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PassPMR - 03 Spinal Cord Injury > 3 - Traumatic & Non-Truamiatic SCI > Flashcards

3 - Traumatic & Non-Truamiatic SCI Flashcards

1
Q

Name the major ligaments of the spine and the spine motions they resist 🔑🔑 MOCK

A
  1. Anterior longitudinal ligament → Extension
  2. Posterior longitudinal ligament → Flexion
  3. Ligamentum flavum and facet joint → Flexion
  4. Interspinous and supraspinous ligaments → Flexion

PMR Secrets – 3rd edition – page 16

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2
Q

Patient with history of RTA or fall and you requested spinal xray. When do consider spine is unstable? Why it’s important? 🔑🔑 Dr. Jamal Question
Denis Three Column of Spine Stability 🔑🔑 MOCK & EXAM Question

A

ANTERIOR COLUMN

  1. Anterior portion of the vertebral body
  2. Anterior portion of the annulus fibrosus
  3. Anterior longitudinal ligament

MIDDLE COLUMN

  1. Posterior portion of the vertebral body
  2. Posterior portion of the annulus fibrosus
  3. Posterior longitudinal ligament.

POSTERIO COLUMN

  1. Pedicles
  2. Facet joints
  3. Laminae
  4. Supraspinous ligament
  5. Interspinous ligament
  6. Facet joint capsule
  7. Ligamentum flavum

Spine is considered unstable if

  • The integrity of the middle and either the anterior or posterior column is affected
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3
Q

AOSpine subaxial cervical spine injury classification.

A

💡 ABCFBL

  1. Compression (A)
  2. Tension like band (B)
  3. Translation (C)
  4. Facet (F)
  5. Bilateral (BL)

Braddom 6th Edition Chapter 49 SCI

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4
Q

41 yo M with stable L1 compression fracture. How long should he be on bed rest and analgesics. What type of bracing would you use? List 4 goals of bracing in this situation. 🔑🔑

A

1-3 weeks analgesia and bed rest for comfort.

Thoracic Lumbar Sacral Orthosis (TLSO) x 12 weeks

  1. Decrease pain.
  2. Provide stability/limit spinal motion.
  3. Prevent further injury/fractures.
  4. Prevent progressive deformity.
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5
Q

Mention 4 most restrictive braces

A

Removable: Minerva, Four poster & SOMI

Non-Removable: Halo

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6
Q

Most common vertebral level of Cervical Flexion/Extension Injuries 🔑🔑 EXAM

Most common neurological level of injury in SCI

Most common neurological level of injury in paraoplegia 🔑

A
  • C5 is overall the most common level of injury
  • T12 is the most common level of injury of paraplegia
  • Most are incomplete tetraplegia > incomplete paraplegia

Cuccurollo 4th Edition Chapter 7 SCI pg7

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7
Q

List 4 most common causes of SCI 🔑🔑

List 4 causes of traumatic SCI.

A
  1. Motor vehicle crashes (Kids)
  2. Falls (Eldarly)
  3. Violance (Adult)
  4. Sports, Diving (Teens)

Cuccurollo 4th Edition Chapter 7 SCI pg535

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8
Q

Types of Odontoid (dens) fracture. Which is the most common type? 🔑🔑

A

Type I

  • Fracture through the tip of dens.
  • No treatment usually required.

Type II (most common)

  • Fracture through the base of odontoid at junction with the C2 vertebra.
  • Treatment: Halo vest, but surgery if unstable.

Type III

  • Fracture extends from base of odontoid into the body of the C2 vertebra proper.
  • Treatement: Halo vest

Cuccurollo 4th Edition Chapter 7 SCI pg548

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9
Q

List four types of flexion-extension injury seen in cervical SCI 🔑

A

💡 Flexion w/ loading or rotation vs Extension

1- Flexion/axial loading or Brust compression fracture

Anterior wedge-shaped-appearing vertebra

2- Flexion/rotation injury (Unilateral facet dislocation)

Incomplete SCI & Unstable with disruption of the PLL

3- Flexion (Bilateral facet dislocation)

Complete SCI & Unstable with disruption of the PLL

4- Hyperextension

Stable; anterior longitudinal ligament may be disrupted

Result in Central cord syndrome (UE weaker than LE +/- bowel)

Cuccurollo 4th Edition Chapter 7 SCI pg541 Table 7.1

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10
Q

30yo Athlete with Hx football spearing or swimming. Now presented with neck pain.

A

Jefferson fracture of C1

Burst fracture of the C1 ring

Management

  • Stable fracture, no neurological findings: Rigid orthosis (i.e., Halo vest)
  • Unstable fractures will require surgery.

Cuccurollo 4th Edition Chapter 7 SCI pg547

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11
Q

History of car accident with head hitting windshield.

A

Hangman fracture (C2 burst fracture)

  • Usually bilateral from an abrupt deceleration injury
  • Most often stable with only transient neurological findings

Management

  • External orthosis (Halo is first-line treatment).
  • Unstable fracture will require surgery

Cuccurollo 4th Edition Chapter 7 SCI pg548

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12
Q

Patient with car accident, was hit from the back leading to hyperextension of neck. Now he complains of neck pain only. What is the resulting injury? is he stable?🔑

A

Hyperextension Injury

  • Acceleration-deceleration injuries.
  • C4–C5 is the most commonly affected level

Result

  • Central cord syndrome

Management

  • Stable; anterior longitudinal ligament may be disrupted
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12
Q

27yo swimmer with headache and neck pain after jumping practice. What would be the type of fracture? Mechanism of injury?

A

BURST/COMPRESSION FRACTURES

  • Cervical flexion with axial loading
  • C5 is the most common compression fracture of the C-spine.
  • Stable if ligaments remain intact
  • Potential Injury in case of retropulsion of bony fragments

XRAY

  • Anterior wedge-shaped-appearing vertebra

Cuccurollo 4th Edition Chapter 7 SCI pg541

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13
Q

Hx Car accident came with abdominal pain and weak legs. Spot Diagnosis. Stable or unstable? Treatment?

A

Chance Fracture

  • Transverse fracture of the thoracic or lumbar spine (T12, L1, and L2 levels) from posterior to anterior through the spinous process, pedicles, and vertebral body.

Mechanism

  • Acute hyperflexion of the thorax

Management

  • Stable fractures and are rarely associated with neurological compromise unless a significant amount of translation occurs.

Cuccurollo 4th Edition Chapter 7 SCI pg548

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14
Q
A

Anterior wedge compression fracture

  • Vertebral body compression fracture
  • May cause thoracic kyphosis

Mechanism

  • Axial compression with or without flexion

Managment

  • Spontaneous vertebral compression fractures are stable injuries—ligaments remain intact

Cuccurollo 4th Edition Chapter 7 SCI pg548

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15
Q

Spot diagnosis.

A

Hyperflexion of the subaxial cervical spine (C3–C7)

  1. Anterior subluxation
  2. Simple compression fracture
  3. BL facet dislocations
  4. Flexion teardrop fracture
  5. Clay shoveler’s fracture.

Result

  • Anterior cord syndrome if not a complete SCI.

Hyperextension of the subaxial cervical spine

  1. Distract to anterior column of the spine
    1. Disrupts the anterior longitudinal ligament
    2. Disrupts the intervertebral disk
    3. Disrupts the posterior longitudinal ligament
    4. Hyperextension teardrop fracture
  2. Compress posterior column: ligamentum flavum to buckle into the spinal canal

Result

  • Central cord syndrome

Braddom 6th Eiditon Chapter 49 SCI pg1055-1056

16
Q

What is SCIWORA 🔑🔑

List 4 Predisposing factors for SCIWORA 🔑🔑

Which syndrome is likely to present?

Management.

A

“Spinal Cord Injury without Radiographic Abnormality” (SCIWORA)

Clinical signs of SCI without evidence of fracture or malalignment on x-ray or CT

💡 Acute central cord syndrome may develop after fall despite absence of spine fracture

Pediatrics

  1. Traction in a breech delivery
  2. Violent hyperextension or flexion

Adults

  1. Fall with hyperextension of the neck, leading to an acute Central Cord Syndrome.

Risk Factors

  1. Increased ELASTICITY of spinal with less-flexible spinal cord.
  2. Large head to neck RATIO.
  3. Poorly developed neck MUSCULATURE.
  4. LAXITY of paraspinal ligaments.
  5. Horizontal and shallow FACETS
  6. Incomplete OSSIFICATION of vertebral end plates
  7. Anterior WEDGING of vertebral bodies.
  8. Poorly developed UNCINATE processes.

Management

  • MRI may be useful to detect soft tissue pathology such as ligamentous injuries as well as cord edema or hematomas.
  • Nonoperatively with immobilization and therapy.

Cuccurollo 4th Edition Chapter 7 pg549

Ref: SCI principles and practice, pg 854; Greenberg p700, 732

https://now.aapmr.org/spinal-cord-injury-without-radiological-abnormality/#disease/-disorder

17
Q

List 5 Nontraumatic SCI etiologies 🔑🔑 EXAM 2021

A
  1. Stenosis (Spondylosis)
  2. Spinal Cord Tumors (Mass)
  3. Infectious (Polio & Transverse myelitis)
  4. Inflammatory Myelopathy (Epidural Abcess)
  5. Insult (Multiple Sclerosis → NMO)
  6. Radiation myelopathy
  7. Vascular (Vascular Ischemia, Hematoma)
  8. Congenital (Spina bifida → Teathered Cord)
  9. Syringomyelia (Fluids)
  10. Toxic-metabolic disorders (Vitamin B12 deficiency)

Cuccurollo 4th Edition Chapter 7 SCI pg543

18
Q

What is the effect of the following conditions on spinal cord structure?🔑🔑 EXAM 2021

  1. Tabes dorsalis 2. Syringomyelia 3. Pernicious anemia 4. ALS
A

Tabes dorsalis (Syphilis):

  • Degeneration of the posterior column of the spinal cord
    • Loss of vibration
    • Loss of proprioception → loss of coordination, balance and repeated falls
    • Lose of fine discriminative touch

Syringomyelia

  • Central cord syndrome

Pernicious anemia

  • Vitamin B12 deficiency myelopathy
  • Degeneration of the posterior and lateral columns of the spinal cord
    • Dorsal columns → unsteady gait and sensory ataxia.
    • Corticospinal tract → Spastic Weakness of legs, arms, and trunk
    • Lateral spinothalamic → Hand and feet paresthesias-tingling/numbness
    • UMN → Increased DTRs and postive Babinski sign

ALS

  • Degeneration of the anterior horn cell
  • Degeneration of the corticospinal tract

Cuccurollo 4th Edition Chapter 7 SCI pg545

Cuccurollo 4th Edition Chapter 5 EDX pg447 Table 5-61

19
Q

List 2 most common causes of non traumatic SCI 🔑

A
  1. Spinal stenosis.
  2. Spinal cord tumors.

Cuccurullo 4th Edition Chapter 7 SCI pg543

20
Q

List two populations at risk for the formation of an epidural abscess? 🔑

A
  1. Diabetes
  2. Immunocompromised

Cuccurullo 4th Edition Chapter 7 SCI pg544

21
Q

60yo male presents with localized pain in the region of L2. Labs show increased WBC and ESR. He also has a Hx of diabetes. Give 3 differential diagnosis.

A
  1. Osteomyelitis.
  2. Discitis.
  3. Compression fracture.
  4. Epidural abscess.

First principles.

22
Q

Risk factors for developing Spinal Epidural Abscess (Think how can infection reached spine?)

A
  1. Immunocompromised
  2. Intervention spinal procedure
  3. Systematic infection
  4. IV drug abuse
  5. Old age
23
Q

Most common single cause of myelopathy. 🔑

A

💡 Cervical spinal stenosis due to spondylosis is the most common cause of myelopathy

Spondylotic changes:

  1. Disc space narrowing
  2. Facet hypertrophy
  3. Osteophytes from vertebral bodies
  4. Ligamentum flavum hypertrophy

💡 Cord is pinched between the disc and the osteophytes from the anterior vertebral bodies.

Cuccurollo 4th Edition Chapter 7 SCI pg543

24
Q

List 5 features of cervical myelopathy. diagnostic tool & management. 🔑🔑

A

Sensory

  1. Vibratory sense or proprioception
  2. Upper extremity (UE) paresthesias

Motor

  1. Hyperreflexia
  2. Atrophy of hand intrinsic musculature
  3. Positive Hoffman’s sign
  4. Gait disturbance and decreased balance (myelopathic gait)

Gold standard

  • MRI cervical spine

Menegement

  • Rehabilitation with gait training and surgical referral.

Cuccurollo 4th Edition Chapter 7 SCI pg543

25
Q

What is a myelopathy? The most common causes of myelopathies?

A

Myelopathy

pathologic process that affects primarily the spinal cord and causes neurologic dysfunction.

Causes of Myelopathy

  1. Syringomyelia
  2. Trauma
  3. Cervical spondylosis
  4. Inflammatory arthritis
  5. Acute disc herniation
  6. Primary spinal and paraspinal tumors
  7. Electrical injury
  8. Radiation
  9. Vitamin B12 deficiency
  10. Thiamine deficiency (beri-beri)
  11. Lupus
  12. Systemic vasculitis
  13. Multiple sclerosis
  14. Neuromyelitis optica
  15. Infection: Epidural infections - Arachnoiditis
  16. Syphilis (tabes dorsalis)
  17. Tuberculosis
  18. Spinal epidural abscess
  19. Epidural hematoma
  20. Atherosclerotic, abdominal aneurysm
  21. Spinal dural arteriovenous fistula and other vascular malformations
  22. Spinal artery infarction

Neurology Secrets 6th Edition Chapter 8 Myelopathy pg103

Causes of Cervical Myelopathy

  1. Cervical spondylitic myelopathy
  2. Multiple sclerosis
  3. Motor neuron disease
  4. Vasculitis
  5. Syringomyelia
  6. Spinal tumors
  7. Neurosyphilis
  8. Subacute combined degeneration

Braddom 6th Edition Chapter 32 Neck pg646 Cervical Myelopathy and Myeloradiculopathy

26
Q

What are the indications for spinal stenosis surgery? 🔑🔑

A

💡 Patient with acute low radiculopathy, develops weakness and incontinence

  1. acute unilateral radicular pain
  2. cauda equina syndrome
  3. progressive neurological deficit
  4. neurogenic claudication

Ref: 2003 – surgical mgmt spinal stenosis, Paul Zak. PMR clinics north america.

27
Q

Transverse myelitis (TS) 🔑🔑 List 4 Causes - Presentation - Poor prognostic factors - Likely outcome - Rule of Rehabilitation

A

Mimicking Anterior Cord

  1. Pain and temperature are usually affected
  2. Proprioception and vibration are often spared.
  3. Weakness in the legs and trunk
  4. Reflexes are initially depressed and then hyperactive.
  5. Sphincter dysfunction is common.

Causes of “Spinal Cord to Myelin Infection”

  1. Multiple Sclerosis (MS)
  2. Neuromyelitis optica (NMO): severe ON and TM with sparing of the brain
  3. Infections
  4. Post infectious inflammation
  5. Autoimmune
  6. Idiopathic

Indicators for poor prognosis

  1. Rapid progression
  2. Back pain
  3. Spinal shock

Outcome

  • One-third of patients with TM recover completely
  • One-third do not improve at all
  • One-third improve but with significant residual neurological deficit

Treatment

  • IV solumedrol, IV immunoglobulins (IVIG), and plasmapheresis

Rehabilitation for Incomplete SCI

  • Mobility, spasticity
  • Bowel and bladder management
  • Avoiding decubitus ulceration and deep venous thrombosis

Cuccurollo 4th Edition Chapter 7 SCI pg544

Neurology Secrets 6th Edition Chapter 8 Myelopathy pg107

DeLisa 5th Edition Chapter 25 MS pg627

28
Q

What is neuromyelitis optica (NMO) 🔑🔑

A

Neuromyelitis Optica (NMO)

  • Disease affecting both optic nerves (optic neuritis) and the spinal cord (transverse myelitis)

Optic Neuritis

  • Blindness

Transverse Myelitis

  • Sensory loss
  • Complete paralysis
  • Bowel and bladder dysfunction.

Treatment

  • Intravenous (IV) glucocorticoids, plasmapheresis, IVIg

Cuccurollo 4th Edition Chapter 7 SCI pg544

29
Q

Name three classes of spinal tumors and provide an example of each. Depending on their location, the spinal cord tumors can be 🔑🔑 EXAM

A

INTRADURAL TUMORS 🔑🔑

  1. Intramedullary: Gliomas, Ependymoma & Astrocytoma (most common neoplasms)
  2. Extramedullary: Meningioma, shwanoma, neurofibroma

EXTRADURAL TUMORS

  1. Spinal metastases (thoracic > lumbar)
  2. Multiple myeloma (primary malignant tumor)
  3. Vertebral hemangioma (vessels)

EXTRADURAL LESIONS

  1. Epidural metastases
  2. Epidural abscess
  3. Epidural hematoma
  4. Herniated disc

Cuccurollo 4th Edition Chpater 7 SCI pg546

Neurology Secrets 6th Edition Chapter 8 Myelopathies pg107

30
Q

List 2 The most common primary malignancies with spinal metastases 🔑🔑

A

💡 Since most common spine tumor is thoracic level, think about adjacent structures

  1. Lung cancer
  2. Breast cancer
  3. Prostate cancer
  4. Lymphoma
  5. Myeloma

Neurology Secrets 6th Edition Chapter 8 Myelopathies pg107

31
Q

Most common primary malignant tumors of the spinal column in adults. 🔑🔑 Hint Spinal Column = BONE

A
  1. Multiple myeloma (bone marrow cancer)
  2. Plasmacytoma

Cuccurollo 4th Edition Chapter 7 SCI pg546

PassPMR - 03 Spinal Cord Injury (9 decks)

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