Spine

Trauma Update

Geragai Clinic
dr. William Aditya
 Geragai- Clinic Medical Lecture

Milestone Spine Trauma (Injury)

2
 Milestone(1)

3000-2500 BC in Egypt, as an ailment not be

treated
460-370 BC Hypocrates Gtrrce, perfomed traction
25 BC50AD, Celsus, Rome performed traction
129-210, Galen, Rome, perform reduction by traction
625-690, Aegina, Greece, pioneered decompression
techniques, particularly laminectomy
625-690, Avicenna, Persia, Advocated stabilisation
and reduction for less seroucs case(s
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 Milestone(2)

1210, Roland, Parma Italy, introduce extension brace

1533-1619, Gabricius, Germany, open reduction of
spinal fracture
1560-1634, Hildanus, Germany, closed reduction of
cervical fracture dislocations
1796, Desault, Decompression for SCI
1815, Cline, UK, performed and recommended
laminectomy for fracture dislocations.

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 Milestone(3)

1815, Mathijseu, Netherland, First immobilised a spinal

fracture using a plaster cast.
1887, Burrell, UK, Pioneered the use of fixation by a
plaster jacket following traction or laminectomy
1890, Hadra, USA, Achieved the first surgical
immobilisation and fusion of the spine, using wires
attached to the spinous processes
1890-1900, Wagner, Germany, reducing spinal
fractures involving continued extension for many
weeks CharlesASjuntak, FKIK-Unja 5
 Milestone(4)

1902, Bonomo, Italy, Introduced hemilaminectomy

1924, Lackum & Smith, USA, Performed the first
anterior spinal surgery
1928, Taylor, USA, First used the technique of halter
traction, followed by immobilisation by a plaster cast
then a neck brace.
1954, Tarlov, USA, Used an experimental model in
dogs to demonstrate that early decompression in SCI
improves neurological outcome
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 Milestone(5)

1956, Hodgson, Hongkong, Anterior fusion for STB

1958, Harrington, USA, Presented his newly-developed
Harrington instrumentation system of rods and hooks,
which provided distraction and compression especially
for scoliosis
1964, Dwyer, Australia, Designed the Dwyer anterior
instrumentation system involving screws that would
cross vertebral bodies, associated with plates
1966, Harrington, USA, Designed a pedicle screw
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 Milestone(6)

1966, Harrington, USA, Designed a pedicle screw

1988, Sapardan, Indonesia, Designed a pedicle screw &
sublaminary wire (PSSW)
1998, Sapardan, Indonesia, Designed UI (University of
Indonesia) System using pedicle screw rod =
sublaminary wire (a k a Hybrid instrumentation)
1997, Japan, Introduced Minimally Invasive Spine
Surgery

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Spine & Spinal Cord
injury

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Confirmation tof significant spine injury

Clinical signs od neurolgical deficit

Radiokogical investigations
Plain X-ray/CT/MRI
Identify bony fracture/subluxation
Presume spinal instability

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 Classification

Incomplete Complete
Presence of Absence of

Sensation (+) Sensory &

Voluntary motoric function
movement of Sacral sparing
extremity Reflex maybe
Sacral sparing present
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 Screening of Spinal injury(1)
Consious patient

Paraplegic/quadriplegic

Spinal instability

Fracture/Sublux Consult
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Screening of Spinal injury(2)
Conscious, neurologis normal:
No neck pain or tenderness
No neck pain or tenderness
Able to concentrate on C-spine
Remove C-collar

If pain
Protection with C-collar & Xray
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Screening of Spinal injury(3)

Unconscious patient
Radiographic visualization of
entire spine
Plain films / CT Scan / MRI

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Type 1 injuries

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Type 2 injuries

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Type 3 injuries

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Management of Spinal injury

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Management
Imobilized
Total body
Use padding
Maintain until all can be excluded

Do not use backboard!

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Conservative Management (1)
Ensure adequate ventilation and oxygenation
espeially quadriplegic (c-4)
Maintain blood pressure
Maintain perfusion of spinal cord
Atropine if bradycardia
Methylprednisolone

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Conservative Management (2)

Management of Hypotension
Assess for asociated bleeding
Consider neurogenic shock
Monitor urinary output

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Conservative Management(4)

Transfer
Unstable fractures
Neurological deficit
Avoid transfer delay
Properly immobilize entire patient
Provide respiratory support as needed

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Surgical management

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Minimally Invasive Spine Surgery
Multiple small incision, cosmetically good
Minimally tissue damage
Early mobilization
Short hospital stay
Minimally bleeding
Safe
A little bit longer operation time
Need C-Arm Xray for guiding
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Question

?
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Thank you

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