Back injury

Back component

• Skeletal

• Non Skeletal

Skeletal

SPINE

C 7

T 12

L 5

Sacrum

Coccyx

Function of the Spine

• Strength and Support

• Movement

• Protection of Nerves

• Blood Supply

• Protection of Major Organs

• Absorption of Impact

Non Skeletal

• Intervertebral Discs

• Muscles, Tendons and Ligaments

• Spinal Canal and Spinal Cord

• Spinal Nerves

1 Intervertebral Disc

2.Muscle, Ligament and Tendon

Back muscle • is complex, with several different roles• support and stabilize the spine• movement of organ e.g.

– head with Sternocleidomastoid muscle

– flexion of the thigh with Psoas Major muscle

– muscles in the vertebral column serve to flex, rotate, or extend the spine

Ligament

• is fibrous tissue • connects bone to bone at or near a joint• providing stability for a joint and

preventing or limiting a certain amount of joint motion.

• Pain occurred if they are strained or torn.

Tendon

• several layers of fibrous connective tissu

e called fascia cover muscles, extends b

eyond the muscle to become the tendon

• connects muscles to bones

• composed of parallel collagen fibers that

are non-elastic and transmit force

generating from a muscle to enable body

movement

• injured tendons heal slowly due to their

limited blood supply

3 Spinal canal and Spinal cord

4 Spinal nerve

Level of Dermatomes

Common causes of back injury

• Road traffic accident• Slip• Trip • Fall• Sports injury • Sudden force of impact fro

m a blunt object.

Signs and Symptoms

• Sudden onset of pain• High levels of pain• Swelling• Bruising• Deformity • Weakness, numbness, or

paralysis in severe cases, where the fractured bone is pushed into the spinal cord or nerve.

Note: acute injury, pain should last no longer than 6 weeks

Investigation

• X-ray: diagnose vertebral fractures, scoliosis, spondylosis,

bone spur formation (osteophytes), spondylolisthesis • CTscan: produce clear pictures of bone, soft tissue, organs,

intervertebral discs and the spinal cord • MRI: produce highly detailed images that are adept at

identifying soft tissue pathologies

Types of Back Injury

Back Contusions Strained / Sprained , causing the muscles to sp

asm in an effort to protect the delicate structures of the spinal canal. This can happen in any region of the spine and can be very serious

Spinal fracture, a result of a fall Nerve damage can be the outcome of a fall, roa

d traffic accident or from a physical assault. Herniated disc may result after lifting something

that is too heavy.

• Back Contusions

• Usually – mild

– uncomplicated

Strains and Sprains

• Pain is usually – sharp

– acute

– occurs immediately

• A strain is a muscle or tendon injury

• Caused by twisting or pulling a muscle or tendon. – Falling down

– Overload

– Overuse

– Poor posture

• Chronic strains are usually the result of overuse

• Common Types of Strains– Back Strain

– Hamstring Strains

– Tendonitis

Strain

Symptoms of Back Muscle Strain

• Back pain • Muscle weakness • Back muscle spasms to reduce motion to

prevent further injury– Muscle spasms are more likely to be a

problem for the first couple of days after an injury when inflammation is at its worst.

– Though not serious, back muscle spasms can cause significant pain. Inflammation also causes pain.

Strain severity• Grade I Strain: mild

– some muscle fibers jury– healing within 2-3 weeks.

• Grade II Strain: moderate– more extensive damage to muscle fibers, but the muscle is

not completely ruptured. – healing within 3 - 6 weeks.

• Grade III Strain: severe– a complete rupture of a muscle. – this typically requires a surgical repair of the muscle– healing period can be up to 3 months.

Sprain

• A back sprain is a ligament injury

• Typically occurs when people fall• Results in an overstretch or tear of the liga

ment(s) supporting that joint

- Can happen in any region of the spine

- Can be very serious even when there is no fracture- A hard cervical collar is needed to protect

the spinal cord. - To bend the neck forward, a subluxation may occur- Detected with MRI scanning or carefully controlled

flexion and extension spine X-rays- Torn ligaments can take up to 12 months to heal fully- Can permanently overstretched leading to long-term spi

nal weakness.

Torn ligament

Ligament Injury (sprain)

Sprain severity• Grade I Sprain: mild

– minimal pain, swelling, and little or no loss of functional ability – bruising is absent or slight,

• Grade II Sprain: moderate– partial tearing of the ligament – moderate pain, bruising, and swelling. – usually has some difficulty putting weight – some loss of function.– x-ray or MRI may be needed.

• Grade III Sprain: severe– complete tear or rupture a ligament. – severe pain, severe swelling, and bruising – unable to put weight – x-ray is usually taken to rule out a broken bone. – often requires immobilization and possibly surgery

Treatment Back strain and sprain

Step 1 Rest

Step 2

Medications Analgesics Anti-inflammatory medicationsMuscle relaxing medications Creams, ointments and salves

Step 3 Physical Therapy/Exercises

Step 4Further Evaluation x-rays or MRI, CT scan, bone scan, laboratory studies

Spine Fracture

Classification of Spine Fractures

• classification systems is based on the "three-column" theory

(Modified from: Garfin S, Blair B, Eismont F, Abitbol J. Thoracic and upper lumbar spine injuries. In: Browner B, Jupiter JB, Levine A, Trafton P, editors. Skeletal trauma. 2nd ed. Philadelphia: W.B. Saunders Company; 1998. p 967--981.)

Spinal column

 

• The spine can be considered as a three-column structure.

• (Modified from: Garfin S, Blair B, Eismont F, Abitbol J. Thoracic and upper lumbar spine injuries. In: Browner B, Jupiter JB, Levine A, Trafton P, editors. Skeletal trauma. 2nd ed. Philadelphia: W.B. Saunders Company; 1998. p 967--981.)

Classification of Spine Fractures

A. Compression fracture

B. Burst fracture

C. Flexion/distraction (Chance) fracture

D. Fracture-dislocation

Compression Fractures – Injury to the anterior column – The most common types of fractures – Usually result from a fall – Usually stable – Rarely associated with neurologic problems

= the downward compression of the superior endplate of the L3

= the anterior portion of the L3 vertebral body has been displaced forward

Compression fracture

Compression fracture

compression fracture of the L1 vertebral body

a large fragment of bone projects into the spinal canal

Axial burst fracture

• Injury to both the anterior and middle column with possible retropulsion of bone into the spinal canal results in a burst fracture

• The vertebra loses height on both the front and back sides.

• Usually occur through a violent compressive load • Often caused by a fall from a height when a person

lands on their feet.

Burst fracture

The posterior margin is displaced into the spinal canal

Flexion/distraction (Chance) fracture

• often caused by seat belts in cars. (the

upper body is thrown forward while the

pelvis is stabilized by a lap seat belt )

• all three columns of the vertebral body can

fail and there may be injury to bone,

ligaments and discs.

• is unstable and required immediate

stabilization of the body and medical

attention.

Fracture-dislocation

• Injury to all three columns results

• significant translation which helps to differentiate fracture--dislocations

• This is an unstable injury • Involving bone and/or soft

tissue, in which one vertebra may move off the adjacent one (displaced).

Subluxation means

Partial dislocation of a joint. A complete dislo

cation is a luxation

C5/C6

Treatment for spinal fracture

• Goals– obtain a painless – balanced, stable spine with optimum

neurologic function and maximum spine mobility.

– the treatment method based upon the type of fracture and other factors.

– Significant controversy exists about the best method to achieve these goals.

Stable fracture

Unstable fracture

loss of 50% of vertebral body height;

angulation of thoracolumbar junction > 20

multiple adjacent compression frx; failure of 2/3 of columns of spine

ALL SPINAL INJURIES ARE UNSTABLE UNTIL PROVED OTHERWISE

Nonsurgical Treatment

• Non-operative treatment is indicated for stable injuries without the potential for progressive deformity or neurologic injury

• stable spine was able to protect cord from the forces of the original accident

• compression fractures and some burst fractures can be treat without surgery.

• may be required to wear a hyperextension brace for sitting and standing activities for 6 to 12 weeks.

• should walk and do other exercises while healing• close monitoring for increased kyphosis

Surgical Treatment

candidates for surgery• unstable, three-column injuries and significant neurologic

deficits.– fracture--dislocations, – flexion--distraction injuries, – burst fractures with neurologic deficit. – Neurologically intact patients with compression fractures and

burst fractures that have greater than 50% loss of vertebral body height or greater than 30 degrees of kyphosis

L spine fracture with surgical stabilization

L2 compression burst fracture : posterior fusion with pedicle screws (yellow arrow) joined by a posterior bar (white arrow). The pedicle screws should be entirely within the bone of the body and pedicle of the vertebral bodies.

L2 burst fracture. Pedicle screws have been placed in the L1, L2, and L3 (yellow arrows) vertebral bodies.

• CT images of a fixation of the thoracic-lumbar junction. • A bone graft and fixation plate have been positioned across the

T11-T12-L1 levels.

• an acute compression fracture (arrow)

• the loss of vertebral body height is less than 50%

• considered for vertebroplasty

the lumbar spine during the performance of a vertebroplasty procedure

Spinal cord injury

Injury occurred

• by direct pressure from a fractured fragment of bone

• by instability and abnormal motion of the vertebrae that can then narrow the spinal canal

• by bleeding within the spinal canal

Signs and Symptoms• Pain or an intense stinging sensation caused by d

amage to the nerve fibers in your spinal cord • Loss of movement • Loss of sensation, including the ability to feel heat,

cold and touch • Loss of bowel or bladder control • Exaggerated reflex activities or spasms • Changes in sexual function, sexual sensitivity and

fertility • Difficulty breathing, coughing or clearing secretion

s from your lungs

Investigation

• X-rays

• CT scan

• MRI

• Myelography

Treatment• Medications

– Methylprednisolone within 8 hours of injury to reduce damage to nerve cells and decrease inflammation

• Immobilization

• Surgery– to remove fragments of bones,

foreign objects that compressing the spine

• Rehabilitation

Disability depend on two factors

• The location of the injury

• The severity of the injury– partial spinal cord injury

• retain some sensation and

possibly some motor function

below the affected area.

– complete spinal cord injury• total or near-total loss of motor function and sensation

below the area of injury and unable to recovery

Immobilization aid

Hard collar Taylor brace