Dr. Ebraheim’s educational animated illustrates spine concepts associated the cervical spine - trauma. Transverse ligament: - It provides the C1-C2 stability - It is behind the odontoid and it anchors the odontoid to the ring of C1 so it prevents an abnormal movement between C1 and C2. - A.D.I. in adults is 3.5 mm. - Of the transverse ligament is injured, C1 and C2 will be free to move & there will be an increase in the A.D.I. - Isolated traumatic injury to the transverse ligament is probably rare. - Jefferson fracture Three types: - Type II: fracture at the base of the odontoid process, most common, troublesome fracture. - Nonunion rate is 20-80% due to interruption of the blood supply. - High nonunion rate in: - More than 5 mm of displacement. - Patients older than 50 years of age. - Other risk factors: - Delay in treatment - Posterior displacement of the fracture - Diabetes - Do not use halo in early patients, risk of death from pneumonia - Treatment of young patients: • Halo: halo traction may be needed initially to reduce fracture, halo for up to 3 months, 30% non-union rate in halo. • When do you do surgery? Displaced fracture in older patients, risk factors for no-union. • Odontoid screw is preferred in the young patient. • Need to preserve C1-C2 motion. • Do not do fusion in young patients. • Can use C1- C2 fusion in older patients. • For older patients: - Orthosis or Fusion of C1- C2 if there is an indication for surgery and if there is a clearance for surgery. Type III: - Fracture through the body of C2. - Treatment: • Cervical orthosis • Halo: if displaced • Hangman’s fracture is a bilateral fracture of the pars interarticularis • The spinal canal is wider and there will be a low risk for spinal cord injury. Levine and Edwards classification: - Type I: stable fracture with less than 3 mm displacement, no angulation, treatment: cervical orthosis. - Type II: most common type, significant translation and some angulation, unstable fracture, treatment: cervical traction and extension to improve the displacement, immobilization in halo vest for about 3 months. - Type IIa: severe angulation and slight translation seen in flexion distraction injuries with tearing of the posterior longitudinal ligament, the fracture is unstable, treatment: do not use traction when there is severe angulation of the fracture. - Type III: surgical type, C2-C3 facet dislocation, rare fracture of the pedicles in addition to the anterior facet dislocation, it has some neurological deficit association, treatment: surgery for reduction of the facet dislocation and stabilization of the injury, open reduction and posterior spine fusion. • Facet dislocations: the association of disk herniation and facet involvement is very high, so watch out for a herniated disc in addition to the bony injury. - Unilateral facet dislocation will usually have less than 50% translation on x-ray and it may affect a nerve root. - Bilateral facet dislocation will have more than 50% translation and probably a spinal cord injury. - Treatment: immediate closed reduction, get an MRI, then do surgery, if the patient has a change in mental status, then get the MRI first, and immediately followed by open reduction and surgical fixation. - When do you go anteriorly? - Go anteriorly if there is a disc herniation, incidence is about 10%-30% in cervical facet dislocation. - If you try to do reduction, the disc fragment may stay in the canal causing spinal cord injury. - When do you do posterior? - If reduction of the dislocation failed and there was no disc herniation. - When do you combined anterior and posterior procedures? - Need to go anteriorly to remove the disc - Need to go posteriorly because the dislocation cannot be reduced by a closed method or by an open anterior technique. • Important points: 1- Get the MRI before surgery: make sure there is not a disc herniation. 2- Ligament injuries do not heal: will need fusion surgery. 3- Know the arrangement of the facets: superior and inferior facets in normal, subluxed, and dislocated positions. Know the “naked facet” or the “empty facet”. Train yourself to know this, especially for exam questions. Naked Facet. Cervical Spine MRI Facet Fracture Ligamentous Injury OF THE Cervical Spine Burst Fracture of Lower Cervical Spine Tear Drop Fracture Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundation/home/Give_Online.aspx?sig=29
See http://navigatingradiology.com for more, including suggested resources. This video introduces basic anatomy, important measurements on CT C-spine, a detailed approach, never to miss findings, commonly missed findings, fracture mimics, and example cases.
Pick your program here - http://athleanx.com/x/my-workouts Subscribe to this channel here - http://bit.ly/2b0coMW Bulging discs are one of the most common conditions that will derail your workouts quickly. In this video, I’m going to show you how to fix a bulging disc in your lower back without requiring surgery. In just 3 simple steps you are going to be able to get rid of the pain that is wreaking havoc on your training and making your life miserable. The first thing that needs to be discussed however are the terms used to describe the condition. Some people refer to a bulging disc as a herniated disc. In both cases, we are talking about a scenario where the inner disc material has protruded from the disc but has not reached a point of no return. The point at which the disc can no longer be repaired without surgery is more accurately called a ruptured disc. Bulging discs are a very common problem and one that we all might have to some degree if we were to MRI our backs. The thing is however, just because we may have a disc that is bulging does not mean that we will have symptoms. The only time it starts to matter is when the presence of the disc starts to become symptomatic and interferes with your life or workouts. The good news about disc issues however is that 98 percent of them are non-operative and solved with a dedication to just a few simple steps. One of those steps however is not stretching the lower back. This may come as a surprise to you, especially if you feel that your low back has become tight or sore as a result of your disc issues. Far too many people are told to lay on their back and start pulling their knee or knees up to their chest to stretch out the tight muscles in the low back. They may even be told to get on their knees and sit back on their heels to stretch out all of the muscles of the back. Both of these would be horrible advice because they not only aren’t treating the cause of the problem but they are aggravating the actual cause and making the disc protrude even more. What you need to do is focus on fixing the disc and recentralizing it through extension. If you can do this, the spasm that you are experiencing in the low back muscles as a result of the herniation will resolve once the disc itself is fixed. There are 3 parts to fixing this issue however and it starts with a decompression of the spine to allow for more room for the nerves that are being compressed by the disc protrusion. This can easily be done by hanging from a pullup bar with your toes slightly in contact with the ground. Let the pelvis drop and feel the spine open up. Do this for about 30 seconds to a minute and then proceed to step two if you need it or just skip to step three if not. Step two is a list correction. This is needed if you find that you are leaning to one side because of the pain of the protrusion. This can easily be done against a wall and will help to put the spine back in the proper alignment prior to moving on to the final step. Lay on your stomach with your hands under your shoulders. Press down on the floor and lift your upper torso off of it. Be sure to keep your hips in contact with the ground to avoid overextension of the lumber spine. Do this a few times a day and always within a zone of comfort. Before you know it, your disc will be centralized and your pain and symptoms down the leg and in the lower back should subside. You will be ready to start attacking your workouts again in no time. If you are looking for a workout program that puts the science back in strength and helps to injury proof your body from letting this happen again, head to http://athleanx.com and get the ATHLEAN-X Training System. For more videos on how to fix lower back pain and the best stretches for your back be sure to subscribe to our channel here on youtube at http://youtube.com/user/jdcav24
In this episode of eOrthopodTV, Orthopaedic Surgeon Randale C. Sechrest, MD narrates this animated video describing the basics of the anatomy of the cervical spine.
Dr. Ebraheim’s educational animated video describes fractures types of the C1 cervical spine vertebrae, also called: Jefferson Fracture. 50% of patients will have associated spine injuries. The canal is wide with low risk of spinal cord injury unless the transverse ligament is disrupted. Difficult visualization on x-ray (usually see on the lateral side). The junctional fracture could be missed. The classic Jefferson fracture is a burst fracture that results from axial load. It could be a four-part fracture with bilateral fracture of the anterior and posterior arch. There are variations which include two and three-part fractures. Incomplete formation of the posterior arch can be mistaken as a fracture. Anatomy C1 and C2 are stabilized together by the transverse ligament. C1 and C2 provide 50% of rotation of the neck. At the upper cervical region, the spinal canal is 2.5 times larger than the cord size. The stability and treatment of Jefferson fractures depend on the integrity of the transverse ligament and the displacement of the fracture. You need to know the important ligaments related to the Jefferson fracture. C1 atlas fracture is axial load burst fracture. Is it just a bony injury or is it a bony and ligamentous injury. Diagnosing ligamentous injury A.D.I (atlanto dens interval) normally should be less than 3 mm in adults and less than 5 mm In children. If the A.D.I is between 3-5 mm, this means there is an injury to the transverse ligament ( the transverse ligament hold the odontoid and C1 together, alar and apical ligaments will be intact). More than 5 mm A.D.I, then there will be injury to the transverse alar and apical ligaments. Fracture types •Bony injury with intact transverse ligament. treatment depends on the type of injury to the transverse ligament. bony avulsion of the transverse ligament uses a halo cautiously. However some surgeons prefer to do fusion of C1 and C2. •Lateral mass displacement less than 7 mm. •Stable fracture: Treatment: Nondisplaced: rigid orthosis, displaced: use halo. •In substance tear of the transverse ligament: treatment is C1-C2 fusion. Nee to do early surgery. Significant injury with risk of spinal cord compression. Open mouth view •Bony injury Jefferson fracture less than7 mm combined overhang, intact transverse ligament, stable fracture •Jefferson fracture with more than 7 mm, combined overhang, torn transverse ligament, unstable fracture. Radiological studies CT scan is probably the best study in diagnosing the characteristics of bony injury. MRI is the best study in diagnosing any associated transverse ligament injury. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Watch the latest Video, moderated by Alexander Vaccaro, MD. The AOSpine Knowledge Forum Trauma was given the task to develop and validate a new classification system. The AOSpine Thoracolumbar and Subaxial Classification systems are the result of a systematic assessment and revision of the Magerl classification. The AOSpine Classification Group reached a consensus on a classification that incorporates both fracture morphology and clinical factors relevant for clinical decision making. After the endorsement of the classification by the International Board, the Knowledge Forum Trauma finalized the validation studies.
Dr. Ebraheim’s educational animated video describes fracture types of the odontoid process. Most common fractures of the axis Type I: Stable Avulsion Fracture of the alar ligament near the tip of the Odontoid. Treatment is soft collar, be aware of significant ligamentous injury. Type II: Fracture at the base of the Odontoid Process. Most common and a troublesome fracture. Nonunion rate is 20-80% due to interruptions of the blood supply. Type IIa: comminuted and unstable. High nonunion rate in patients over 50 years of age and more than 5 mm of displacement. Posterior displacement extension injury is rare (anterior displacement Is more common-flexion injury). Delay in treatment. Gap of more than 2 mm. Treatment of type II fractures •Halo jacket traction may be needed initially to reduce fracture. •Keep halo for approximately 3 months •30% nonunion rate in halo. •Fusion C1-C2 (fusion decreases rotation by 50%). Odontoid screw is preferred in the young patient. Indications for fusion : 1-Nonunion 2-Displaced fracture in older patients 3- Failure of the halo 4-Type II a (comminuted/unstable). Type III: Fracture through the body of C2. Rich blood supply so heals in the majority of the cases. Treatment •Cervical orthosis •Halo if displaced Diagnosis of odontoid fractures •Lateral view •Open mouth view •CT scan is the best Odontoid fractures in the elderly •Simple fall, usually a missed diagnosis •Usually associated with increased complications and mortality •Do not use a halo, use external orthosis •Fibrous union might be adequate if the fracture is not badly displaced, otherwise do fusion of C1-C2. Odontoid fractures in pediatrics Synchondrosis between odontoid and the C2 body, fusion by the age of six. Odontoid fractures occur in young children around 4 years of age. Treatment •Minerva brace •Halo vest if displaced: use more pins and less torque. Finger tightness. Differential diagnosis- Os Odontoidium: with oval shaped sclerotic edges and the os is smaller than the normal dens. In type II dens fracture: the odontoid shape is preserved with sharp edges. Os is smaller than normal odontoid and fixed to the C1 anterior ring. Os Odontoidium looks like a fracture, but it is probably an old trauma. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC