By Dr. Jean-Claude Dosch (auth.)
ISBN-10: 3642455808
ISBN-13: 9783642455803
ISBN-10: 3642455824
ISBN-13: 9783642455827
Progress in traumatology of the vertebral backbone has been limited for a very long time through hindering elements. the 1st challenge is gifted by means of the diversities in procedure and a clash of competences. The neurosurgeons, contemplating simply the spinal chord, have constrained themselves to symptoms for laminectomy, an inadequate and typically useless intervention. The orthopedic surgeons, nonetheless, obsessed via the phobia of medullary lesions, have lengthy hesitated to use the elemental principles for the therapy of fractures, specifically designated aid by way of strict immobilization, therefore depriving themselves of the efficacy of radiculomedul lar decompression and of the safety this method provides to those constructions once they are themselves taken with the trauma. Taking those evidence under consideration, including the fairly negative result of laminectomy, the experts have properly and effectively prompt that one should still abstain from treating the preliminary lesion, yet really attenuate the wear and tear through appropiate nursing care and enough reeducation. the second one hindering issue used to be the inadequate wisdom of the extraordinary complexity of the anatomic lesions. This explains the orthopedists' relative warning; one basically treats good what one understands good. extra exact research of the lesions, not just of the bones but in addition of the joints, i. e., the osteofibrous involvement, is especially in response to strict radiologic semiology, that is rendered tough simply because those buildings are concurrently affected. we're tremendously indebted to Dr. DOSCH, radiologist at our heart, for having untertaken this hard activity, utilizing all on hand traditional radiologic techniques.
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Additional info for Trauma: Conventional Radiological Study in Spine Injury
Example text
1Sa, b. Mobile pseudarthrosis of an odontoid neck fracture revealed on the occasion of a new trauma. The edges of the fracture are dense and smooth (arrows) . The dynamic study in the flexion position reveals an instability. Conventional films xray picture (a) reveals swelling of the prevertebral soft tissues (*). The tomogram is also shown (b) The instability should be checked by active dynamic studies carefully carried out in conscious patients. From these studies we decide the orthopedic immobilization modalities (in the reduction position) or the mode of surgical fixation (graft, interspinous wiring, JUDET'S first or second mode, screwing).
Some workers, such as ROy-CAMILLE, consider that it is an involvement of the mobile segment, while others, such as FUENTES, see it as a lesion resulting from flexion-compression. We believe both hypotheses to be correct. The flexion-compression hypotheses is especially credible in that there are most often other lesions associated, either of the posterior arch or of the vertebra above or below, of the sagittal fracture type. Moreover, the tear-drop fracture is quite frequent in diving accidents.
C) Wedge-Compression Fracture Wedge-compression is seen on a roentgenogram in the diminished height of one aspect of the vertebral body, usually the anterior or the lateral aspect, associated with compression of the bone structure, which thus appears more dense. Compression can be global, extending from the anterior to the posterior wall, or only partial, i. , anterior or lateral. When there is a wedge-compression fracture displacements should be looked for. These can be of different types: No displacement.