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#phase 2.1: msk > Cervical Spine Fractures > Flashcards

Cervical Spine Fractures Flashcards

1
Q

What is the most common spine fracture?

A

Lumbar

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2
Q

Why is the lumbar spine the most common part to have back pain? (2 things)

A
  1. Upper body loads lumbar spine region
  2. Higher mechanical stresses + strains
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3
Q

What are the possible causes of neck and back pain? (9 things)

A
  1. Degenerative Disc Disease
  2. Disc herniation
  3. Spinal stenosis
  4. Congenital anomalies
  5. Spondylolisthesis
  6. Trauma
  7. Facet-joint pain
  8. Sacro-iliac joint pain
  9. Cancer
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4
Q

What is the gold standard investigation for back pain?

A

MRI

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5
Q

When are XR and CT useful for back pain?

A

In trauma setting (e.g #s)

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6
Q

What are the treatment options for back pain? (4 things)

A
  1. Analgesia
  2. Physio
  3. Psychological pain management
  4. Spinal fusion surgery
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7
Q

In spinal fusion surgery, what is given to the patient at the expense of what?

A

Pain relief at the expense of movement

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8
Q

What is sciatica?

A

Pain in leg @ distribution of sciatic nerve

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9
Q

Is sciatica back pain or nerve root pain?

A

Nerve root pain

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10
Q

What are the causes of sciatica? (4 things)

A

Nerve root compression / irritation from:

  1. Herniated (slipped) disc
  2. Spinal stenosis
  3. Trauma – bone fragment retropulsed aka gone backwards into spinal canal)
  4. Tumour
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11
Q

What is the gold standard investigation for sciatica?

A

MRI lumbar spine

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12
Q

What is the treatment for sciatica? (2 things)

A
  1. Analgesia
  2. Remain active
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13
Q

Most sciatica resolves with X?

A

Time

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14
Q

What should be considered if there is persistent pain in sciatica, and the MRI shows dermatomal distribution of symptoms?

A

Discectomy

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15
Q

What is whiplash?

A

A flexion-extension injury to neck

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16
Q

What is whiplash caused by?

A

Sudden deceleration

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17
Q

What are the symptoms of whiplash? (3 things)

A
  1. Neck pain + stiffness
  2. Neck muscle tenderness
  3. Headaches
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18
Q

How long after an accident does it take for whiplash symptoms to develop?

A

6-12 hours

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19
Q

How is a diagnosis of whiplash made? (3 things)

A
  1. History
  2. @ exam: muscle spasm, neck tenderness, ROM
  3. Imaging not usually req
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20
Q

What is the treatment for whiplash? (3 things)

A
  1. Self limiting
  2. Analgesia
  3. Encourage normal neck movements
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21
Q

What is the purpose of the Cervical spine? (2 things)

A
  1. Supports head
  2. Provides motility
22
Q

How are C spine fractures classified in terms of region? (3 regions)

A

Type 1 = Occipital condyle + Craniocervical junction
Type 2 = C1 ring + C1/2 joint
Type 3 = C2 + C2/3 joint

(pic shows Occipital condyle)

23
Q

How are C spine fractures classified in terms of fracture type? (3 things)

A

Type A = Bony injury only
Type B = Tension band injuries
Type C = Translation injuries (dislocation)

24
Q

What is the Tension Band in the spine?

A

Group of muscles / ligaments / processes / pedicles

that maintain integrity of vertebral column

25
Q

What are the possible clinical features of a C spine fracture?

A
  1. Neck pain (doesn’t present if there are other concurrent injuries)
  2. Neuro involvement:
  • Sensory / motor deficit
  • Defected innervation to diaphragm
  • Poor vasomotor tone (determine artery pressure)
  1. Post circulation stroke (if vertebral artery injured)
26
Q

What are some different diagnosis of C spine fractures? (3 things)

A
  1. Cervical spondylosis
  2. Cervical dislocation
  3. Whiplash
27
Q

What are some named types of C spine fractures? (2 things)

A
  1. Hangman’s Fracture
  2. Odontoid Peg Fractures
28
Q

What is a Hangmans Fracture also known as?

A

Traumatic spondylolisthesis of axis

29
Q

What is a Hangmans Fracture? (2 things)

A
  1. # thru pars interarticularis of C2 bilat.
  2. Subluxation (partial dislocation) of C2 onto C3
30
Q

What is a Hangmans Fracture caused by?

A

Cervical hyperextension (getting hung by a noose innit)

31
Q

What is required if a Hangmans Fracture is unstable?

A

Surgical fixation

32
Q

What is a common cause of Odontoid peg fractures?

A

Low impact injury in elderly

33
Q

Can Odontoid peg fractures be fatal?

A

Yeah, esp w significant displacement of odontoid

34
Q

Those who survive Odontoid peg fractures have no X?

A

Neurology

35
Q

What rules determine if a pt needs imaging for C spine fracture?

A

Canadian C spine rules

36
Q

Who qualifies to even be considered by the Canadian C spine rules? (2 things)

A
  1. Glasgow Coma scale 15/15
  2. Stable condition
37
Q

Who does the Canadian C spine rules say needs imaging? (3 things)

A
  1. 65+ yrs
  2. Dangerous mechanism
  3. Paraesthesia in extremities
38
Q

Who does the Canadian C spine rules say does NOT need imaging? (5 things)

A
  1. Simple-rear end motor vehicle collision
  2. Waiting in sitting position
  3. Ambulatory at any time
  4. Delayed onset neck pain
  5. Absence of midline C spine tenderness
39
Q

If Canadian C spine rules say someone does not need imaging, what should be done instead?

A

ROM assessment

40
Q

What scans does Canadian C spine rules say should be done for adults vs children?

A 
CT = adults 
MRI = children
41
Q

How should a patient w sus C spine fracture be managed?

A

Per ATLS guidelines, including: 3-point C-spine immobilisation

42
Q

Why should movement of the spine be restricted in a sus C spine fracture?

A

To prevent spinal cord damage cah movement at level of unstable # can cause neurological defect

43
Q

What are the indications for NON-operative management of C spine fractures? (2 things)

A
  1. Stable #s
  2. Pt in which surgiacal intervention is risky
44
Q

What are the non-operative management options of C spine fractures? (3 things)

A
  1. Rigid collars
  2. Halo vests
  3. Traction devices
45
Q

What are Rigid collars used for in non-operative management of C spine fractures?

A

Immobilisation of C spine # extrication + initial assessment

46
Q

What are Halo vests used for in non-operative management of C spine fractures?

A

When more rigid support is needed
Non-operative Unstable C spine #s

47
Q

What is a Halo vest (non-operative management of C spine fractures)? (3 steps)

A
  1. Pins placed in outer table of skull under local
  2. Pins connected to Halo device
  3. Device mounted on thoracic brace
48
Q

When are Traction devices used as definitive treatments for in non-operative management of C spine fractures? (2 things)

A
  1. When surgical treatment risky
  2. When # reduction required (e.g facet joint dislocation)
49
Q

What is the indication for Operative management of C spine fractures?

A

Unstable #

50
Q

What are the Operative management options for C spine fractures? (2 things)

A
  1. Fusion
  2. Stabilisation
51
Q

What is the Fusion operation for C spine fractures? (2 things)

A
  1. Fusing injured segment of spine to uninjured segments above + below
  2. +/- decompression of vertebral canal
52
Q

What is the Stabilisation operation for C spine fractures?

A

Fragments fixated using pedicle screws and rods

(Patient lying prone)

#phase 2.1: msk (15 decks)

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