Ch 7 - SCI: Spinal Pathology

Question 1

What is the MOI of cervical compression fractures?

Answer 1

Cervical flexion with axial loading ruptures the plates of the vertebra and
compresses the body

Question 2

What is the most common cervical compression fracture?

Answer 2

C5

Question 3

What is seen on xray in cervical compression fractures?

Answer 3

Anterior wedge-shaped appearing vertebra

Question 4

What is the MOI of cervical unilateral facet joint dislocations?

Answer 4

Cervical flexion-rotation injury

Question 5

When are cervical facet joint dislocations considered unstable?

Answer 5

Posterior longitudinal ligament (PLL) is disrupted

Question 6

What is seen on xray in unilateral facet joint dislocations?

Answer 6

Vertebral body <50% displace

Question 7

What is the most common level in unilateral and bilateral facet joint dislocations?

Answer 7

C5–C6

Question 8

What is the MOI of cervical bilateral facet joint dislocations?

Answer 8

Flexion injury

Question 9

What is seen on xray in bilateral facet joint dislocations?

Answer 9

Vertebral body >50% displaced causing significant narrowing of the spinal canal

Question 10

What is the most common level in hyperextension injuries?

Answer 10

C4-C5

Question 11

What are the MCC of non-traumatic SCI in US?

Answer 11

Spinal stenosis with myelopathy

Spinal cord tumors

Question 12

Who is MC affected by epidural abscess?

Answer 12

Diabetic and immunocompromised patients

Question 13

What is the time frame to develop Radiation myelopathy?

Answer 13

Months to years after treatment

Question 14

What is the clinical presentation of Radiation myelopathy?

Answer 14

Weakness
Loss of sensation
Sometimes Brown-Séquard-like syndrome
Prognosis for recovery is poor

Question 15

What are the majority of spinal cord tumors?

Answer 15

Metastatic in origin, and 95% of these are extradural

70% of spinal metastases occur in the thoracic spine

Question 16

What is the clinical presentation of spinal cord tumors?

Answer 16

Pain worse at night and in the supine position

Question 17

What are the MC sources of secondary spinal cord tumors?

Answer 17

Breast
Lung
Prostate

Question 18

What are the MC primary spinal cord tumors?

Answer 18

Ependymomas

Astrocytoma

Question 19

What is the order of least to most restrictive cervical orthoses?

Answer 19

Soft collar 
Philadelphia collar
SOMI brace
Four poster
Minerva brace
Halo collar

Question 20

When are complete lesions MC seen?

Answer 20

– Bilateral cervical facet dislocations
– Thoracolumbar flexion-rotation injuries
– Trans-canal gunshot wounds

Question 21

When are incomplete lesions MC seen?

Answer 21

– Cervical spondylosis (falls)
– Unilateral facet joint dislocations
– Noncanal penetrating gunshot/stab injuries

Question 22

What is a Jefferson fracture?

Answer 22

Burst fracture of the C1 ring. Usually a stable fracture with no neurological findings

Question 23

What is the MOI of a Jefferson fracture?

Answer 23

Axial loading causing fractures of anterior and posterior parts of the atlas (i.e., football spearing)

Question 24

What is the treatment of a Jefferson fracture?

Answer 24

Stable: Rigid orthosis (Halo vest)
Unstable: surgery

Question 25

What is a Hangman fracture?

Answer 25

C2 burst fracture

Question 26

What is the MOI of a Hangman fracture?

Answer 26

Usually bilateral from an abrupt deceleration injury (e.g., MVC with head hitting windshield)
Most often stable with only transient neurological findings

Question 27

What is the treatment of a Hangman fracture?

Answer 27

Stable: Rigid orthosis (Halo vest)
Unstable: surgery

Question 28

Describe a Type I Ondontoid (dens) fracture.

Answer 28

Fracture through the tip of dens

No treatment usually required

Question 29

Describe a Type II Ondontoid (dens) fracture.

Answer 29

Most common
Fracture through the base of odontoid at junction with the C2 vertebra
Treated with a Halo

Question 30

Describe a Type III Ondontoid (dens) fracture.

Answer 30

Fracture extends from base of odontoid into the body of the C2 vertebra
Treated with a Halo

Question 31

What is a Chance fracture?

Answer 31

Transverse fracture of the thoracic or lumbar spine from posterior to anterior through the spinous process, pedicles, and vertebral body

Question 32

What is the MOI of a Chance fracture?

Answer 32

Lap seat belts
Falls
Crush injury w/ acute hyperflexion of thorax

Question 33

What is the MOI of a Vertebral Body Compression fracture?

Answer 33

Axial compression with or without flexion

Question 34

What is a Dowager hump?

Answer 34

Thoracic kyphosis

Question 35

Who is Spinal Cord Injury without radiologic abnormality (SCIWORA) seen in?

Answer 35

Young children

Older adults

Question 36

What is the MOI of Spinal Cord Injury without radiologic abnormality (SCIWORA) in Children?

Answer 36

■ Traction in a breech delivery

■ Violent hyperextension or flexion

Question 37

What are predisposing factors of Spinal Cord Injury without radiologic abnormality (SCIWORA) in Children?

Answer 37

■ Large head-to-neck size ratio
■ Elasticity of the fibrocartilaginous spine
■ Horizontal orientation of the planes of the cervical facet joints

Question 38

What is the MOI of Spinal Cord Injury without radiologic abnormality (SCIWORA) in Adults?

Answer 38

■ A fall with hyperextension of the neck, leading to an acute central cord syndrome
■ Ligamentum flavum may bulge forward into the central canal and narrow the sagittal diameter as much as 50%