L13: Neck trauma and spinal injury

Question 1

Significance of C1 Vertebrae?

What passes above?

Answer 1

Holds up the skull

NO Vertebral Body (Ring)

Vertebral arteries travel through forman to supply hindbrain

Passes above:

• First Cervical Nerve
• Third part of vertebral artery

Question 2

Atlantoaxial instability common in Down’s syndrome?

Answer 2

Occipitalization of Atlas (0.5% of the population)

Question 3

Fracture impacting C1 => Anterior and Posterior Arch Disrption?

Answer 3

Jefferson’s Burst fracture

caused by axial load => diving into swimming pool that is too shallow

Question 4

C1 versus C2

Answer 4

Question 5

Fracture impacting C2 => fracture of the pedicle

Answer 5

Hangman’s Fracutre

Extension Injury

Question 6

What is the rule of thirds?

Answer 6

Rule of thirds states that the area inside the atlas is equally occupied in thirds by the dens, spinal cord, and space.

Question 7

What type of injury leads to fracture of the Odontoid Process (Dens)?

Answer 7

Question 8

What type of injury is this?

Answer 8

Type I Flexure Injury of Odontoid Process (Dens)

Question 9

What type of injury is this?

Answer 9

Type II Flexure Injury of Odontoid Process (Dens)

Most common- DIFFIFULT
requires surgery as it disrupts blood flow

Question 10

What type of injury is this?

Answer 10

Type III Flexure Injury of Odontoid Process (Dens)

Question 11

Answer 11

Question 12

Answer 12

Question 13

What can often look like a fracture on a vertebral XRAY?

Answer 13

Basi vertebral veins

Differentiated as they change direction dramatically when looking at different slice

Question 14

Answer 14

Question 15

Answer 15

Question 16

What gives rise to anterior cord syndrome?

Answer 16

Anterior spinal artery occlusion (Only 1 Artery)

Question 17

_________ transmitted in dorsal columns

_________ fibers enter from the BACK on one side and cross before ascending

Swelling of the central canal can disturb _______________ fibers (BOTH sides lost)

Answer 17

Touch transmitted in dorsal columns

Pain/Temperature fibers enter from the BACK on one side and cross before ascending

Swelling of the central canal can disturb pain/temperature fibers (BOTH sides lost)

Question 18

What is this syndrome and what are the consequences of this injury?

Answer 18

Anterior Cord Syndrome

Sensation is preserved (Touch transmitted in dorsal column and is not damaged)

Descending motor control system removed:

• Level of Lesion = Lower motor outputs
• Increase in discharge of secondary motor neurons below injury

Question 19

What is this syndrome and what are the consequences of this injury?

Answer 19

Central Cord Syndrome

The cord is squeezed between ligamentum flavum and discs resulting in a central cord bleed.

Upper limbs more likely to be affected than lower limbs!!

Question 20

What is this syndrome and what are the consequences of this injury?

Answer 20

Brown Sequard (Hemi-Cord)

Common amongst sugarcane farmers of Mauritius

Symptoms:

• Level of Injury: Flaccid Paralysis
• Ipsilateral: Spastic Paralysis/Loss of Touch
• Contralateral: Loss of Pain and Temperature (Fibers cross spinal cord anteriorly)

Question 21

Cauda Equina vs. Conus Medullaris Syndromes

Answer 21

Cauda Equina: Herniated disk usually affects one side, muscles lose tone:

• NO UPPER motor neuron signs as it is below the chord
• Saddle parenthesis: From sitting on horses (loss of bowel)

Connus Medullaris (L1): Bilateral, upper limb efects possible

Question 22

Most common site of disc herniation?

Consequences?

Answer 22

Cauda Equina: Herniated disk usually affects one side, muscles lose tone:

• NO UPPER motor neuron signs as it is below the chord
• Saddle parenthesis: From sitting on horses (loss of bowel)