Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of injury. 5% of patent with neurological symptom. Excluding.

Waleed Awwad, MD, FRCSC

Waleed Awwad, MD, FRCSC

Introduction• Multiple injuries.• Brain injury.• Spinal injury.• Area of injury.• 5% of patent with neurological

symptom.• Excluding the presence of spinal

injury.

• Multiple injuries.• Brain injury.• Spinal injury.• Area of injury.• 5% of patent with neurological

symptom.• Excluding the presence of spinal

injury.

Anatomy• Spinal Column

Anatomy• Spinal Column

Anatomy• Spinal Column

Anatomy• Spinal Column

Anatomy• Spinal Column

Anatomy• Spinal Column

Anatomy• Spinal Column

Anatomy• Spinal Column

Anatomy• Spinal Cord

Anatomy• Spinal Cord

Anatomy• Spinal Cord

• Complete spinal cord injury.

• Incomplete spinal cord injury.

• Sacral sparing.

• Neurogenic shock Vs Spinal shock

• Spinal Cord

• Complete spinal cord injury.

• Incomplete spinal cord injury.

• Sacral sparing.

• Neurogenic shock Vs Spinal shock

AnatomySensory Examination C5 over deltoid

C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1st & 2nd toe S1 Lateral border of the foot S4-5 Perianal region

Sensory Examination C5 over deltoid

C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1st & 2nd toe S1 Lateral border of the foot S4-5 Perianal region

Anatomy• Myotomes

C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors

• Myotomes

C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors

Classification Level.

Severity.

Spinal cord syndrome.

Morphology.

Of spinalCord injury

Classification Level

Neurologic level.

Sensory level.

Motor level.

T1 level

Level

Neurologic level.

Sensory level.

Motor level.

T1 level

Of spinalCord injury

Classification Severity of neurologic deficit

Complete

Incomplete

? Any sensation ? Sacral spairing

Severity of neurologic deficit

Complete

Incomplete

? Any sensation ? Sacral spairing

Of spinalCord injury

Classification Spinal cord Syndromes

Central cord syndrom.

Anterior cord syndrom.

Brown-Sequard’s Syndrom.

Spinal cord Syndromes

Central cord syndrom.

Anterior cord syndrom.

Brown-Sequard’s Syndrom.

Of spinalCord injury

Classification Central Cord Syndrom

# Characterized by disproportionally.

# Mechanism: # Occure with or without… # Recovery… # Prognosis… # Due to…

Central Cord Syndrom

# Characterized by disproportionally.

# Mechanism: # Occure with or without… # Recovery… # Prognosis… # Due to…

Of spinalCord injury

Classification Anterior Cord Syndrom

# Characterized..

# Posterior column Function

# Due to…

# Prognosis…

Anterior Cord Syndrom

# Characterized..

# Posterior column Function

# Due to…

# Prognosis…

Of spinalCord injury

Classification Brown-Sequard’s Syndrome # Occurance..

# Due to…

# Characteristic…

Brown-Sequard’s Syndrome # Occurance..

# Due to…

# Characteristic…

Of spinalCord injury

Classification Morphology

# Fractures.

# Fracture dislocations.

# SCIWORA.

# Penetrating Injury.

# Blunt trauma.

Morphology

# Fractures.

# Fracture dislocations.

# SCIWORA.

# Penetrating Injury.

# Blunt trauma.

Of spinalCord injury

Classification

Of spinalCord injury

Classification

Of spinalCord injury

Classification

Of spinalCord injury

Classification

Of spinalCord injury

Classification

Of spinalCord injury

Classification

Of spinalCord injury

Classification

Of spinalCord injury

Specific types Atlanto-occipital dislocation. Atlas fracture. Axis fractures: Odontoid fracture. Posterior element fracture of C2.

Fractures and dislocations ( C3-C7 ). Thoracic spine fractures. Thoracolumber junction fractures. Lumbar fractures.

Specific types Atlanto-occipital dislocation.

# Uncommon.

# Sever flexion and Distraction.

# Prognosis…

# Shaken baby syndrom.

# Traction??

Atlanto-occipital dislocation.

# Uncommon.

# Sever flexion and Distraction.

# Prognosis…

# Shaken baby syndrom.

# Traction??

X-Ray Evaluation

C-Spine X-ray. lateral, open mouth and Flex-Ext.

CT-Scan.

MRI.

CT myelography.

X-Ray Evaluation

Rad. Evaluation

management Immobilization

management IV Fluids. Medications. Vasopressors: Phynylephrine, Dopamine

or NE Steroids:

> Within .. > First 3hrs… > Between 3-8hrs….

IV Fluids. Medications. Vasopressors: Phynylephrine, Dopamine

or NE Steroids:

> Within .. > First 3hrs… > Between 3-8hrs….

Thank you