Ch 7 - SCI: Spinal Pathology Flashcards
What is the MOI of cervical compression fractures?
Cervical flexion with axial loading ruptures the plates of the vertebra and
compresses the body
What is the most common cervical compression fracture?
C5
What is seen on xray in cervical compression fractures?
Anterior wedge-shaped appearing vertebra
What is the MOI of cervical unilateral facet joint dislocations?
Cervical flexion-rotation injury
When are cervical facet joint dislocations considered unstable?
Posterior longitudinal ligament (PLL) is disrupted
What is seen on xray in unilateral facet joint dislocations?
Vertebral body <50% displace
What is the most common level in unilateral and bilateral facet joint dislocations?
C5–C6
What is the MOI of cervical bilateral facet joint dislocations?
Flexion injury
What is seen on xray in bilateral facet joint dislocations?
Vertebral body >50% displaced causing significant narrowing of the spinal canal
What is the most common level in hyperextension injuries?
C4-C5
What are the MCC of non-traumatic SCI in US?
Spinal stenosis with myelopathy
Spinal cord tumors
Who is MC affected by epidural abscess?
Diabetic and immunocompromised patients
What is the time frame to develop Radiation myelopathy?
Months to years after treatment
What is the clinical presentation of Radiation myelopathy?
Weakness
Loss of sensation
Sometimes Brown-Séquard-like syndrome
Prognosis for recovery is poor
What are the majority of spinal cord tumors?
Metastatic in origin, and 95% of these are extradural
70% of spinal metastases occur in the thoracic spine
What is the clinical presentation of spinal cord tumors?
Pain worse at night and in the supine position
What are the MC sources of secondary spinal cord tumors?
Breast
Lung
Prostate
What are the MC primary spinal cord tumors?
Ependymomas
Astrocytoma
What is the order of least to most restrictive cervical orthoses?
Soft collar Philadelphia collar SOMI brace Four poster Minerva brace Halo collar
When are complete lesions MC seen?
– Bilateral cervical facet dislocations
– Thoracolumbar flexion-rotation injuries
– Trans-canal gunshot wounds
When are incomplete lesions MC seen?
– Cervical spondylosis (falls)
– Unilateral facet joint dislocations
– Noncanal penetrating gunshot/stab injuries
What is a Jefferson fracture?
Burst fracture of the C1 ring. Usually a stable fracture with no neurological findings
What is the MOI of a Jefferson fracture?
Axial loading causing fractures of anterior and posterior parts of the atlas (i.e., football spearing)
What is the treatment of a Jefferson fracture?
Stable: Rigid orthosis (Halo vest)
Unstable: surgery
What is a Hangman fracture?
C2 burst fracture
What is the MOI of a Hangman fracture?
Usually bilateral from an abrupt deceleration injury (e.g., MVC with head hitting windshield)
Most often stable with only transient neurological findings
What is the treatment of a Hangman fracture?
Stable: Rigid orthosis (Halo vest)
Unstable: surgery
Describe a Type I Ondontoid (dens) fracture.
Fracture through the tip of dens
No treatment usually required
Describe a Type II Ondontoid (dens) fracture.
Most common
Fracture through the base of odontoid at junction with the C2 vertebra
Treated with a Halo
Describe a Type III Ondontoid (dens) fracture.
Fracture extends from base of odontoid into the body of the C2 vertebra
Treated with a Halo
What is a Chance fracture?
Transverse fracture of the thoracic or lumbar spine from posterior to anterior through the spinous process, pedicles, and vertebral body
What is the MOI of a Chance fracture?
Lap seat belts
Falls
Crush injury w/ acute hyperflexion of thorax
What is the MOI of a Vertebral Body Compression fracture?
Axial compression with or without flexion
What is a Dowager hump?
Thoracic kyphosis
Who is Spinal Cord Injury without radiologic abnormality (SCIWORA) seen in?
Young children
Older adults
What is the MOI of Spinal Cord Injury without radiologic abnormality (SCIWORA) in Children?
■ Traction in a breech delivery
■ Violent hyperextension or flexion
What are predisposing factors of Spinal Cord Injury without radiologic abnormality (SCIWORA) in Children?
■ Large head-to-neck size ratio
■ Elasticity of the fibrocartilaginous spine
■ Horizontal orientation of the planes of the cervical facet joints
What is the MOI of Spinal Cord Injury without radiologic abnormality (SCIWORA) in Adults?
■ 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%
