7. Spinal Injuries Flashcards
What clinical picture can exclude spinal injury?
No neuro deficity
No pain or tenderness
No evidence of intoxication
No disctracting injuries
Which three spinal cord tracts can be readily assessed clinically?
Lateral corticospinal tract
Spinothalamic tract
Dorsal columns
How do you test corticospinal tract?
Voluntary muscle contractractions
Or involuntary response to pain
How do you test the spinothalamic tract
Pinprick sensation
How do you test the dorsal columns?
Proprioception or vibration.
Injury to what levels of the spine can cause neurogenic shock?
T6 and above.
What is central cord syndrome?
Disproportionately greater loss of motor strength upper extremities than lower extremities.
Typically caused by hyperextension injury (e.g. fall on face)
What is anterior cord syndrome?
Paraplegia and a bilateral loss of pain.
Caused by injury to motor and sensory pathways in ANTERIOR part of cord.
Thus, the dorsal colmn (position, vibration and deep pressure sense) remains intact.
What is Brown Sequard syndrome?
Ipsilateral motor loss and loss of position sense
Contralateral loss of pain and temperature sensation.
Typically caused by hemisection of the cord from penetrating trauma.
What is a Jefferson / burst fracture?
Disruption of the anterior and posterior rings of C1.
Usually caused by axial loading (large load falls on head).
What is an anteror wedge compression injury?
Thoracic spinal fracture caused by axial loading with flexion
What are chance fractures?
Transverse fractures through the vertebral body.
What tools are used to rule out C-spine injury?
Canadian C-spine Rule
NEXUS criteria
What does NEXUS stand for?
Neuro deficit ETOH intoxication X-treme disctracting injuries Unable to provid history (altered GCS) Spinal tenderness in the midline.
If none are there, no need for radiography.
When should flexion extension X rays be taken?
Neck pain
Normal radiography.
Should be followed up by flexion-extension X-rays or MRI.
