Cervical Spine Trauma - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 12 มิ.ย. 2024
- 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
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#!/DrEbraheim_UTMC
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
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I broke the c1, c2 and base of the odontoid process, I was in traction in the spinal unit for a couple of months. I was going to then have the halo but was given a Somi brace for about 6 weeks. As the fractures never healed i had a Gallie Fusion done where they take out some of your hip bone to fuse it with wires in your neck. I was about 16 and yes have lost about 50% of movement in turning my head but I'm forever grateful as I just missed my spinal cord by a 1/4 Of a millimetre.
Thank you for your video. You do a great job!
I want to add that C1-2 can become unstable with connective tissue disorders such as Ehlers Danlos Syndrome without any trauma or with trauma due to faulty ligaments because of the connective tissue disorder. CT scan with 90•rotation shows this as most often static imaging doesn’t show how unstable it truly is. I walked around for 3 years disabled and felt like I was dying with many neurological symptoms. I had 10mm to the left and 8mm right translation because static imaging did not show this. I was dismissed for 3 years because of static imaging!! It’s so important to to add that rotation into the imaging. I’m lucky to be alive today because I didn’t give up searching for answers.
Sarah Gontarek , Hi Sarah, I am really with serious neurological symptoms after a bad chiropractor neck adjustment. I’ve been to ER number of times and Neurologist with no help. It’s battle every day to go on and really lonely as no one understands. Could i please contact you. My information is on my profile🙏😭
Please I need help. I am also having neurological symptoms. I don’t know how to come out of this. Please help me 🙏🏼😭😰
Please I need help. I am also having neurological symptoms. I don’t know how to come out of this. Please help me 🙏🏼😭😰
@@jwm6262 how are u now ?
I got many pain too from chiropractor and idk which doctor i can trust now. Im still looking for help now
@@carltonjimburton9026 Use prolotherapy, PRP or prozone therapy the repair torn ligaments or other stretches ligaments, this is the cure, don't go in surgery to put screws and rods.
Currently sitting in the hospital. Had a c1 fracture cause of a car accident. I can walk and everything fine and have all my senses. Luckily it wasn't as bad as it could have been
Hello I just read your comment please have further test done as delayed symptoms are slowly developing I hope your recover is to a state of no suffering.
Why im saying this is because three years ago I was hit by a car and vaulted into the air , I was first only treated with a x-ray on my left foot that never showed up my fractures in my ankle bones but six weeks latter i had bone scan and all these hot spots showed on my scan three fractures in my left foot plus tracer uptake to these parts of my spine... c2,c3 c5, c6 c7 and thoracic t12, and lumber 4, 5 with bulging disc with tearing to one of them
Now three years latter I'm still no better I can't have surgery for my cervical i have melyopathy symptoms and struggle getting up and down out of bed these symptoms have progressed. Please have more test for any changes you notice thank you for reading this if you do.
@@charmainemiles4089 hey I appreciate the concern and hope your health improves over time. But all the tests came back clear. It was just a slight fracture around the bone which healed. I got all my senses and movements luckily and I workout almost everyday now and go for bike rides almost daily
Get prolotherepy, were r u located?
@DeepDishSpecial Will you please share your experience because i also had a c1fracture and active with all the senses
I've been watching Dr.Ebraheims videos for about a month now trying to learn more about my sons unfused dens. Over a year ago we rushed him to the emergency room at a local hospital & after physical evaluation & xrays the emergency physician recommended that we take him to UC Davis here in sacramento ca. for a CAT SCAN & MRI due to his finding the unfused dens on xray.
After 24 hours spent in a hospital room we were introduced to 12 physicians from the UC Davis spinal center. We were told that nothing was hurt or injured & his physical test came out great. I then asked what about his unfused dens? and the lead physician said that it was just imaging that a lot of people have it yet go on with a normal life.The only thing they wanted us to do was refrain our son from any contact sport for 2 weeks than he may start back as he feels. My son plays youth football & does well at it but my wife wanted a 2nd opinion so she took him to shriners than a 3rd opinion from Stanford sports medicine & both Shriners & Stanford agreed that he can no longer play football due to his unfused dens even though the rest of his team might have unfused dens being that they are all the same age but that is a parents choice i was told. Last month we went for a yearly check up & yes his dens are fusing but still no clearance for any kind of sports activity. Dr.Ebraheim you are a renowned spinal specialist is this really the end for my 9 year old sons future in sports? pls advise my son has not stopped his training which consist of 2 /12 hours of physical training 5 days a week all year since he was told he could not play anymore,But keeps asking when can he play again & its hard for me as a parent that i can not give him an answer.
Dr. Ebraheim you are a GODSEND, thank you for your video!
Yess it was you learn something every DAY 💯💯
THANK YOU SIR ANOTHER AMAZING VIDEO
Very simple and good explanation
super graphics, and great medical information especially for a non-medical person ...
Thank you. Helpful video
Best Cervical Video ever!
Love it. You sure don't sugar-coat anything, but that's how it should be.
thank you for your effort
God bless you Sir
My 70-year-old father just fell down his stairs and ended up with fractured C1 and C2 along with a skull fracture. An aneurism was found in the MCA adjacent to his skull fracture. The doctor didn’t make much out of it (5mm) but said to follow up down the road after the fractures are healed. If this is actually a traumatic aneurism or pseudoaneurism, is that something that needs more careful attention than just ‘we’re going to refer you to a vascular neuro in a few weeks’? Thank you for this video and your time.
Thank youuu so much 😄
Need a video on Alar and Accessory ligaments for C1/C2
Great video! Thank you.
اعانكم الله شكرا#الجزائر
very helpful
Thanks for nice helpful video
Great teacher
Another brilliant video. Informative and interesting
Excellent teacher
Very informative,concise excellent vedios
Very helpful, thank you
Thank you that was very helpful❤
Thank you
Nice information sir
Thank u so much .
I have this person who has been suffering from headaches, as well as arthritis. They say it's her c2 that is putting pressure on c3-6, she's already gone to several specialist, but none can seem to help her. She can't have her c1 and 2 fused, because she'll be discharged from the navy. What would you recommend?
Fantastic
Thank you very much this is the best vido
What about facet joint pain in cervical C1 C2? There is a lot of arthritis. Why do facet joints hurt there? Are there nerves inside the cervical facet joint?
Thanks
V useful videos ....
JazakAllah .
I have a ruptured disc in my C-spine that happened from a car accident going on 9yrs now. I never got surgery for it. I just had a new MRI of my neck to keep an eye on it and it shows spinal cord compression with fractures in the vertebra ..i am thinking probably compression fractures for not having injury on my neck for so long and my body trying to compensate for the injury. do you have an email where I can send you a picture of the MRI to see if it is an emergency situation. I am afraid if I leave it, that I will end up in a wheel chair. I as well have a ruptured disc in my lower lumbar spine as well, with early DDD and loss of T2, hyperintensity at L3-4 L 4-5- L5-S1. with encroachment on the descending left L5 nerve. foraminal stenosis with encroachment on the exiting L4 nerve. spinal stenosis, and advanced facet arthropathy. central protrusion with annular tear, foraminal stenosis. list goes on. thank you....
I love your videos! Just one minor (audio) mistake at 6:53 you said "pedicle" of C2 but have it written correctly as pars interarticularis. Great video nonetheless! Keep them coming
it's actually either the pedicles or pars interarticularis.
Nabil ibrahim best dr for ever l seen
How cervical affect brain stem
Please doctor Ebraheim how can one see you ? I am having neurological symptoms and I have been to many doctors with no answers. How can you help me ? Please I need your help
I had spinal c5 c6 fused in 2011 .I'm also seeing on my notes now i have residual gliotitc scarring in my cervical cord bot sure what that means ?
Is there any restriction on nack movement after c1 C2 screw rod fixsation
Sir,
My cervical spine c2#
Spindle cort is normal.
6 week complete .
But last 4to 5 day left hand and lag mild tingling and numbness .
Sir please suggest me.
Sir i have many problems like c1 c2 tilled and movement was also rigid
So What can i do ?
Hello! Can it Cause Hemihypertrophy? Can Hemihypertrophy be Treated?
Speech and swalling problem for this ?
Hi
i have experience severe neck pains, back pains, headache, ear pain and nausea at time. I had a CT scan and an MIR performed.
the results of the MRI were "Significant thickening of the posterior atlantoaxial ligament complex with minimal
irregularity of the adjacent posterior aspect of the dens and indentation of the ventral cord at this level. This may be aggravated dynamically resulting in neurological symptoms."
the doctors told me that something is wrong with my c1 and c2, the suggested i wear a collar but it just makes the pain worse.
i tested negative for Juvenile rheumatoid arthritis.
I use to go for physio, but my orthopedic surgeon told me to stop,
pls help
and you think asking for help here is better than consulting an orthopaedic surgeon LOL
Have you tried an atlas orthogonal chiropractor
Are you aware of prolotherapy to heal ligaments?
May I ask would prolotherapy heal a ligament injury and help facet joints? Caring Medical show xray, and digital motion xray results of improvement. It is successfully used for ligament sport injuries, early intervention for degenerative hips etc. However I dont know if it would be possible to reach the ligament at C1/2?
@Achala Devi I have the same question. I saw an old vid where he was doing a prolotherapy to a patient and it looks like he is reaching C1/C2. But if it's teaching the inner ligaments not sure on that. May be you can also comment on his channel and let me know his answer please. I'll do the same and update you here. Thanks
*reaching
My newborn son actually has a gap between the base of his skull and c1-c2
HEY! PLS answer this question! thank you. So, this morning I woke up and it was very cold, then I went to the toilet to pee. I sat down for awhile and decided to turn my head diagonally to crack it, as soon as I cracked it i heard quite a loud pop on the right back of my neck and it started to hurt. I then felt a bump on the back of my neck, I'm not sure but I think is the c7. I'm scared if it's dislocated or broken. I don't feel any numbness anyone, or pain anywhere else but the back right side of my neck . Can you help me diagnose my situation. today is the second day after this incident.
Hey how you doing now? Im in same situation now with lots of migraines and chronic headaches plz help me out
Educational animated illustrates spine concepts associated the cervical spine - trauma.
How can halo cause pneumonia ?
Sir as I want to contact you
Why could elderly patients die from Pnemonia with a halo ?
Only 💖💖💖
Sir😭😭😭my son that have damage now
कृपया हिंदी मे भी सिखाए
Telugu lo
Doctor plis HEL ME WITH YOUR NUMBER my baby have this PROBLEM 😰😭😭😭😭😭
WRONG MY FREIND, LIGAMENT INJURY DOES NOT HEAL YES, BUT YOU NEED PROLOTHEREPY NOT SURGERY MY FREIND, YOU NEED A TISSUE REGENERATION THERAPY NOT SCREWS AND RODES TO HOLD THE HEAD STABLE, YOU NEED TO STRESS THE ROOT CAUSE, AND REVERSE HOW IT WAS BEFORE.
Thank you