By Grundy, Beckinham, Andrew Haines, Anna Donald, David Grundy, Andrew Swain
Spinal twine trauma is probably the main devastating final result of damage to the backbone. This well-established, useful consultant offers a close review from the scene of the twist of fate to rehabilitation and discharge from medical institution care. This most up-to-date version has been considerably rewritten to incorporate the newest advancements in sensible administration of sufferers with capability backbone damage and risk-minimisation options. there's additionally a brand new bankruptcy on spinal wire damage in constructing international locations.
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Extra resources for ABC of Spinal Cord Injury
Once the spine is radiologically stable the firm collar can often be dispensed with at about 12 weeks after injury and a soft collar worn for comfort. Twelve weeks after injury following plain x ray, if there is any likelihood of instability, flexion-extension radiography should be performed under medical supervision but if pain or paraesthesiae occur the procedure must be discontinued. It must be remembered that pain-induced muscle spasm may mask ligamentous injury and give a false sense of security.
If internal fixation is indicated an anterior or posterior approach can be used, but if there is anterior cord compression, such as by a disc, anterior decompression and fixation is necessary. Fixation must be sound to avoid the need for extensive additional support. The decision to perform spinal fusion is usually taken early, and sometimes it will have been performed in the district general hospital before transfer to the spinal injuries unit. The decision about when to operate will depend on the expertise and facilities available and the condition of the patient, but we suspect from our experience that early surgery in high lesion patients can sometimes precipitate respiratory failure, requiring prolonged ventilation.
Right: anteroposterior view shows Jefferson fracture clearly with outward displacement of the right lateral mass of the atlas. by gentle controlled skull traction under radiographic control. Immobilisation is continued for at least three to four months, depending on radiographic signs of healing. Halo bracing is very useful in managing this fracture. Atlanto-axial fusion may be undertaken by the anterior or posterior route if there is non-union and atlanto-axial instability. Anterior odontoid screw fixation may prevent rotational instability and avoid the need for a halo brace.
ABC of Spinal Cord Injury by Grundy, Beckinham, Andrew Haines, Anna Donald, David Grundy, Andrew Swain