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Gwen - MSK > Basics of Spinal Trauma > Flashcards

Basics of Spinal Trauma Flashcards

1
Q

What is a myotome?

A

Group of muscles that a single spinal nerve root innervates. Nerve levels are associated with certain movements as seen in image attached

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2
Q

What is a dermatome?

A

An area of skin supplied by a single nerve root

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3
Q

In terms of anatomical columns of the spine, what constitutes the anterior column of the spine?

A
  • Anterior longitudinal ligament
  • Anterior annulus
  • Anterior 2/3rd’s vertebral body
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4
Q

In terms of anatomical columns of the spine, what constitutes the middle column of the spine?

A
  • Posterior 1/3 of the vertebral body
  • Posterior annulus
  • Posterior longitudinal ligament
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5
Q

In terms of anatomical columns of the spine, what constitutes the posterior column of the spine?

A

Everything posterior to the PLL

  • Pedicles
  • Facet joints and articular processes
  • Ligamentum flavum
  • Neural arch and interconnecting ligaments
  • Spinous Processes
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6
Q

What system is most commonly used to classify thoracolumbar spinal fractures?

A

McAfee Classification system

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7
Q

What is a wedge compression fracture?

A

Isolated anterior column compresson

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8
Q

What is the following fracture?

A

Wedge compression fracture

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9
Q

What is a stable burst fracture?

A

Anterior and middle column compression, but posterior column is normal

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10
Q

What type of fracture is this?

A

Burst Fracture - stable

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11
Q

What is an unstable burst fracture?

A

Anterior and middle column compression, with disrupted posterior column

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12
Q

What is the mechanism of injury of a burst fracture?

A

High-energy compressive injury (axial loading) - IV disc is rammed into vertebral body

Typically fall from height or motor vehicle accident

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13
Q

What is the mechanism of injury of a flexion distraction fracture?

A

Axis of flexion: posterior to anterior longitudinal ligament

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14
Q

What is a flexion-distraction fracture?

A
  • Compressive failure of the anterior column while the middle and posterior columns fail in tension
    • Tensile failure of the middle column results in tear or attenuation of the posterior longitudinal ligament
    • Subluxation, dislocation or fracture of the facets can occur
  • Most varieties of this injury are potentially unstable because the ligamentum flavum, interspinous ligament, and supraspinous ligament usually are torn
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15
Q

What type of fracture is the following?

A

Burst fracture - Unstable

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16
Q

What is a Chance fracture?

A
  • Flexion-distraction type injuries of the spine that extend to involve all three spinal columns
    • The anterior and middle columns fail in compression, and the posterior column fails in distraction
    • Extend all the way through the spinal column: from posterior to anterior through the spinous process, pedicles, and vertebral body, respectively
  • Unstable injuries and have a high association with intra-abdominal injuries.
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17
Q

What type of fracture is the following?

A

Flexion distraction injury

18
Q

What type of fracture is the following?

A

Chance fracture

19
Q

What are translational spinal fractures?

A
  • All three columns have failed in shear
  • Displacement in the transverse plane with alignment disruption of the spinal canal
20
Q

What is the mechanism of injury of a chance fracture?

A

Flexion about an axis anterior to the anterior longitudinal ligament - e.g. seatbelt in a car crash

21
Q

What type of fracture is the following?

A

Translational fracture

22
Q

What types of thoracolumbar injuries fall under the category of tranlational fractures?

A

Rotational fracture-dislocations and pure dislocations

23
Q

What criteria does a fracture have to meet to be classified as unstable?

A

Any one of:

  • > 30o kyphosis
  • > 50 % loss of vertebral height
  • Both columns involved
  • Pedicles splayed
24
Q

What can cause spinal injury?

A
  • Spinal fractures
  • Motor vehicle accidents
  • Falls from height
  • Sports injuries
  • Violence
  • Penetrating injuries – gunshots, stabbings
25
Q

What is spasticity?

A

Resistance to the passice movement of a limb that is maximal at the beginning of a movement and gives way as more pressure is applied (also known as clasp - knife rigidity)

Symptom of damage to the pyramidal tract in the brain or spinal cord

Usually accompanied by weakness in the affected limb

26
Q

What are the general clinical features of cervical, thoracic, lumbar and sacral injury?

A
  • Pain
  • Flaccidity, paralysis, numbness
  • Paraesthesia, paresis, weakness
  • Priapism, incontinence
  • Hypotension
  • Bradycardia
  • Vasodilatation
27
Q

What is spinal shock?

A

Loss of sensation accompanied by motor paralysis with initial loss, but gradual recovery, of reflexes, following a spinal cord injury (SCI) – most often a complete transection

Reflexes below the level of injury are depressed (hyporeflexia) or absent (areflexia), while those above the level of the injury remain unaffected

If the injury is to recover ⇒ some distal sensation and bulbo-cavernosus reflex should have occurred within 24 hours (described as an incomplete injury)

28
Q

What is neurogenic shock?

A

Trauma causes a sudden loss of background sympathetic stimulation to the blood vessels⇒ vasodilation resulting in a sudden decrease in blood pressure (secondary to a decrease in peripheral vascular resistance)

Can have slowed heart rate due to unopposed vagal activity

THIS IS LIFE THREATENING

29
Q

What symptoms would indicate neurogenic shock?

A
  • Paralysis
  • Hypotension
  • Bradycardia
30
Q

What are the initial stages of management in the treatment of a spinal injury?

A
  • ATLS - ABCDE
  • Immediate life-threatening injuries - e.g. haemorrhage
  • Immobilise spine
  • Other injuries?
  • Mechanism of injury
31
Q

What grading system is used to assess the severity of a spinal cord injury?

A

Frankel grading system

32
Q

What does frankel grade A indicate?

A

Complete paralysis

33
Q

What does frankel grade B indicate?

A

Sensory function only below level of injury

34
Q

What does frankel grade C indicate?

A

Incokmplete motor function below the level of injury

35
Q

What does frankel grade C indicate?

A

Incokmplete motor function below the level of injury

36
Q

What does frankel grade D indicate?

A

Fair to good motor function below the level of the injury

37
Q

What does frankel grade E indicate?

A

Normal function

38
Q

What is the bulbocavernous reflex?

A

Polysynaptic reflex that is useful in testing for spinal shock and gaining information about the state of spinal cord injuries (SCI)

Mediated by spinal level S2-S4

39
Q

How would you test the bulbocavernous reflex?

A

Monitor internal/external anal sphincter contraction in response to squeezing the glans penis or clitoris, or tugging on an indwelling Foley catheter

40
Q

What would an abscent bulbocavernous reflex potentially indicate?

A
  • Spinal shock
  • IF SPINAL SHOCK NOT SUSPECTED - Injury to conus medullaris or sacral nerve roots
41
Q

If the bulbocavernous reflex had returned after being absent, but motor and sensory function had not, what would this indicate?

A

Complete spinal cord injury

Gwen - MSK (28 decks)

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