Trauma Week 2024 Day 3

Dr. Amber Gordon and Brooke Van Veghel, NP, spoke with us today regarding our ATV victim's injuries. An unstable lumbar burst fracture is a significant spinal injury requiring specialized care and often surgical intervention. Dr. Gordon is the only female neurosurgeon in Mobile, AL, and was the third female to ever graduate from UAB's neurosurgery program. Neurosurgery includes the treatment of the brain, spinal cord, and nerves, making it pivotal in addressing spinal injuries such as burst fractures. These injuries often occur due to high-energy trauma, such as falls, resulting in axial loading that causes the vertebrae to fracture. Unlike compression fractures, which may heal with bracing over 6-8 weeks, burst fractures often compromise spinal stability and can push bone fragments into the spinal cord, necessitating surgical correction.

To assess spinal cord injuries, Dr. Gordon uses the ASIA grading scale:

• A (Complete): No motor or sensory function below the injury level.

• B (Incomplete): Sensory function preserved, but no motor function.

• C (Incomplete): Some motor function, but less than 50% of muscles below the injury level can move against gravity.

• D (Incomplete): Most muscles below the injury are functional.

• E (Normal): Full motor and sensory recovery.

This grading helps determine the severity of the injury and guides treatment decisions. Using this scale we were able to determine what severity our patient's injury was, we concluded that her injury could be classified as grade A. Dr. Gordon also taught us how to recognize compression fractures and burst fractures, and how to tell them apart. Later on, we were able to insert screws and rods into model spines ourselves.

In cases of unstable burst fractures, like our patient, an internal cast made up of screws and rods stabilizes the spine. The surgical toolkit includes specialized instruments like an awl, gear shift, tap, and ball-tip probe, all of which help ensure precise screw placement while avoiding nerve damage. Surgery typically focuses on stabilizing the spine, relieving pressure on spinal nerves, and restoring function. Dr. Gordon revealed at the end of class that our patient had regained her ability to walk, but recovery would be extremely challenging. Recovery involves wearing a TLSO brace for 6-8 weeks, restricting bending, lifting, and twisting (BLT) activities for 2-4 weeks, and avoiding lifting objects over 10 pounds. Driving is off-limits for the first two weeks post-surgery to ensure safety.