28 Spine Injuries

Question 1

What is an incomplete spinal cord injury?

Answer 1

Any residual motor or sensory function > 3 segments below level of injury (can be sensory, voluntary, or sacral sparing)

Question 2

Types of incomplete spinal cord injury?

Answer 2

Central cord
Anterior cord
Posterior cord
Brown-Sequard

Question 3

What is a complete spinal cord injury?

Answer 3

No motor or sensory 3 segments below lesion. 3% will develop some recovery, but no distal recovery if last for > 72h.

Question 4

What is spinal shock?

Answer 4

1. hypotension (shock) after spinal cord injury
   - interruption of sympathetic (above T1) results in loss of vascular tone below injury
   - loss of muscle tone below injury results in venous pooling
   - blood lost
2. transient loss of all neurologic function

Question 5

Most common nonfatal automobile injury

Answer 5

Whiplash

Question 6

5 grades of whiplash injury

Answer 6

Grade 0 - no complaint
Grade 1 - neck pain
Grade 2 - reduced ROM/point tenderness
Grade 3 - weakness, sensory deficits, DTR abnormalities
Grade 4 - fracture or dislocation

Grade 0-1: no rad studies, 2: CS, 3: CT, MR and treat as SCI

Question 7

What tends to get injured in pediatric spinal injury?

Answer 7

Ligamentous types (ligamentous laxity and immature paraspinal muscles)

Question 8

What level of spine is most vulnerable in age group <9?

Answer 8

Cervical (67% in upper 3)

Question 9

What can be confused as a jefferson fracture in children?

Answer 9

Pseudospread of the atlas (>2mm overlap of 2 C1 lateral masses on C2)

Question 10

Are jefferson fractures common in children?

Answer 10

No - more common in teenage years.

Question 11

Major causes of death in spinal cord are:

Answer 11

Aspiration and shock

Question 12

Associated findings suggestive of spinal cord injury:

Answer 12

Abdominal breathing and priapism (autonomic dysfunction)

Question 13

In spinal cord injury with hypotension in the field, agent of choice is:

Answer 13

Dopamine
Avoid phenylephrine (can increase vagal tone with bradycardia)

Question 14

Hypopnea from spinal cord injury may be secondary to:

Answer 14

Paralysis of intercostal muscles, diaphragm (phrenic nerve), LOC

Question 15

Spinal cord injury can cause temperature dysregulation by:

Answer 15

vasomotor paralysis - poikilothermy

Question 16

Spinal cord injury can cause electrolyte disturbances by:

Answer 16

hypotension/hypovolemia increases aldo - hypokalemia

Question 17

What should be administered after a spinal cord injury to improve outcome?

Answer 17

Methylprednisolone by 8 hours for 1y mortality benefit

Question 18

Protocol for methylprednisolone after spinal cord injury:

Answer 18

Initial 30 mg/kg IV bolus over 15 min.
Pause 45 min.
Maintenance infusion of 5.4 mg/kg/hr IV

Question 19

DVT prophylaxis in spinal cord injury

Answer 19

Pneumoboots + subcutaneous heparin titrated to PTT 1.5

Question 20

When is MRI of spine appropriate in spinal injury?

Answer 20

CT spine is inconclusive
Patient with neurologic deficits.
Should be done within 48-72h. Use T2W and FLAIR

Question 21

Contraindications to emergent operation for acute spinal cord injury

Answer 21

Complete spinal cord injury
Unstable medically
Central cord syndrome