Complications of Spine Trauma Flashcards
How many SCI patients experience at least 1 complication during initial hospitalization?
50% or more
- dependent upon ASIA grade. ASIA A, 90% have 2 complications during stay
Rates of traumatic dural injuries:
- 9-36% in lumbar spine
- 2-9% in cervical spine
Rates of vascular injury in C-spine trauma
15-30%
get imaging for any subaxial subluxation, fx through transverse foramina, craniocervical dislocations,
Patients with AS have higher complication rates because of these co-morbid conditions:
complication rate >80%!!!, mortality between 35-40%
- cardiac conduction abnormalities
- pulmonary fibrosis
- interstitial lung disease
- renal impairment from chronic NSAID use
- chest wall rigidity –> decreased thoracic expansion
- risk of increased blood loss and stiff rigid spine
Leading cause of mortality in SCI patients is:
pulmonary complications
- primary lung injury from the trauma
- secondary pulmonary compromise from decreased innervation of the diaphragm and intercostal muscles
- lost sympathetic tone causing bronchial constriction
- weak/paralyzed abdominal muscles preventing cough
Best way to prevent early vent-associated PNA and aspiration?
early tracheostomy
Should IVC filter be used for SCI patients?
not as first-line prevention given the risk profile and absence or mortality benefit
- can be used if there is a contraindication to AC (such as major surgery)
Cardiac complications of SCI:
SCI at T6 and above have highest risk of cardiovascular dysfunction
- loss of sympathetic vascular control (can cause orthostatic hypotension)… neurogenic shock
- unopposed parasympathetic input from the vagus nerve
- 2nd leading cause of death for ASIA A and B
- arrhythmia
- bradycardia
- cardiac arrest
- MI
- shock
- CHF/pulmonary edema
Gastric complications from SCI:
decreased sympathetic tone
unopposed parasympathetic tone
- high gastric and pancreatic secretions (pancreatitis)
- gastric hypomotility (GERD, aspiration)
- gut hypomotility (ileus)
