Anatomy of the vertebral column and spinal and head injury

Question 1

how to evaluate a patient presenting with spinal trauma?

Answer 1

primary survey- airway (with cervical spine control), breathing, circulation, disability, exposure
secondary survey- head to toe, spinal assessment- log roll palpate spine
imaging- X-ray/ CT

Question 2

what is the impact of trauma to the spinal column?

Answer 2

bony- fractures/dislocations
intervertebral disc damage
neurological- spinal cord damage
damage to ligaments/muscles

Question 3

what are the causes and signs of caudate equina syndrome?

Answer 3

causes- vertebral fracture/ sublauxation, disc herniation, neoplasm/ infection/ iatrogenic
signs- LMN lesion, severe back pain, sexual dysfunction, reduced perianal sensation, absence of anal tone, bladder/bowel dysfunction

Question 4

what are the parts of the intervertebral discs?

Answer 4

nucleus pulposus (inner)
annulus fibrosus (outer)

Question 5

what is myelopathy?

Answer 5

an injury to the spinal cord due to severe compression or constriction

Question 6

how do we assess severity of head injury?

Answer 6

GCS
mild- >12
moderate- 9-12
severe- 8 or less

Question 7

what is the process of assessing head injury?

Answer 7

primary survey- ABCDE with control of C spine
secondary survey- head to toe, identifying injuries
neurological assessment- general- GCS, focal- cranial nerves, pupillary response, peripheral nerves (tone, power, sensation, reflexes)
investigation- CT

Question 8

what can cause raised ICP in head trauma?

Answer 8

blood- haematoma

brain tissue swelling- e.g high MAP

Question 9

what are the characteristics of brain death?

Answer 9

GCS 3
Non-reactive pupils
absent brainstem reflexes
no spontaneous ventilatory effort

Question 10

what is closed head trauma?

Answer 10

brain injury caused by an external impact from sudden violent motion that does not break the skull
they result in swelling or bleeding within the skull, which can lead to brain damage or death

Question 11

what are the consequences of closed head trauma?

Answer 11

epidural (extradural) haematoma, subdural haematoma, concussion

Question 12

how many vertebrae are in each region?

Answer 12

7 cervical 
12 thoracic
5 lumbar
5 sacral 
3/4 coccygeal

Question 13

what are the names of the first 2 vertebrae?

Answer 13

C1- atlas

C2- axis

Question 14

what are the distinguishing features of atlas and axis?

Answer 14

atlas- has facets for the occipital condyles, no vertebral body
axis- has large superior facets which articulate with atlas, structure called dens which protrudes through the vertebral foramen of atlas

Question 15

which ligament holds dens in place?

Answer 15

the transverse ligament of atlas

Question 16

what are the normal curvatures of the spine?

Answer 16

cervical lordosis
thoracic kyphosis
lumbar lordosis
sacral kyphosis

Question 17

what can cause excessive thoracic kyphosis?

Answer 17

erosion of anterior vertebrae which can occur in osteoporosis

Question 18

what are the intrinsic muscles of the back?

Answer 18

develop embryologically in the back 
they include (superficial to deep):
splenius muscles 
erector spinae muscles 
transversospinale muscles

Question 19

what are the intrinsic muscles of the back innervated by?

Answer 19

posterior rami of spinal nerves

Question 20

where does the spinal cord terminate?

Answer 20

conus medlaris at L2