C spine Lecture Flashcards
abt how many pts receive spinal immobilization each year
5 million
what percentage of cervical fractures are males?
and what % involve ETOH?
80% males
25% involve ETOH
True or False..
Increased risk of cervical fractures are seen in older pts, pts with RA, down syndrome or on chronic steroid therapy
True
MC site for vertebral fracture?
cervical (55% of spinal injuries)
thoracic, thoracolumbar jxn, lumbar are each 15%
fracture of bony elements, dislocation at one or more joints, tearing of ligaments, disruption of discs—force + flexion, extension, rotation, compression
primary fracture
minutes to hours after injury—incompletely understood, ischemia, hypoxia, inflammation, edema
Secondary fracture
First steps in management of spinal injury? then what?
First…ABCD (airway, breathing, circulation, disability)
Then.. gross motor, senstation and reflexes
*no posterior midline c-spine tenderness
*no evidence of intoxication
*normal level of alertness
*no focal neuro deficits
*no painful distracting injuries
all patients with trauma should get c-spine radiography unless they meet how many of the above criteria?
ALL criteria must be met to avoid getting c-spine radiography
is pt awake and alert?
any neuro deficits?
any major distracting injuries?
midline neck pain?
if no to all..?
if yes to any..?
No to all…can take off collar. no imaging needed
If yes to any..C spine plain films or CT
3 views needed for c-spine films?
Long AP
Lateral (must include T1)
Open mouth
Where is the injury…
loss of spontaneous breathing
C4
Where is the injury…
loss of shoulder shrug
C5
Where is the injury…
loss of flexion at elbow, biceps reflex
C6
Where is the injury…
loss of extension at elbow, triceps reflex
C7
Where is the injury…
loss of flexon at fingers
C8/T1
Where is the injury…
Loss of intercostal muscle and abdominal use
T1/T2
70% of detectable c-spine abnormalities will be visible in what view?
lateral view
image of choice for “low risk” c-spine pts?
image of choice or high risk?
low risk…plain films
high risk..CT
C1 fracture
VERY UNSTABLE
Caused by axial loading (ie diving)
Jefferson fx
More than 1/2 of all C2 fractures
VERY unstable
Odontoid fxs
C2 fracture caused by MVAs, falls, crashes
caused by force hyperextension of neck
Unstable bu opens spinal canal
These pts may walk in
Hangman’s fx
Fracture of the upper part of the odontoid peg (c2)
*rare, potentially unstable
Odontoid Type 1 Fracture
Fracture at the base of the odontoid
*unstable
**has high risk of non-union
Odontoid type II fracture
Through the odontoid and into the lateral masses of C2
**best prognosis for healing
Type III Odontoid Fracture
Fractures of the spinous process of a lower cervical vertebra (usually C7)
*usually a sress fracture
Clay-shoveler fracture
Complete paralysis below lesion
Loss of pan and temperture sensation
*No loss in proprioception or vibratory sensation
BAD prognosis!
Anterior cord syndrome
Quadriparesis that is worse in upper extremities
Some pain and temperature sensation loss (worse in upper than lower)
Good prognosis
Central cord syndrome
Ipsilateral spastic paresis
Loss of vibratory and proprioception
Loss of contralateral pain and temperature sensation
Good prognosis
Brown Sequard Syndrome
