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Lumbar InjuriesLumbar Injuries
George SapkasGeorge SapkasAsc. ProfessorAsc. Professor
11stst Orthopaedic Dept. Orthopaedic Dept.Medical SchoolMedical School
Athens UniversityAthens University
Basic Mechanical PrinciplesBasic Mechanical Principles
ClassificationClassification
THE THREE COLUMN SPINE THE THREE COLUMN SPINE and its significance in the classification of and its significance in the classification of
acute thoracolumbar spinal injuries.acute thoracolumbar spinal injuries. Denis F. Denis F. ((Spine 1983Spine 1983))
DESTRUCTIONDESTRUCTION22
out of theout of the33
COLLUMNSCOLLUMNS
MAJOR INSTABILITYMAJOR INSTABILITY
A comprehensive classification of A comprehensive classification of thoracic and lumbar injuries.thoracic and lumbar injuries.
Magerl F, Aebi M, Gertzbein SD, Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. Harms J, Nazarian S.
Eur Spine J 1994Eur Spine J 1994
Type AType A
Type BType B
Type CType C
DESTRUCTIONDESTRUCTIONof theof the
33COLLUMNSCOLLUMNS
MAXIMUM INSTABILITYMAXIMUM INSTABILITY
ROTATIONAL ROTATIONAL INJURIESINJURIES
RADIOLOGICAL RADIOLOGICAL INVESTIGATIONSINVESTIGATIONS
A.S.I.A. classificationA: Complete sensomotor deficitB: Complete motor paralysis
Sensory normalC: Useless motor capacityD: Useful motor capacityE: Normal
TREATMENTTREATMENT
Injuries of the Upper Cervical Spine
C1– C2
Injuries of Middle and Lower Cervical Spine
C3 – C7
Injuries of Thoracic Spine
T1 – T11
Injuries of the Thoraco-lumbar Spine
T11 – L1
Injuries of the Lumbar Spine
L2 – L5
Check listCheck listofof
Lumbar instabilityLumbar instability
Radiological parametersRadiological parameters
Kyphosis of the vertebral body
Segmental kyphosis
Disc height
Vertebral body height:Beck index
White A- Panjabi M Clinical Biomechanics of the Spine
1978.
Check l ist for the diagnosis of cl inical instabil i ty in lumbar spine
Element Point value
Anterior elements destroyed or unable to function2
Posterior elements destroyed or unable to function2
Radiographical criteriaA. Flexion / extension x- rays
1. Sagital plane transplantation > 4.5 mm or 15% (2pts)2. Sagital plane rotation
> 15o at L1 – L2 , L2 – L3, L3 – L4 (2pts)> 20o at L4 – L5 (2pts)> 25o at L5 – S1 (2pts)OR
4
B. Resting x-rays
1. Sagital plane displacement > 4.5 mm or 15% (2 pts)2. Relative sagital plane amgulation > 22o (2 pts)
Cauda equina damage 3
Dangerous loading aticipated 1
Total of 5 or more = unstable
Purposes of Operative Purposes of Operative TreatmentTreatment
A.A. The stabilization of the spineThe stabilization of the spine
B.B. The decompression of the spinal cord-The decompression of the spinal cord-nervesnerves
C.C. The correction of the spinal deformityThe correction of the spinal deformity
Posterior procedure
Case B.P.
M – 55 yrs
Fall
Level : L2
Type: A3
N(-)ve
A.S.I.A. : E
IMPLANTS : LEGACY (SOFAMOR-DANEK)
Case B. Lyr.
F – 53 yrs
Fall
Level : L2
Type: A3.3
N(-)ve
A.S.I.A. : E
IMPLANTS : M.O.S.S. - Miami
Case GAR. MAN.
F – 16 + 6 yrs
R.T.A.
Level : L3
Type: A3.1 + B1.2
N(+)ve
A.S.I.A. : D
IMPLANTS : M.O.S.S. - Miami
Case M. I.
F – 76 yrs
Fall
Level : L2
Type: A2
N(-)ve
A.S.I.A. : E
IMPLANTS : CD-Horizon
Case A.K.
F – 34 yrs
Fall
Level : L3
Type: A3.3
N(+)ve
A.S.I.A. : B - C
IMPLANTS : a) TITANIUM MESH + MOSS b) ISOLA
Case J.TS.
M – 24 yrs
Fall
Level : L3
Type: A3.2
N(+)ve
A.S.I.A. : B - C
IMPLANTS : M.O.S.S. - Miami
Inadequate reduction decompression and stabilizations
Anterior ±
Posterior procedure
Case K. M.
F – 39 yrs
Fall
Level : L2
Type: A3.2
N(+)ve
A.S.I.A. : C
IMPLANTS : Autologous Iliac Graft
Case K. M. –M.
M – 48 yrs
Fall
Level : L4
Type: A3.3
N(+)ve
A.S.I.A. : D
IMPLANTS : a) Cage expandable (ULRICH) b) M.O.S.S. - Miami
Osteoporotic fractures
CT-scan
Spinal fixationSpinal fixation
Posterior stabilizationPosterior stabilization
Anterior – Posterior
Stabilization
N(+)VEN(+)VE
Anterior Anterior Posterior Posterior
StabilizatioStabilization n
Minimal invasive techniques
Vertebroplasty - Kyphoplasty
Kyphoplasty