REFERAT 2

Heron R.F Titarsole

Konsulen:
Dr. Wijaya J. Chendra, Sp.OT
 There are approximately 11,000 new spinal
cord injuries requiring treatment each year.
The ratio of male to female patients
sustaining vertebral fractures is 4:1.
In older patients (>75 years of age), 60% of
vertebral fractures are caused by a fall.
For patients with a spinal cord injury, the
overall mortality during the initial
hospitalization is 17%.
 Inspection and palpation: Occiput to Coccyx

Neurological assessment
Sensation
Motor function
Reflexes
Rectal examination
Frankel Classification
Grade A: Absent motor and sensory function
Grade B: Absent motor function, sensation
present
Grade C: Motor function present, but not
useful (2 or 3/5), sensation present
Grade D: Motor function present and useful
(4/5), sensation present
Grade E: Normal motor (5/5) and sensory
function
 Grade A: Complete: No motor or sensory function is
preserved in sacral segments S4-5.
Grade B: Incomplete: Sensory but not motor function
is preserved below the neurologic level and extends
through the sacral segment S4-5.
Grade C: Incomplete: Motor function is preserved
below the neurologic level; most key muscles below
the neurologic level have a muscle grade <3.
Grade D: Incomplete: Motor function is preserved
below the neurologic level; most key muscles below
the neurologic level have a muscle grade >3.
Grade E: Normal: Motor and sensory function is
normal.
 Brown-Sequard Syndrome
Sindroma Spinalis Anterior
Sindroma Spinalis Sentral Servikal
Sindroma Spinalis Posterior
Sindroma Konus Medullaris
Sindroma Kauda Equina
 Upper C-spine ( C1 C2)
Lower C-spine ( C3 C7)
 Nasofaring space (C1) 10 mm (dewasa)
Retropharyngeal space (C2-C4) - 5-7 mm
Retrotracheal space (C5-C7) - 14 mm (anak),
22 mm (dewasa).
Type I:
Nondisplaced, no angulation; translation
<3 mm; C2-C3 disc intact (29%);
relatively stable
Type Ia:
Atypical unstable lateral bending
fractures that are obliquely displaced and
usually involve only one pars
interarticularis
Type II:
Significant angulation at C2-C3;
translation >3 mm; most common injury
pattern; unstable; C2-C3 disc
Type IIA:
Avulsion of entire C2-C3 intervertebral
disc in flexion with injury to posterior
longitudinal ligament,
Type III:
Rare; results from initial anterior facet
dislocation of C2 on C3
 Compressive flexion (shear mechanism)
Vertical compression (burst fractures)
Distractive flexion (dislocations)
Compressive extension
Distractive extension
Lateral flexion
 Stage I:
Blunting of anterior body; posterior elements intact
Stage II:
Beakingof the anterior body; loss of anterior vertebral height
Stage III:
Fracture line passing from anterior body through the inferior
subchondral plate
Stage IV:
Inferoposterior margin displaced <3 mm into the neural canal
Stage V:
Teardrop fracture; inferoposterior margin >3 mm into the
neural canal; failure of the posterior ligaments and the posterior
longitudinal ligament
 Stage I:
Failure of the posterior ligaments, divergence of the
spinous processes, and facet subluxation
Stage II:
Unilateral facet dislocation; translation always <50%
Stage III:
Bilateral facet dislocation; translation of 50%
Stage IV:
Bilateral facet dislocation with 100% translation
 Stage I:
Unilateral vertebral arch fracture
Stage II:
Bilateral laminar fracture without other tissue failure
Stages III, IV:
Theoretic continuum between stages II and V
Stage V:
Bilateral vertebral arch fracture with full vertebral body
displacement anteriorly; ligamentous failure at the
posterosuperior and anteroinferior margins
 Stage I:
Failure of anterior ligamentous complex or
transverse fracture of the body; widening of
the disc space and no posterior displacement
Stage II:
Failure of posterior ligament complex and
superior displacement of the body into the
canal
 Stage I: Asymmetric, unilateral compression
fracture of the vertebral body plus a vertebral
arch fracture on the ipsilateral side without
displacement
Stage II: Displacement of the arch on the AP
view or failure of the ligaments on the
contralateral side with articular process
separation
 Neurologic injury complicates 15% to 20% of
fracture at the thoracolumbar level.
 McAfee Classification

Six types

COLUMNS
Type Anterior Middle Posterior Mechanism
Wedge Compression Compression None None Forward Flexion
Stable Burst Compression Compression None Axial Compression
Unstable Burst Compression Compression Comp, Lat Flex, Rot Comp,Lat Flex, Rot
Flexion-Distraction Compression Tension Tension Anterior Fulcrum
Chance Tension Tension Tension Anterior Fulcrum
Translational Shear Shear Shear Shear
 Compression fractures (48%)
Type A: Fracture of both endplates (16%)
Type B: Fracture of superior endplate (62%)
Type C: Fracture of inferior endplate (6%)
Type D: Both endplates intact (15%)
Type A: Fracture of both endplates (24%)
Type B: Fracture of the superior endplate (49%)
Type C: Fracture of inferior endplate (7%)
Type D: Burst rotation (15%)
Type E: Burst lateral flexion (5%)
 Type A: One-level bony injury (47%)
Type B: One-level ligamentous injury (11%)
Type C: Two-level injury through bony
middle column (26%)
Type D: Two-level injury through
ligamentous middle column (16%)
 Type A: Flexion-rotation:
Type B: Shear:
Type C: Flexion-distraction:
 <3 jam 3-8 jam
30 mg/kgBB 30 mg/kgBB
23 / 47 jam 5,4 mg/kbBB/jam 5,4 mg /kgBB/jam
Total 24 jam 48 jam