two areas commonly involved in cervical spine injuries,C1-2 and C5-7. According to meyer C2 and C5 are commonly involved.Neurological damage is seen in 40 percent of cases.In 10 percent of cases,radiographs are normal.

CAUSES:

  • Fall from height-most common cause in developing countries.
  • Diving injuries-diving into water with insufficient depth or in an inebriated condition.
  • Road traffic accidents-common cause in developed countries,e.g.whiplash injury
  • Gunshot injuries,etc-These injure the cervical spine and the cord directly.

MECHANISM OF INJURY:

  • Pure flexion force-e.g compression fracture of vertebral body,e.g fall from height
  • Flexion rotation force-e.g fall on one side of the shoulder,disruption of facet capsule.
  • Axial compression-e.g fall of an object on the head results in load compression,e.g explosive comminuted fracture of C5 body.
  • Extension force-e.g avulsion fracture of superior margin of vertebral body,e.g whiplash injury.
  • Lateral flexion-e.g fracture pedicle,practure transverse process and facet joints,etc.
  • Direct injuries-e.g fracture spinous process and body.Due to assault,gunshot injury etc.

CLINICAL FEATURES

Patient usually gives history of trauma following which there will be pain,swelling and inability to move the neck.Tenderness over the involved spinous process and there could be a palpable gap.There may be signs of neurological involvement.The injuries to the spinal cord at the cervical region can manifest in the following ways.

  • Concussion : This is a state of spinal shock and there will be sensory loss,flaccid paralysis,visceral paralysis,reflexes are in abeyance and anal reflex is absent.By 8 hours concussion is known to regress and by 8-10 days there is complete recovery.
  • Nerve root involvement:Individual nerve roots could be affected at their respective intervertebral foramen.All the features of peripheral neryve injury with LMN type of lesion are seen.The myotome and the dermatome should be assessed to know the root involvement.
  • Cord involvement:could be:
    Complete:This leads to quadriplegia or quadriparesis.
    Incomplete:Here the central cord,lateral cord,anterior or posterior cord could be involved.

DIAGNOSIS:

X –RAYS:

this is helpful in:

  • Confirmation of diagnosis
  • Assessment of mechanism of injury
  • Assessment of the stability of the spine

TOMOGRAM:

  • Helps in better delineation of the doubtful area

CT-SCAN  :

  • The damaged structures can be seen more clearly and bony fragment in the canal can be noted.

MRI :

  • Is helpful for getting a better picture of injured bones and soft tissue.

TREATMENT:

  • Immediate First Aid for Neck Injuries : Any injury to the head or neck should be evaluated for a neck fracture. A cervical fracture is a medical emergency that requires immediate treatment. Spine-related trauma may injury the spinal cord and could result in paralysis, so keeping the neck still is critical.
    If there is any chance of a cervical fracture, the patient’s neck should be immobilized (not moved) until medical attention arrives and X-rays can be taken. It’s best to assume there is a neck injury in anyone who has an impact, fall or collision-type of injury.
    Symptoms of a cervical fracture include severe neck and head pain, pain that radiates [travels] to the shoulders or arms, or bruising and swelling at the back of the neck.
  • Treatment of Cervical Fractures : The treatment of a cervical fracture depends upon which cervical vertebrae was damaged and the extend of the fracture. A minor (compression) fracture is often treated with a cervical collar or brace worn for six to eight weeks until the bone heals on its own.
    A more severe or complex fracture may require traction, or surgical repair or a spinal fusion.
    Surgical repair of a cervical fracture can result in a long recovery time followed by physical therapy.

COMPLICATION:

  • Spinal nerve injury
  • Paralysis
  • quadriplegia

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Relief pain
  • Restoring neck range of motion
  • Restore Flexibility of cervical spine
  • Strengthening of paracervical ,cervical, upper limb and lowerlimb muscles
  • Prevention of complications
  • Restoration of activities of daily living pain free sitting and standing
  • Transfer techniques
  • Gait and ambulation

Visit Physioline for the Consultation and treatment

 

FRACTURE OF THORACIC AND LUMBOSACRAL SPINE

INTRODUCTION:

Fracture of one or more bones of the spinal column (vertebrae) of the middle (thoracic) or lower (lumbar) back is a serious injury. thoracolumbar spine is generally regarded as extending from 10th thoracic vertebrae to 2nd lumbar vertebrae and is the transitional area between kyphotic upper thoracic spineto the lordotic lumbar spine.

MECHANISM OF INJURY:

It is usually caused by high-energy trauma such as a

  • car crash,
  • fall from height,
  • sports accident,
  • violent act (for example, a gunshot wound and assualt).

People with osteoporosis, tumors, or other underlying conditions that weaken bone can get a spinal fracture with minimal trauma or normal activities of daily living.

Males experience fractures of the thoracic of lumbar spine four times as often as females. The spinal cord may also be injured, depending on the severity of the fracture.

Never attempt to move a person with a spinal injury because movement can cause more damage.

CLASSIFICATION OF SPINE FRACTURES:

Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury.

  • Compression fracture. While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and is rarely associated with neurologic problems.
  • Axial burst fracture. The vertebra loses height on both the front and back sides. It is often caused by a fall from a height when a person lands on their feet.
  • Flexion/distraction (Chance) fracture. The vertebra is literally pulled apart (distraction). This can happen in accidents such as a head-on car crash, in which the upper body is thrown forward while t
  • Transverse process fracture. This fracture results from rotation or extreme sideways (lateral) bending and usually does not affect stability.
  • Fracture-dislocation. This is an unstable injury involving bone and/or soft tissue, in which one vertebra may move off the adjacent one (displaced)

CLINICAL FEATURES:

  • Pain
  • Posterior swelling
  • Tenderness
  • Palpable interspinous gap
  • Neurological involvement may vary from paraplegia to individual nerve root involvement
  • Spinal shock is present for 24hrs during which all reflexes are lost
  • Cuada equina paralysis is present if lesion is below L1

DIAGNOSIS:

After checking heart rate, breathing, and other vital signs, a doctor will locate the fractured part or parts of the spine and determine the extent of the damage. The doctor will determine exactly how the vertebra broke (fracture pattern) and whether there is any nerve injury and/or spinal instability.

  • Medical History : Every detail you can recall about what caused the injury may help the doctor. did the accident eject the patient from a vehicle? Was there windshield or steering column damage? Was the person using a lap and/or shoulder seat belt? Did an airbag deploy? Sometimes, rescue workers or witnesses can supply more information.
  • Physical Examination :The doctor will carefully remove the patient’s clothing and immobilize the patient with a spine board for a complete physical examination. This may include checking for swelling, bruising, and other signs of injury to the head, chest, abdomen and back; evaluating strength, motion and alignment of arms and legs; feeling for tenderness on each rib and along the entire length of the spine; testing the tone and sensation of rectal muscles; and other evaluations.
  • Neurologic examination : May also be needed. This may include tests of sensory (temperature, pain, and pressure sensitivity), motor (muscle strength) and reflex functions of the nervous system. If there is neurologic damage, certain tests can show whether the patient may recover some function (incomplete deficit) or not (complete deficit).
  • Imaging : X-rays of the entire spine from multiple angles may be necessary to see bone alignment and check for damage to soft tissue. Sometimes, computed tomography (CT) or magnetic resonance imaging (MRI) scans are required to help the doctor better visualize the injury.

TREATMENT:

Treatment goals include protecting nerve function and restoring alignment and stability of the spine. The doctor will determine the best treatment method based upon the type of fracture and other factors.

Nonsurgical Treatment :

  • Doctors usually treat compression fractures and some burst fractures without surgery.
  • With a simple compression fracture, patients may be required to wear a hyperextension brace for sitting and standing activities for 6 to 12 weeks.
  • Patients should walk and do other exercises while healing and may take medications for pain.
  • With a transverse process fracture, patients may need to wear a thoracolumbar corset and participate in an aerobic walking program.

COMPLICATIONS:

  • Patients with spinal cord injuries are prone to multiple complications, including
  • Decubitus ulcers
  • Pulmonary problems
  • Urinary sepsis
  • Occasionally, patients develop delayed progressive neurologic deterioration months to years after sustaining spinal trauma due to instability and progressive spinal deformation.
  • Intraoperative complications
  • Failure of the fusion
  • Infections
  • Thromboembolic disease(deep vein thrombosis)
  • Stress ulcers.
  • Adynamic ileus and Ogilvie syndrome
  • Genitourinary complications

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Relief pain
  • Restoring range of motion
  • Strengthening of paraspinal muscles
  • Prevention of complications
  • Restoration of activities of daily living pain free sitting and standing
  • Transfer techniques
  • Gait and ambulation

Visit Physioline for the Consultation and treatment