19) Spinal Cord Injuries

Question 1

What are some causes of spinal injuries?

Answer 1

Car collision, contact sports, assault, falls, alcohol

Question 2

Where do most spinal injuries occur? How does this differ in children?

Answer 2

C6/7

In children C1/2

Question 3

What are the mechanisms of injury to the spine?

Answer 3

Hyperflexion
Hyperextension
Lateral stress
Rotation 
Compression
Distraction - pulling apart of vertebrae

Question 4

What fractures are due to flexion injuries of the spine?

Answer 4

Anterior wedge
Flexion teardrop
Clay-shoveler’s

Question 5

What dislocations are due to flexion injuries of the spine?

Answer 5

Anterior subluxation
Bilateral interfacet dislocation
Atlanto-occipital
Anterior atlanto-axial

Question 6

What fractures are due to extension injuries of the spine?

Answer 6

Hangman’s

Teardrop

Question 7

What dislocation is due to extension injury of the spine?

Answer 7

Anterior atlanto-axial dislocation

Question 8

Which is more likely to cause neurological injury: flexion of extension injury of the spine?

Answer 8

Flexion

Question 9

What are the causes of complete cord transection syndrome?

Answer 9

Trauma
Infarction
Transverse myelitis
Abscess
Tumour

Question 10

What are the features of complete cord transection syndrome?

Answer 10

Spinal shock and autonomic dysfunction (high lesion)
Priapism - prolonged, sustained erection
Complete loss of sensation and paralysis below lesion
Hypotension (loss of sympathetic)

Question 11

What is Brown-Séquard syndrome?

Answer 11

Hemisection of spinal cord (rare to be complete)

Question 12

What are the causes of Brown-Séquard syndrome?

Answer 12

Penetrating trauma
Fractured verebrae
Tumour
Abscess
MS

Question 13

What are the features of Brown-Séquard syndrome?

Answer 13

Same side - loss of motor function, conscious proprioception, vibration and touch sensations (DC)
Contralateral - loss of pain and temp sensation

Question 14

What are the causes of anterior cord syndrome?

Answer 14

Flexion injury - fracture, dislocation or disc herniation

Injury to ant spinal artery (cross clamp of aorta)

Question 15

What are the features of anterior cord syndrome?

Answer 15

Flaccid paralysis below level (corticospinal)
Loss of pain and temp sensation below
Autonomic dysfunction

Question 16

What are the causes of central cord syndrome?

Answer 16

Trauma - hyperextension (elderly), hyperflexion (young)
Disruption of blood flow to cord
Cervical spinal stenosis 
Degenerative spinal disease
Syringomyelia
Cervical canal ependymoma

Question 17

What is syringomyelia?

Answer 17

Development of syrinx (cyst) in or within the central canal

Question 18

What signs would someone with syringomyelia present with?

Answer 18

Loss of sensitivity to painful and thermal stimuli in cape like distribution (medial parts of spinothalamic tract affected first)

Question 19

What are the features of central cord syndrome?

Answer 19

Motor loss > sensory loss
Distal > proximal
Upper extremity > lower extremity
Bladder dysfunction and urinary retention

Question 20

What are the causes of posterior cord syndrome?

Answer 20

Spondylosis
Spinal stenosis
Infections
Vit B12 def
Occlusion of posterior spinal artery

Question 21

What are the features of posterior cord syndrome?

Answer 21

Loss of conscious proprioception, vibration, 2-point discrimination and light touch (DC) below level of lesion

Question 22

What is the general management for spinal cord injuries?

Answer 22

Consider intubation (C5 and above)
ICU
Early immobilisation of C spine
Physio

Question 23

When should surgery be used in spinal cord injuries?

Answer 23

Progressive neurological defects

Unstable spinal fractures

Question 24

Describe the immediate management of spinal cord injuries:

Answer 24

ABCDE
Consider intubation
Use log roll, backboard and rigid C collar

Question 25

What is manual inline stabilisation?

Answer 25

Crouching above patient with hands placed on the patient’s mastoid process or cradling their occiput

Question 26

Describe the emergency management of spinal cord injuries:

Answer 26

ABCDE - HR, RR, BP
Address hypoxia - O2
Address hypotension - fluid challenge, vasopressors
Address hypothermia, blankets
Neuro exam, bladder volume and distension