Cortex - Adult trauma (spinal fractures/spinal cord injuries) - 4th year core stuff so don't think i really need to know it) Flashcards
What is the common mechanism of C-spine fractures ?
They are commonly high energy injuries (RTA, fall from height)
What criteria must be met for the C-spine to be cleared in the acute management of someone with a suspected C-spine injury ?
ALL of the following criteria must be satisfied:
- No history of loss of consciousness
- GCS 15 with no alcohol intoxication
- No significant distracting injury (such as head injury, chest trauma or other fractures including more distal spinal fractures)
- No neurological symptoms in the upper or lower limbs
- No midline tenderness on palpation of the c-spine
- No pain on gentle active neck movement (ask the patient to gently flexed forward, then rotate to each side)
If there is any doubt over any of these criteria when clinically clearing the C-spine, the c-spine cannot be clinically cleared and the collar must stay in situ.
What then must be done before the spine can be cleared?
Further imaging in the form of X‐Rays (AP & lateral views +/‐ odontoid peg open mouth view) or CT scan of the c‐spine is required so that a c-spine injury can be radologically cleared.
What assessment should any suspected C-spine injury undergo?
A full trauma assessment (ABCD) and a full neurological examination including:
- peripheral motor function
- coarse touch sensation
- upper & lower limb reflexes
- cranial nerve evaluation
- rectal examination, and
- assessment of bulbocavernous reflex.
How are C-spine injuries treated acutely and then long-term ?
Acutely - immobilization with a hard collar and sand bags or blocks on a spinal board
Long-term:
- Stable can be treated in a firm cervical collar.
- Unstable injuries may require immobilization in a “halo vest” or surgical stabilization including fusions, wiring or internal fixation
What are the 2 main ways in which thoracolumbar spinal fractures occur ?
- Majority of thoracolumbar spine fractures occur due to motor vehicle accidents or falls from a height
- Can also be due to osteoporosis/osteoporotic “wedge” insufficiency fractures in the elderly (these don’t usually require treatment)
What are throacolumbar injuries often associated with ?
Neurological deficit - 15-20% of the time
What type of fractures do most thoracolumbar spine injuries caused by osteoporosis tend to be ?
Wedge/compression fractures
What type of fractures do most thoracolumbar spine injuries caused by high energy injuries tend to be ?
‘Burst’ or “Chance” flexion‐distraction fractures
What is the treatment of throacolumbar spinal fractures ?
- If stable then a brace or plaster jacket
- If neurological deficit or unstable then surgery - may involve stabilization with pedicle screws and rods, spinal fusion and decompression (creation of space around the cord or nerve roots) in the presence of a neurologic deficit.
Define what central cord syndrome is
- Most common injury pattern of the spinal cord
- Commonly occurring due to hyperextension injury in a cervical spine with OA
- Paralysis of the arms more than the legs
Define what anterior cord syndrome is in terms of spinal cord injury
Loss of motor function (corticospinal tracts) as well as loss of coarse touch, pain and temperature sensation (lateralspinothalamic tract) whilst proprioception, vibration sense and light touch are preserved (dorsal columns).
What is posterior cord syndrome ?
Spinal cord injury with loss of dorsal column function (proprioception, vibration sense and light touch) it is rare.
Define what Brown‐Sequard syndrome following a spinal cord injury is
Ipsilateral paralysis and loss of dorsal column sensation occurs with contralateral loss of pain, temperature and coarse touch sensation.
