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neuro > A13. Trauma of the spine and spinal cord > Flashcards

A13. Trauma of the spine and spinal cord Flashcards

1
Q

Prevalence of spinal column trauma:

A

64/100 000

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2
Q

spinal column trauma Neurological dysfunction is found in how many % of cases

A

in 10-30% of cases

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3
Q

spinal column trauma can be an injury to either

A

Vertebral column or spinal cord injury

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4
Q

which part of spine is affected in Trauma of the spine

A

50% affects cervical spine, 50% lumbar spine

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5
Q

spinal column trauma average age

A

32 y.o.

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6
Q

Most vulnerable parts of spinal column

A

are border between rigid and flexible regions (craniocervical,
cervicothoracal,
thoracolumbar zones)

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7
Q

Polytrauma (injury over several regions of spine) occurs in how many %

A

in 20-25%

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8
Q

Trauma of the spine and spinal cord causes

A
  • motor vehicle accidents,
  • falls,
  • sports injuries,
  • industrial accidents,
  • assaults,
  • gunshot
  • wounds, minor traumas in weakened spine (osteoporosis, osseal tumors
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9
Q

outcome of spinal column trauma depends on

A

Outcome depends on
* neurological and radiological assessment,
* biomechanical knowledge,
* surgical treatment,
* emergency care
* effective rehabilitation

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10
Q

Spinal cord injuries are they medical emergencies?

A

yes!

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11
Q

in Spinal cord injuries what is important

A
  • BP must be stabilized and
  • oxygenation is important for
    adequate blood perfusion to the spinal cord.
  • Patients must be moved with caution.
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12
Q

symptoms of spinal cord injuries depend on

A

Symptoms depend on
injury level (spinal cord, conus, epiconus, cauda syndrome, radicular signs

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13
Q

list Spinal cord injuries

A
  1. Acute transverse spinal cord injury, spinal shock
  2. Brown-Séquard syndrome = hemisection
  3. Anterior cord syndrome
  4. Central cord syndrome
  5. Conus medullaris syndrome
  6. Spinal cord concussion
  7. Cauda equina syndrome
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14
Q

complete VS incomplete spinal cord injury manifest as

A
  • complete:
    *paraplegia
    *quadriplegia/tetraplegia
  • incomplete:
    *paraplegia
    *tetraplegia/quadriplegia
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15
Q

Acute transverse spinal cord injury, spinal shock - where is the lesion

A

Lesion of all ascending and descending pathways
→ Motor, sensory, autonomic
dysfunction

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16
Q

Acute transverse spinal cord injury, spinal shock symptoms

A

● Hypesthesia or anesthesia of all sensory modalities below the lesion

● Paraparesis or quadriparesis (corticospinal tract injury)

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17
Q

in Acute transverse spinal cord injury, spinal shock does Hypesthesia or anesthesia of all sensory modalities occur above or below the lesion

A

Hypesthesia or anesthesia of all sensory modalities below the lesion

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18
Q

Acute transverse spinal cord injury, spinal shock - what is the acute phase

A
  • flaccid muscle tone,
  • areflexia,
  • no pyramidal signs (spinal shock)
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19
Q

Acute phase of Acute transverse spinal cord injury, spinal shock

A

Spinal shock =
* transient depression of all spinal cord functions below level of lesion (also reflexes and autonomic: paralytic ileus,
vasoparalysis with drop in BP,
cardiac shock,
flaccid bowel and bladder → urinary retention and overflow
incontinence).
Usually lasts hours-weeks.

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20
Q

how long does spinal shock last

A

Usually lasts hours-weeks.

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21
Q

Acute transverse spinal cord injury, spinal shock - what happens after acute phase

A
  • spasticity,
  • brisk deep tendon reflexes,
  • pyramidal signs,
    indicating
    upper motoneuron lesion
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22
Q

Brown-Séquard syndrome is mainly due to

A

= hemisection
● Rare, mainly due to trauma (e.g. gunshot,
stabwound)

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23
Q

Brown-Séquard syndrome symptoms

A
  • Ipsilateral proprioceptive sensory loss (proprioceptive tract)
  • weakness (corticospinal tract) with contralateral loss of pain and temperature (spinothalamic tract)
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24
Q

Anterior cord syndrome is similar to which other syndrome

A

Similar to anterior spinal artery syndrome

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25
Q

cause of Anterior cord syndrome

A

Either due to
* compression of anterior part of
spinal cord
or
* the interruption of blood supply
from the anterior spinal artery

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26
Q

Anterior cord syndrome symptoms

A

● Below the lesion:
* Loss of motor function, pain and temperature sensation

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27
Q

Central cord syndrome is often associated with

A

flexion type of injuries to cervical spine

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28
Q

Central cord syndrome symptoms

A

● Weakness of upper limbs and some weakness of lower limbs
● Spinothalamic sensory loss
with intact proprioceptive sensation is also typical

29
Q

Conus medullaris syndrome what is it

A

● Sensory loss (numbness) in the perianal region and inner thighs (saddle anesthesia)
and
loss of bladder control
(retention with overflow incontinence) without leg weakness
or diminished stretch reflexes

30
Q

Spinal cord concussion is it permanent neurologic deficit

A

● No permanent structural damage or neurological deficit

31
Q

Spinal cord concussion symptoms

A
  • Temporary neurological deficit, similar to cerebral concussion
  • No permanent structural damage or neurological deficit
32
Q

Cauda equina syndrome symptoms

A
  • Radicular pain in several dermatomes,
  • flaccid paralysis of lower limbs
  • with loss of deep tendon reflexes and
  • overflow incontinence
33
Q

list Vertebral fractures

A
  1. Jefferson’s fracture - Simultaneous fracture of anterior and posterior arches of C1
  2. Dens fracture (C2)
  3. Hangman’s fracture (C2-axis trauma)
34
Q

what is Jefferson’s fracture

A

Simultaneous fracture of anterior and posterior arches of C1
* Often from axial impact of head, when head is pushed towards the spine.
* The atlas is caught between the occipital condyles and its arches break.

not bold ones will be mentioned in other questions

35
Q

when does Jefferson’s fracture occur

A
  • Often from axial impact of head, when head is pushed towards the spine.
  • The atlas is caught between the occipital condyles and its arches break.
36
Q

what happens to the atlas in Jefferson’s fracture

A

Often from axial impact of head, when head is pushed
towards the spine.
The atlas is caught between the occipital condyles and its arches break.

37
Q

does Jefferson’s fracture involve one or multiple arches?

A

both
* May be fracture of one or multiple (56%) arches

38
Q

Jefferson’s fracture symptoms

A
  • Stiff neck,
  • pain when moving neck,
  • no neurological signs,
  • may have structural instability
39
Q

Dens fracture is common in which age

A

Common in elderly

40
Q

Dens fracture is a fracture of which vertebra

A

(C2)

41
Q

Dens fracture is usually due to

A

motor vehicle accidents

42
Q

is Dens fracture fatal and why

A

Fatal in 25-40% due to medulla compression

43
Q

fatal complication of Dens fracture

A

Fatal in 25-40% due to medulla compression

44
Q

how do C2 fractures happen

A

either be from the
* dens breaking off
* or body of C2 breaking

45
Q

Dens fracture symptoms

A
  • Usually causes structural instability that needs stabilization
  • Neck pain radiating to occipital region (worse with neck movements), typically the patient will hold their head
46
Q

in Dens fracture what happen if alar ligament tears

A

Tear of alar ligaments may occur without a fracture
→
Atlanto-axial subluxation and
dislocation

47
Q

can Tear of alar ligaments occur without a fracture

A

YES
may occur without a fracture

48
Q

Hangman’s fracture epidemiology

A

7% of cervical fractures

49
Q

Hangman’s fracture occurs at which vertebra

A

C2-axis trauma

Body of C1 slides forward on body of C2 → Fracture of C2 arches

50
Q

when does Hangman’s fracture occur

A

during hanging

51
Q

Hangman’s fracture can be similar to what fracture

A

Can also have similar fracture with spinal cord injury from motor vehicle accidents where
the neck is suddenly hyperextended

52
Q

AO (Association for Osteosynthesis) classification of subaxial and thoracolumbar fractures- types

A
  • Type A (15% of subaxial cervical ,⅔ of thoracolumbar)
  • Type B (50% of subaxial cervical)
  • Type C (35% subaxial cervical)
53
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

Type A subaxial and thoracolumbar fractures fracture location

A

(15% of subaxial cervical, ⅔ of thoracolumbar)

54
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

what happens in Type A fracture

A
  • Axial compressive forces → Vertebral compression and a burst fracture → Segment shrinkage.
  • When force strikes the spine from the vertical
    direction (e.g. diving into shallow water, fallow on the head in motor vehicle accidents).

Half are associated with severe neurological deficit
below the level of the injury with predominantly anterior spinal cord symptoms.

55
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

symptoms in Type A fracture

A
  • Half are associated with severe neurological deficit
    below the level of the injury
  • with predominantly anterior spinal cord symptoms.
56
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

direction of force in Type A fracture

A

When force strikes the spine from the vertical
direction (e.g. diving into shallow water, fallow on the head in motor vehicle accidents).

57
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

Type B fracture location

A

50% of subaxial
cervical)

58
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

how does Type B fracture occurs

A
  • Distractive forces (flexion-extension) → Tear of parts of the segment and segment elongation.

E.g. whiplash injury in motor vehicle accidents
where cervical spine suffers hyperflexion followed by hyperextension.

59
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

type B fracture are often associated with

A
  • central cord syndrome and
  • hematomyelia (the presence of a well-defined focus of hemorrhage within the spinal cord itself)
60
Q

what is central cord syndrome

A

injury to the central region of the spinal cord (central corticospinal tracts and decussating fibers of the lateral spinothalamic tract)

(most common incomplete spinal cord injury )
typically affects the cervical cord.

61
Q

ETIOLOGY OF central cord syndrome

A
  • hyperextension of the neck,
  • syringomyelia,
  • intramedullary spinal cord tumors
  • Degenerative spine disease
  • Cervical spondylosis
  • Traumatic disk herniation
62
Q

AO (Association for Osteosynthesis) classification of subaxial and thora

Type C
fracture location

A

(35% subaxial
cervical)

63
Q

Type C fractures are caused by

A

by shearing forces → Either shrinkage or elongation of the segment.

64
Q

Degree of spine instability (and risk of neurological deficit) for AO (Association for Osteosynthesis) classification of subaxial and thoracolumbar fractures

A

spine instability increases A-C.

C most unstable

65
Q

According to the classification, List three principles of surgical intervention in spinal trauma:

A

a. Reposition
b. Decompression
c. Stabilization

66
Q

Acute spinal injury is often accompanied by

A

severe neurological deficits

67
Q

For spinal cord compression,
what does functional injury depends on

A

functional injury depends on the
* time of surgical intervention.

68
Q

how can Secondary effects of the injury be
prevented

A

with high dose (1-2g) i.v. corticosteroids until surgery.

neuro (32 decks)

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