Applied Spinal Trauma Flashcards
What vertebral levels are the spinal cord, conus medullaris and cauda equina between?
- SC = C1-T12
- CM = T12-L1
- CE = L2-sacrum
What is a radiculopathy?
Spinal root injury
What is a myelopathy?
Spinal cord injury
What is quadriplegia?
Loss of function in upper and lower limbs
What is paraplegia?
Loss of function in lower limbs
What is paraparesis?
Weakness due to cord/root compression
What does neural compression above C4 cause?
Loss of ventilation
What does neural compression at C5 cause?
Quadriplegia
What does neural compression at C5-T1 cause?
Decreasing arm function
What does neural compression at T1-L1 cause?
Paraplegia
What does neural compression at L2-5 cause?
Decreasing leg function
What does neural compression L5 and below cause?
- Impaired sphincter + sexual function
- Foot + ankle weakness
What does compression of the conus medullaris cause?
- Flaccid paresis/paralysis
- Absent reflexes
- Absent plantar response
- Autonomous neurogenic bladder
- Impotence
What does cauda equina compression cause?
- Radicular weakness
- Muscle wasting + fasciculation
- Decreased tone + loss of reflexes
- Autonomous dribbling bladder
- Impotence
Initial assessment for spinal trauma
- ATLS protocol
- Airway + C-spine control
- Breathing
- Circulation (hypovolaemic vs neurogenic shock)
What symptoms increase suspicion of spinal trauma?
- Mechanism of injury
- Blunt trauma above clavicle
- Facial fractures
- Altered consciousness
- Ankylosing spondylitis
What means you should suspect a spinal cord injury?
- Flaccid areflexia
- Loss of anal tone
- Priapism
- Spinal shock + the bulbo cavernosus reflex
How do you clear the C-spine of an alert patient?
- If no tenderness + full ROM
> No X-ray needed - If pain + reduced ROM
> C-spine series
> Normal X-ray, low index of suspicion = observe
> Normal X-ray, high energy, focal pain, loss of movement = CT/MRI
How do you clear the C-spine of a non-cooperative patient?
- All have C-spine series
- If normal - retain collar until cooperative or MRI
Systemic approach for assessing radiographs
- A = adequacy and alignment
- B = bony abnormality
- C = contours + cartilage
- D = disc spaces
Types of spinal fracture
- Wedge compression
- Flexion distraction
- Burst fracture
- Fracture dislocation
Types of primary spinal cord injury
- Contusion
- Compression
- Traction
- Shear
Types of secondary spinal cord injury
- Hypotension
- Hypoxia
- Oedema
- Ischaemia
Treatment of a spinal cord injury
- Primary immobilisation
- Assessment of stability
- Assessment of neurological compromise
- Start a plan for long-term rehab
Options of timing of spinal cord surgery after injury
- Immediate
- Within a few hours
- Within 24h
What is considered when deciding timing of spinal cord surgery after injury?
- Deteriorating neurology
- Stable neurology
- Mechanical stability
