Issues In Management Of Thoracolumbar Spine Injuries
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ISSUES IN MANAGEMENT OF THORACOLUMBAR SPINE INJURIES DR J SHUKLA ASSOCIATE PROFESSOR DEPT. OF ORTHOPAEDICS GANDHI MEDICAL COLLEGE BHOPAL MP
HISTORY Earliest refrance to spinal cord injury is mentioned in the document, dating to 2500 BC and obtained by the Egyptologist Edwin Smith in 1862 •The author describes, with great detail, the diagnosis and treatment of fractures, sprains, and open wounds involving the spinal column.
• Hippocratic treatment of spine injuries—the rack system and the technique of using gravity to straighten the spine
• Aulus Cornelius Celsus (30 BC)[11,14] was the first to note rapid death following the injury to the cervical spinal cord.[11,14] This is thought to be the first reference to the spinal cord as the offending tissue in this disorder.
• Surgical intervention in a living patient was first proposed by Paulus of Aegina who lived in the seventh century. Paulus recommended that a fracture associated with paralysis should be treated by removal of bone fragments that cause a neurological deficit. It has been documented that, in addition to using traction devices, Paulus used a red hot iron during spinal interventions
EPIDEMIOLOGY • Younger age group • Male predominance (3>1) • Incidence In all Indian series fall from height rates highest among the etiological factors. (a) There is a gradual trend towards increasing incidence of RTA indicating gradual urbanization of society and increase in number of vehicles on roads in India. (a) Traumatic Spinal Cord Injuries in Haryana: An Epidemiological Study Roop Singh, Sansar Chand Sharma, Rajeev Mittal, Ashwini Sharma Indian Journal of Community Medicine Vol. 28, No. 4 (2003-10 - 2003-12)
Mode of trauma Series Chacko et al (1986, India)
Fall from Height (%)
RTA (%)
55.2
12.8
66
14
49.4
36.5
29.42
25.19
Present series
44.5
34.8
Karacan et al (2000, Turkey)
36.5
48.8
Lan C et al(Taiwan)
23.3
61.6
Shingu et al (1994, Japan)
29.2
44.6
Shanmugusundram (1987, India) Dave et al (1994, India) Madras Model(India)
•Region involved first lumbar followed by D12 •Seasonal distribution of SCI showed a marked increase during summer, signifying increased movement of people in this season
biomechanics
classification
THREE COLOUMN CLASSIFICATION
WATSON JONES CLASSIFICATION • One of the earliest classifications of spinal fractures was by Watson Jones in 1931, which was based primarily on diagnosis and treatment of flexion injuries
HISTORY Earliest refrance to spinal cord injury is mentioned in the document, dating to 2500 BC and obtained by the Egyptologist Edwin Smith in 1862 •The author describes, with great detail, the diagnosis and treatment of fractures, sprains, and open wounds involving the spinal column.
• Hippocratic treatment of spine injuries—the rack system and the technique of using gravity to straighten the spine
• Aulus Cornelius Celsus (30 BC)[11,14] was the first to note rapid death following the injury to the cervical spinal cord.[11,14] This is thought to be the first reference to the spinal cord as the offending tissue in this disorder.
• Surgical intervention in a living patient was first proposed by Paulus of Aegina who lived in the seventh century. Paulus recommended that a fracture associated with paralysis should be treated by removal of bone fragments that cause a neurological deficit. It has been documented that, in addition to using traction devices, Paulus used a red hot iron during spinal interventions
EPIDEMIOLOGY • Younger age group • Male predominance (3>1) • Incidence In all Indian series fall from height rates highest among the etiological factors. (a) There is a gradual trend towards increasing incidence of RTA indicating gradual urbanization of society and increase in number of vehicles on roads in India. (a) Traumatic Spinal Cord Injuries in Haryana: An Epidemiological Study Roop Singh, Sansar Chand Sharma, Rajeev Mittal, Ashwini Sharma Indian Journal of Community Medicine Vol. 28, No. 4 (2003-10 - 2003-12)
Mode of trauma Series Chacko et al (1986, India)
Fall from Height (%)
RTA (%)
55.2
12.8
66
14
49.4
36.5
29.42
25.19
Present series
44.5
34.8
Karacan et al (2000, Turkey)
36.5
48.8
Lan C et al(Taiwan)
23.3
61.6
Shingu et al (1994, Japan)
29.2
44.6
Shanmugusundram (1987, India) Dave et al (1994, India) Madras Model(India)
•Region involved first lumbar followed by D12 •Seasonal distribution of SCI showed a marked increase during summer, signifying increased movement of people in this season
biomechanics
classification
THREE COLOUMN CLASSIFICATION
WATSON JONES CLASSIFICATION • One of the earliest classifications of spinal fractures was by Watson Jones in 1931, which was based primarily on diagnosis and treatment of flexion injuries
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