10. Examination of spinal injuries; diagnosis. Surgical indications in the management of spinal injuries

Question 1

What happens if the spine is injured at C4?

Answer 1

PHRENIC NERVE DAMAGE!
;respiratory failure

Question 2

What happens if the spine is injured at C6?

Answer 2

TETRAPLEGIC

Question 3

What is conus medularis syndrome?

Answer 3

Injury between T12 – L1
Back pain
Incontinence
Bilateral sensory loss

Question 4

What is cauda equina syndrome?

Answer 4

Damage to or compression of the cauda equina (nerve fibers L3–S5) located below L2

The cauda equina is inferior to the spinal cord and contains a bundle of lumbar and sacral nerve roots.

• lumbosacral Radicular pain: A condition of pain that follows a dermatomal distribution of a nerve due to an inflamed and/or compressed nerve root.
• Bowel / Bladder dysfunction
• Saddle anesthesia: lack of sensitivity in the dermatomes S3–S5, affecting the areas around the anus, genitalia, and inner thighs (may be asymmetric)

Question 5

What is Central cord syndrome?

Answer 5

SENSOSRY AND MOTOR DEFICIT
Hyperextension injury
Arm weakness (not plegia)
non surgical-stable

Question 6

What is Anterior cord syndrome?

Answer 6

Anterior spinal artery syndrome (∼ 95% of cases): reduced blood flow or occlusion of the anterior spinal artery (ASA)

ischemia anterior spinal artery
- complete motor paralysis (corticospinal tract)
- loss of pain and temperature feeling (spinothalamic)

Question 7

What is Brown-Sequard cord syndrome?

Answer 7

• hemiparaplegic syndrome
• Ipsilateral (same side) loss of
  –>proprioception-fine touch (position)- (spinothalamic)
  –>motor (spastic paralysis -corticospinal tract)
• contralateral (opposite) loss of
  –> loss of pain and temperature feeling -(dorsal column)
• Caused by penetrating injury

Question 8

How do you diagnose spinal cord injuries?

Answer 8

SPINAL COLUMN INJURY MUST BE SUSPECTED BEFORE IT IS EXCLUDED

X-ray (CT) → vertebral bone injury
MRI → spinal cord injury

Question 9

What is spondylodesis?

Answer 9

Surgical spinal fusion

stabilizes the spine by permanently joining two vertebrae, eliminating movement between them. Typically, bone grafts are placed between vertebrae to help them fuse together. In time, new bone grows over the graft.

Question 10

What is the indication for spondylodesis?

Answer 10

Unstable fractures OR neurological symptoms

Question 11

What are the types of minimally invasive spinal procedures?

Answer 11

Vertebroplasty: injection of bone cement into the fractured vertebra for immediate stabilization

Kyphoplasty: reexpansion of the fracture through insertion of an inflatable balloon into the vertebral body and injection of bone cement

Question 12

What is the indication for minimaly invasive spinal surgery?

Answer 12

stable vertebral compression fractures with progressive pain or kyphosis despite conservative treatment