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ATLS > Chapter 7- Spine and Spinal Cord Trauma > Flashcards

Chapter 7- Spine and Spinal Cord Trauma Flashcards

1
Q

__% of patients with a spinal injury have at least mild brain injury

A

25%

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2
Q

__-% of patients with a cervical spine fracture have second noncontiguous vertebral column fracture

A

10%

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3
Q

is cervical spinal injury common in children?

A

No, seen in

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4
Q

In a patient w/o neuro deficit what else is needed to r/o spinal injury

A

no pain or tenderness along the spine
not intoxicated
no distracting injury

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5
Q

what part of the spine is most vulnerable to injury

A

cervical spine

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6
Q

at what age is a child’s spinal cord similar to an adult

A

age 12

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7
Q

are most thoracic fractures associated with spinal cord injury

A

no, most are wedge compression fractures

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8
Q

what makes up the dorsal columns

A

fasciculus gracilis

fasciculus cuneatus

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9
Q

15% of spinal injuries occur in what region

A

thoracolumbar

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10
Q

where does the spinal cord originate?

A

caudal end of the medulla oblongata at the foramen magnum and ends near L1

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11
Q

patient has no demonstrable sensory or motor function below a certain level

A

complete spinal cord injury (can’t be diagnosed w/i the first couple weeks)

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12
Q

injury where any degree of motor or sensory function remains, prognosis is better

A

incomplete spinal cord

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13
Q

where is the corticospinal tract located?

A

posterolateral segment of the cord

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14
Q

what does the corticospinal tract control

A

motor power on the same side of the body

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15
Q

how to test corticospinal tracts

A

voluntary muscle contractions or involuntary response to painful stimuli

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16
Q

where is the spinothalamic tract located

A

anterolateral aspect of the cort

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17
Q

what does the spinothalamic tract do

A

transmits pain and temp sensation from teh OPPOSITE side of the body

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18
Q

how to test spinothalamic tract

A

pinprick and light touch

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19
Q

where are the dorsal columns located

A

posteromedial aspect of the cord

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20
Q

what do the dorsal columns do

A

carry position sense (proprioception), vibration sense and some light touch form same side of the body

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21
Q

testing of dorsal columns

A

position sense in the toes/ vibratory sense

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22
Q

spinal nerve tha tinnervates perianal region

A

S4 and S5

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23
Q

innervates xiphisternum

A

T8

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24
Q

innervates medial aspect of calf

A

L4

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25
Q

innervates web space b/w 1st and 2nd toes

A

L5

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26
Q

innervates lateral border of the foot

A

S1

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27
Q

innervates symphysis pubis

A

T12

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28
Q

innervates middle finger

A

C7

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29
Q

innervates little finger

A

C8

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30
Q

INnervates thumb

A

C6

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31
Q

innervates ischial tuberosity area

A

S3

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32
Q

innervates nipple

A

T4

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33
Q

innervates area over deltoid

A

C5

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34
Q

what provides innervation to the region overlying the pectoralis muscle (cervical cape)

A

C2-C4

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35
Q

Neurogenic shock is rare in the spinal cord injury below what level?

A

T6

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36
Q

flaccidity and loss of reflexes seen after spinal cord injury

A

spinal shock (spinal cord may not be destroyed though)

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37
Q

Muscle strength score with full ROM w/ gravity eliminated

A

2

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38
Q

muscle strength score with Full ROM against gravity

A

3

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39
Q

muscle strength score for full ROM bull

A

4

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40
Q

muscle strength score for palpable or visible contraction

A

1

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41
Q

muscle strength score for total paralysis

A

0

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42
Q

Myotome for deltoid

A

C5

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43
Q

myotome for flexing wrist and fingers

44
Q

myotome for extending forearm (biceps)

45
Q

myotome for extending forearm (triceps)

46
Q

myotome for small finger abductors (abductor digiti minimi)

47
Q

Myotome for ankle plantar flexors (gastrocnemius, soleus)

48
Q

myotome for knee flexion (hamstrings)

A

L4,L5 to S1

49
Q

myotomse for hip flexors

50
Q

myotomse for knee extensors (quads, patellar reflexes)

51
Q

myotome for ankle and big toe dorsiflexors (tibilalis anterior and extensor hallucis longus)

52
Q

The 4 ways spinal cord injuries are classified

A

1- level
2- severity of neuro deficit
3- spinal cord syndromes
4- morphology

53
Q

what is the neurological level of a spinal cord injury

A

most caudal segment of the spinal cord with normal sensory and motor function on both sides.
sensory= normal sensory function
motor= normal motor function (at least 3/5)

54
Q

Injury of the first __ cervical segments of the spinal cord result in quadriplegia

55
Q

Lesions below the level of ___ result in parapelgia

56
Q

What is the bony level of injury

A

vertebra at which the bones are damaged

57
Q

why is there frequently a discrepancy b/w the bony and neurologic levels of injury

A

spinal nerves enter the spinal canal through the foramina and ascend or descend inside the spinal canal before actually entering the spinal cord. Further down more pronounced the discrepancy is

58
Q

what does incomplete paraplegia suggest

A

incomplete thoracic injury

59
Q

what does complete quadriplegia suggest

A

complete cervical injury

60
Q

any motor or sensory funciton below the level of injury constitutes what

A

an incomplete injury

61
Q

signs of incomplete injury

A

voluntary movement in LE
sacral sparing
voluntary anal sphincter contraction
voluntary toe flexion

62
Q

Does the bulbocavernosu reflex or anal wink qualify as sacral sparing

63
Q

disproportionately greater loss of motor strenght in the UE than the LE with varying degrees of sensory loss

A

central cord syndrome

64
Q

what causes central cord syndrome

A

hyperextension injury in patient with preexisiting cervical canal stenosis and hx of fall forward that resulted in facial impact

65
Q

what is thought to cause central cord syndrome

A

Due to vascular compromise of the anterior spinal artery (motor fibers topographically arranged toward center of the cord arms and hands affected more severely)

66
Q

CHaracteristic pattern of recovery with central cord syndrome

A

LE regain strength
bladder function comes back
proximal upper extremitites next
hands last

67
Q

paraplegia and dissociated sensory loss with a loss of pain and temp sensation

A

anterior cord syndrome

68
Q

what is preserved in anterior cord syndrome

A

dorsal column function (position, vibration, deep pressure sense)

69
Q

what causes anterior cord syndrome

A

infarction fo the cord in the territory supplied by the anterior spinal artery.

70
Q

what syndrome has the poorest prognosis of the incomplete injuries

A

Anterior cord syndrome

71
Q

results from hemisection fo the cord usually from penetrating trauma

A

Brown-Sequard syndrome

72
Q

What is brown sequard syndrome

A

ipsilateral motor loss (corticospinal tract)
loss of position sense (dorsal column)
associated with C/L loss of pain and temperature sensation beginning 1-2 levels below injury (spinothalamic tract)

73
Q

who should be considered to have an unstable spinal injury

A

all patient w/ radiographic evidence of injury and all those with neuro deficits

74
Q

patients with this injury die of brainstem destruction and apnea or have profound neuro impairments (ventilator dependent, quadriplegic).

A

atlanto-occipital dislocation

75
Q

waht is a commonc ause of death in cases of shaken baby syndrome

A

atlanto-occipital dislocation

76
Q

What is the most common C1 (atlas) fracture

A

Jefferson (burst fracture)

77
Q

mechanicm for atlas (C1) jefferson fracture

A

large load falls vertically on head/ patient lands on top of head in neutral position

78
Q

best way to see atlas fracure

A

open mouth view of C1 to C2 region and axial CT scans

79
Q

who is C1 rotary subluxation most often seen in

80
Q

how does C1 rotary subluxation present

A

persistent rotaiton of the head (torticollis)

81
Q

how is C1 roatry subluxation best seen

A

open-mouth odontoid view (odontoid is not equidistant form teh two lateral msses of C11)

82
Q

Largest cervical vertebrae with most unusual shape and is most susceptible to various fractures

83
Q

60% of C2 fractures involve what

A

the odontoid process (peg-shpaed bony protuberance that projects upward and is normally positioned in contact with anterior arch of C1)

84
Q

most common type of odontoid fracture

A

Type II- occur though base of the dens

85
Q

Fracture that involves the posterior elements of C2 (pars interarticularis) and is usually caused by extension like injury

A

hangman’s fracture (posterior elements fractures)

86
Q

what levels does the greatest flexion and extension of the cervical spine occur

87
Q

in adults where is the most common level of cervical certebral fracture

A

C5 (most common subluxation is C5 on C6)

88
Q

are neuro injuries high or low with facter dislocations

89
Q

what are the 4 categories of thoracic spine fractures. Which one is stable? (the other three usually require internal fixation)

A

anterior wedge compression injury (stable)
burst injury
chance fracture
fracture- dislocation

90
Q

what type fracture does axial loading with flexion produce

A

anterior wedge compression injury

91
Q

injury caused by vertical-axial compression

A

burst injury

92
Q

transverse fractures though a vertebral body cause by flexion about an axis anterior to the vertebral column. Often seen in MVAs with only lap belt

A

chance fractures

93
Q

who are at risk for thoracolumbar junction fractures

A

people who fall form a height and restrained drivers who sustain severe flexion energy transfer

94
Q

Injury to what level of the cord commonly results in bladder and bowel dysfunction and decreased sensation and strength in LE

A

Level of L1

95
Q

what type fractures are particularly vulnerable to rotational movement

A

thoracolumbar fractures

96
Q

is complete neuro deficit more or less likely with lumbar fractures

A

Less likely since onlyt he cauda equina is involved

97
Q

3 type of fractures that are more likely to result in blunt carotid and vertebral vascular injuries

A

C1-C3 fracture
cervical spine fracture w/ subluxation
fractures involving foramen transversarium

98
Q

who is cervical spine radiography indicated in

A 
all trauma patients with
midline neck pain
tenderness on palpation
neuro deficits referable to cervical spine
ALOC
distracting injury
99
Q

Preferable screening modality for cervical spine injury

A

axial CT from occiput to T1 with sagittal and coronal reconstructions

100
Q

what must been seen on a lateral cervical x-ray to be acceptable

A

all 7 cervical vertebrae and 1st thoracic vertebrae (if not all seen then swimmer’s view of lwoer cervical and upper thoracic area needed)

101
Q

what to do for patients with neck pain and normal films

A

evaluate by MRI or flexion/ extension x-ray films OR

semirigid cervical color for 2-3 weeks

102
Q

____ % of patients with a cervical spine fracture have a second, noncontiguous vertebral column fracture

A

ten percent

so do a full x-ray screening on entire spine in patients with cervical spine fracture

103
Q

patients with neurogenic shock typically have what type heart rate

A

bradycardia

104
Q

vasopressors that are recommended in neurogenic chock

A

Phenylephrine hydrochloride, dopamine, norepi

105
Q

cervical spine injures above ___ can result in partial or total loss of respiratory function

ATLS (6 decks)

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