Traumatic Brain Injuries - TBI
Classification & Terminology
The damage from TBI can be focal, confined
to one area of the brain, or diffuse,
involving more than one area of the brain.
Diffuse trauma to the brain is frequently
associated with concussion (a shaking of the
brain in response to sudden motion of the
head), diffuse axonal injury, or coma.
Localized injuries may be associated with
neurobehavioral manifestations, hemiparesis
or other focal neurologic deficits.
Types of focal brain injury include bruising
of brain tissue called a contusion and
intracranial hemorrhage or hematoma, heavy
bleeding in the skull. Hemorrhage, due to
rupture of a blood vessel in the head, can
be extra-axial, meaning it occurs within the
skull but outside of the brain, or
intra-axial, occurring within the brain.
Extra-axial hemorrhages can be further
divided into subdural hematoma, epidural
hematoma, and subarachnoid hemorrhage. An
epidural hematoma involves bleeding into the
area between the skull and the dura. With a
subdural hematoma, bleeding is confined to
the area between the dura and the arachnoid
membrane. Bleeding within the brain itself
is called intracerebral hematoma.
Intra-axial bleeds are further divided into
intraparenchymal hemorrhage which occurs
within the brain tissue itself and
intraventricular hemorrhage which occurs in
the ventricular system.
TBI can result from a closed head injury or
a penetrating head injury. A closed injury
occurs when the head suddenly and violently
hits an object but the object does not break
through the skull. A penetrating injury
occurs when an object pierces the skull and
enters brain tissue.
As the first line of defense, the skull is
particularly vulnerable to injury. Skull
fractures occur when the bone of the skull
cracks or breaks. A depressed skull fracture
occurs when pieces of the broken skull press
into the tissue of the brain. A penetrating
skull fracture occurs when something pierces
the skull, such as a bullet, leaving a
distinct and localized injury to brain
tissue. Skull fractures can cause cerebral
contusion.
Another insult to the brain that can cause
injury is anoxia. Anoxia is a condition in
which there is an absence of oxygen supply
to an organ's tissues, even if there is
adequate blood flow to the tissue. Hypoxia
refers to a decrease in oxygen supply rather
than a complete absence of oxygen, and
ischemia is inadequate blood supply, as is
seen in cases in which the brain swells. In
any of these cases, without adequate oxygen,
a biochemical cascade called the ischemic
cascade is unleashed, and the cells of the
brain can die within several minutes. This
type of injury is often seen in
near-drowning victims, in heart attack
patients, or in people who suffer
significant blood loss from other injuries
that decrease blood flow to the brain.
Other terms you may encounter include:
ALIF -
Anterior Lumbar Interbody Fusion - is the
placement of bone or cages between vertebrae
from an anterior approach.
Annulus - The outer portion of a disc in the spinal
column, the annulus provides structure and
strength to a disc and is comprised of a
complex series of interwoven layers of
fibrous tissues, which hold it's nucleus in
place.
Anterior -
Refers to the frontal or ventral surface of
the body.
Arthroscopic Lumbar Discectomy
-
PLD using an endoscope for visualization.
Autograft -
This refers to bone taken from the patient,
usually the hip, to be used as graft.
Bone Graft -
An option for fusing the spine. This
requires either moving bone from one part of
the body (autograft) or using bone from an
outside source (allograft).
Cat Scan -
Computerized x-ray system which provides
cross-sectional images of the spine or other
parts of the body. Sometimes is done
following a myelogram or discogram.
Cervical -
Pertains to the neck.
Conservative Therapy -
Method of relieving pain with bed rest,
analgesics and chiropractic and physical
therapy.
Degenerative Disc Disease -
Deterioration in disc structure and
function, which commonly causes pain and
loss of function.
Diagnostic -
Test or process used to determine the source
of a problem, i.e., a diagnosis.
Disc - Discs serve as shock absorbers between the
vertebrae of the spinal column. The center
of the disc is known as the nucleus and the
outer ring of the disc is called the
annulus.
Discectomy -
The procedure where a disc is removed
surgicaly.
Discogram -
Provocative discography is the instillation
of sterile saline (not dye) into the disc to
try and reproduce the patient's pain.
Dorsal -
Refers to a position toward the posterior or
back side of the body.
Fusion -
Growth of bone where bone does not normally
grow, as in replacing a disc with a bone
graft. The bone graft is normally taken from
the patient or a donor.
Herniated Disc -
AKA a slipped disc, is a condition in which
nucleus tissue is moved from the center of a
disc into the spinal canal. Herniated discs
cause great pain in the low back and leg or
the neck and arm and they create pressure
against one or more of the spinal nerves.
Other names for herniated discs are
prolapsed discs or ruptured discs.
Interbody Fusion -
Placing of a graft or cages between
vertebral bodies.
Kyphoplasty -
A surgical procedure designed to stop the
pain caused by the bone fracture, stabilize
the bone, and to restore the lost vertebral
body height due to the compression fracture.
Laminectomy -
Surgery technique in which part of the back
of the vertebra is removed in order to reach
to the nerves and discs. This may or may not
require the disc be removed as part of the
procedure.
Ligaments -
This is bands of fibrous tissue that connect
bones or cartilages that support and
strengthen the bone joints. Ligaments
surround the spine on all sides.
Lumbar -
This refers to the lower back.
Microdiscectomy -
Surgical technique for removal of a disc via
a small opening using a microscope.
Morbidity -
Refers to postoperative pain and
complications from to surgery.
MRI Scan -
Computerized magnetic imaging system that
provides cross-sectional images of the spine
or other body parts.
Myelogram -
Diagnostic procedure in which an iodine is
injected as a dye into the spinal canal and
shows up on x-rays that are taken.
Nucleus -
The center part of a disc and is made of a
soft, rubber-like material that takes the
shock of movement such as standing, walking,
running, etc.
Pedicle Fixation -
Invlolves placing bone screws into the spine
from a posterior approach through what is
known as the pedicle. Screws are then used
with a rod or plate to keep the spine stable
following bone grafting.
Percutaneous Cervical Discectomy
-
An outpatient procedure that uses
minimally-invasive suction to remove
herniated cervical discs.
Percutaneous Lumbar Discectomy
-
PLD using an endoscope for visualization.
PLIF -
Stand for Posterior Lumbar Interbody Fusion,
which is the placement of bone or cages
between vertebrae from a posterior approach.
PLITF -
Stands for Posterior Lateral
Inter-Transverse Process Fusion, which
involves the placement of bone graft on and
between transverse process of vertebrae to
promote bone fusion.
Porous -
Surface area amount which allows for bone
growth from the implant.
Posterior -
This term refers to the back or dorsal
surface of the body.
Prolapsed Disc -
AKA a slipped disc, is a condition in which
nucleus tissue is moved from the center of a
disc into the spinal canal. Herniated discs
cause great pain in the low back and leg or
the neck and arm and they create pressure
against one or more of the spinal nerves.
Other names for herniated discs or ruptured
discs.
Ruptured Disc -
See above
Sacrum -
This is the lower portion of the spinal
column.
Slipped Disc - See Ruptured Disc.
Spinal Cord -
This is the primary nervous system, that
runs from base of the skull to the lower
back via the spinal canal. Problems or
impingement of bony or soft tissues on cord
or nerve roots is primary reason for spine
surgery.
Spinal Fusion -
Surgical treatment for back pain in which
the disc between two adjacent vertebrae is
removed. Then two vertebrae are fused using
bone graft and instrumentation methods.
Spine -
This is the structure composed of vertebrae,
discs, and ligaments. It contains 26
vertebrae in five separate regions. There
are 7 cervical, 12 thoracic, 5 lumbar, 1
sacral, and 1 coccygeal vertebrae. The
primary function of the spine are body
support and spinal cord protection.
Spinal Column -
Longitudinal skeletal axis of the human body
that is composed of 26 distinct bones which
are called vertebrae.
Therapeutic -
A procedure which is related to the
treatment of disease in the human body.
Thoracic Spine -
The twelve vertebrae in mid-torso that are
attached to the rib cage.
Thorax -
The portion of the chest composed of the
spine, ribs and, breast bone.
Titanium Alloy -
This is a very bio-compatible material with
great fatigue strength and good imaging
characteristics.
Vertebra -
This a bone that is used as a building block
for the spinal column.
Vertebral Column -
The longitudinal skeletal axis of the body
that is composed of 26 distinct bones which
are called vertebrae.
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