Applied Spinal Trauma

Question 1

What vertebral levels are the spinal cord, conus medullaris and cauda equina between?

Answer 1

• SC = C1-T12
• CM = T12-L1
• CE = L2-sacrum

Question 2

What is a radiculopathy?

Answer 2

Spinal root injury

Question 3

What is a myelopathy?

Answer 3

Spinal cord injury

Question 4

What is quadriplegia?

Answer 4

Loss of function in upper and lower limbs

Question 5

What is paraplegia?

Answer 5

Loss of function in lower limbs

Question 6

What is paraparesis?

Answer 6

Weakness due to cord/root compression

Question 7

What does neural compression above C4 cause?

Answer 7

Loss of ventilation

Question 8

What does neural compression at C5 cause?

Answer 8

Quadriplegia

Question 9

What does neural compression at C5-T1 cause?

Answer 9

Decreasing arm function

Question 10

What does neural compression at T1-L1 cause?

Answer 10

Paraplegia

Question 11

What does neural compression at L2-5 cause?

Answer 11

Decreasing leg function

Question 12

What does neural compression L5 and below cause?

Answer 12

• Impaired sphincter + sexual function
• Foot + ankle weakness

Question 13

What does compression of the conus medullaris cause?

Answer 13

• Flaccid paresis/paralysis
• Absent reflexes
• Absent plantar response
• Autonomous neurogenic bladder
• Impotence

Question 14

What does cauda equina compression cause?

Answer 14

• Radicular weakness
• Muscle wasting + fasciculation
• Decreased tone + loss of reflexes
• Autonomous dribbling bladder
• Impotence

Question 15

Initial assessment for spinal trauma

Answer 15

• ATLS protocol
• Airway + C-spine control
• Breathing
• Circulation (hypovolaemic vs neurogenic shock)

Question 16

What symptoms increase suspicion of spinal trauma?

Answer 16

• Mechanism of injury
• Blunt trauma above clavicle
• Facial fractures
• Altered consciousness
• Ankylosing spondylitis

Question 17

What means you should suspect a spinal cord injury?

Answer 17

• Flaccid areflexia
• Loss of anal tone
• Priapism
• Spinal shock + the bulbo cavernosus reflex

Question 18

How do you clear the C-spine of an alert patient?

Answer 18

• 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

Question 19

How do you clear the C-spine of a non-cooperative patient?

Answer 19

• All have C-spine series
• If normal - retain collar until cooperative or MRI

Question 20

Systemic approach for assessing radiographs

Answer 20

• A = adequacy and alignment
• B = bony abnormality
• C = contours + cartilage
• D = disc spaces

Question 21

Types of spinal fracture

Answer 21

• Wedge compression
• Flexion distraction
• Burst fracture
• Fracture dislocation

Question 22

Types of primary spinal cord injury

Answer 22

• Contusion
• Compression
• Traction
• Shear

Question 23

Types of secondary spinal cord injury

Answer 23

• Hypotension
• Hypoxia
• Oedema
• Ischaemia

Question 24

Treatment of a spinal cord injury

Answer 24

• Primary immobilisation
• Assessment of stability
• Assessment of neurological compromise
• Start a plan for long-term rehab

Question 25

Options of timing of spinal cord surgery after injury

Answer 25

• Immediate
• Within a few hours
• Within 24h

Question 26

What is considered when deciding timing of spinal cord surgery after injury?

Answer 26

• Deteriorating neurology
• Stable neurology
• Mechanical stability