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Y4R4 - Surgery II 👨‍⚕️ > L9: Spinal Trauma > Flashcards

L9: Spinal Trauma Flashcards

1
Q

Anatomy of Vertebral Column

A
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2
Q

Anatomy of Vertebral Column

  • Lordosis in ….
A
  • Cervical & Lumbar
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3
Q

Anatomy of Vertebral Column

  • Kyphosis in ……..
A

Thoracic & Sacral

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4
Q

Cervical Vertebra

  • Characters
A
  • Vertebral bodies (lesser weight bearing).
  • Extensive joint surfaces allow greater Range of Movement “ROM”
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5
Q

Cervical Vertebra

  • Movements allowed
A
  • Rotation
  • Flexion
  • Extension
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6
Q

Thoracic Vertebra

  • Characters
A
  • Rib bearing vertebrae.
  • Designed to remain stiff
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7
Q

Thoracic Vertebra

  • Movements allowed
A
  • Minimal Flexion & Extension
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8
Q

Lumbar Vertebra

  • Characters
A
  • Weight-bearing vertebrae
  • Houses cauda equine
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9
Q

Lumbar Vertebra

  • Movements allowed
A

Minimal Rotation

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10
Q

Sacral Vertebra

  • Characters
A

Transmits weight of body to the pelvis

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11
Q

Sacral Vertebra

  • Movements Allowed
A

No Motion

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12
Q

Spinal nerve roots Exit through the intervertebral foramen …….

  • C1- C7
A

Above

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13
Q

Spinal nerve roots Exit through the intervertebral foramen …….

  • C8 - S5
A

Below

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14
Q

Spinal cord ends below lower border of …..

A

L1.

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15
Q

What is cauda equina formed of?

A
  • Formed by lumbosacral nerve root in the spinal canal before exiting.
  • Cauda equina is below L1.
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16
Q

Level of Cauda Equina

A
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17
Q

if the vertebra level is ……, Then the cord Level is ……

A
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18
Q

if the vertebra level is C2 - C7, Then the cord Level is ……

A

Add 1+

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19
Q

if the vertebra level is T1 - T6 , Then the cord Level is ……

A

Add 2+

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20
Q

if the vertebra level is T7 - T9, Then the cord Level is ……

A

Add 3+

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21
Q

if the vertebra level is T 10, Then the cord Level is ……

A

L1, L2

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22
Q

if the vertebra level is T11, Then the cord Level is ……

A

L3, L4

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23
Q

if the vertebra level is T12, Then the cord Level is ……

A

L5

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24
Q

if the vertebra level is L1, Then the cord Level is ……

A

Sacrococcygeal Segments

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25
Q

Spinal Cord Nucleui

A

Spinal nerve cells: ventral (motor), dorsal (sensory):

  • Sensory cells in dorsal horn.
  • Motor cells in Ventral horn.
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26
Q

Mid Dorsal Spinal Cord & Neural Canal Space

A

Complete Lesion

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27
Q

Neurlogical Recovery in cauda equina

A

Unpredictable

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28
Q

Denis Column Model

A
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29
Q

Denis Column Model

  • Anterior Column
A
  1. Anterior longitudinal ligament.
  2. Anterior annular ligament.
  3. Anterior half of VB.
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30
Q

Denis Column Model

  • Middle Column
A
  1. Posterior long. Lig.
  2. Posterior annular ligament.
  3. Posterior half of VB.
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31
Q

Denis Column Model

  • Posterior Column
A
  1. Ligamentum flavum.
  2. Superior & Interspinous lig.
  3. Intertransverse capsular lig.
  4. Neural arch.
  5. Pedicle & spinous process.
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32
Q

What is an Unstable Fracture?

A

Middle column
+
either anterior or Posterior column is damaged.

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33
Q

Rupture of interspinous ligament

  • Characters
A
  • Associated with avulsion of spinous process.
  • Unstable spin
  • Further flexion → increase neurological injury
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34
Q

Mechanisms (Causes) of Spinal Trauma

A
  • Direct Injury
  • Indirect Injury
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35
Q

Mechanisms (Causes) of Spinal Trauma

  • Direct Injury
A
  • Penetrating injuries to the spine: e.g., firearms and knives.
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36
Q

Mechanisms (Causes) of Spinal Trauma

  • Indirect Injury
A
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37
Q
  • Most common cause of significant spinal damage.
A

Indirect njury

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38
Q
  • Most important spinal cord injury indicator is the ……
A

Mechanism

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39
Q

When to suspect Spinal Injury?

A
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40
Q

Sites of spinal cord injury

A
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41
Q

Injuries of the vertebral column tend to cluster in …….

A
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42
Q

Neurological level is at ……

A

lowest segment with normal motor & sensory function.

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43
Q

Why is level of spinal injury level hard to determine?

A
  1. Muscles receive motor nerve supply from more than one level.
  2. Dermatomes have imprecise boundaries.
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44
Q

Dx of Spinal Injury

A
  • Clinically
  • Radiologically
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45
Q

Dx of Spinal Injury

  • Clinically
A
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46
Q

Dx of Spinal Injury

  • Inspection & Palpation
A

Occiput to Coccyx

A. Tenderness.
B. Gap or Step.
C. Edema and bruising.
D. Spasm of associated muscles.

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47
Q

Dx of Spinal Injury

  • Neurological Assessment
A

A. Sensation.
B. Motor function.
C. Reflexes.
D. Rectal examination.

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48
Q

Sensory Assessment in Spinal Trauma

  • C5
A
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49
Q

Sensory Assessment in Spinal Trauma
- C6

A
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50
Q

Sensory Assessment in Spinal Trauma
- C7

A
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51
Q

Sensory Assessment in Spinal Trauma
- C8

A
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52
Q

Sensory Assessment in Spinal Trauma

  • T1
A
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53
Q

Sensory Assessment in Spinal Trauma

  • T3
A
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54
Q

Sensory Assessment in Spinal Trauma

  • T4
A
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55
Q

Sensory Assessment in Spinal Trauma

  • T8
A
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56
Q

Sensory Assessment in Spinal Trauma

  • T10
A
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57
Q

Sensory Assessment in Spinal Trauma

  • T12
A
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58
Q

Sensory Assessment in Spinal Trauma

  • L2
A
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59
Q

Sensory Assessment in Spinal Trauma

  • L3
A
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60
Q

Sensory Assessment in Spinal Trauma

  • L4
A
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60
Q

Sensory Assessment in Spinal Trauma

  • L5
A
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61
Q

Sensory Assessment in Spinal Trauma

  • S1
A
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62
Q

Sensory Assessment in Spinal Trauma

  • S2
A
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63
Q

Sensory Assessment in Spinal Trauma

  • S3
A
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64
Q

Sensory Assessment in Spinal Trauma

  • Grading
A
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65
Q

Motor Assessment in Spinal Trauma

A
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66
Q

Motor Assessment in Spinal Trauma

  • C5
A

Deltoids / biceps

67
Q

Motor Assessment in Spinal Trauma

  • C6
A

Wrist extensors

68
Q

Motor Assessment in Spinal Trauma

  • C7
A

Elbow extensors

68
Q

Motor Assessment in Spinal Trauma

  • C8
A

Finger flexors

68
Q

Motor Assessment in Spinal Trauma

  • T1
A

Finger Abductors

68
Q

Motor Assessment in Spinal Trauma

  • L2
A

Hip flexors

69
Q

Motor Assessment in Spinal Trauma

  • L3
A

Knee extensors

70
Q

Motor Assessment in Spinal Trauma

  • L4
A
  • Knee extensors
71
Q

Motor Assessment in Spinal Trauma

  • L5
A
  • Ankle Dorsiflexion
  • Long toe extensors
72
Q

Motor Assessment in Spinal Trauma

  • S1
A
  • Ankle Plantar Reflex
  • Long Toe Plantar Reflex
73
Q

Motor Assessment in Spinal Trauma

  • Grading
A
74
Q

Rectal Assessment in Spinal Trauma

A
75
Q

Rectal Assessment in Spinal Trauma

  • Tone
A

the presence of rectal tone in itself does not indicate an incomplete injury.

76
Q

Rectal Assessment in Spinal Trauma

  • sensation
A

….

77
Q

Rectal Assessment in Spinal Trauma

  • Bulbocavernous Reflex
A
78
Q

Stimulus for Bulbocavernous Reflex

A
  • Squeezing the glans penis or clitoris.
  • Tugging on an indwelling Foley catheter
79
Q

Center of Bulbocavernous Reflex

A

S2 - S4

80
Q

Response of Bulbocavernous Reflex

A

Anal Sphincter Contraction

81
Q

Significance of Present Bulbocavernous Reflex

A
82
Q

Significance of Absent Bulbocavernous Reflex

A
83
Q

Sacral Sparing in complete Spinal Cord Injury

  • Right or Wrong?
A

Wrong, Absence of sensory and motor functions in the lowest sacral segments.

84
Q

How to Evaluate Sacral Sparing?

A
85
Q

Sacral Sparing in Incomplete Spinal Cord Injury

  • Right or Wrong?
A
  • Preservation of sensory or motor function below the level of injury, including the lowest sacral segments
86
Q

Sacral sparing may include the triad of

A
  1. Perianal sensation.
  2. Rectal tone.
  3. Great toe flexion.
87
Q

Recoveryt of Spinal Shock

A

Lasts even days till reflex neural arcs below the level recovers.

87
Q

CP of Spinal Shock

A
  1. Loss anal tone, reflexes, autonomic control within 24-72 hr.
  2. Flaccid paralysis bladder & bowel.
  3. Priapism.
  4. Lasts even days till reflex neural arcs below the level recovers.
87
Q

Def of Spinal Shock

A
  • Loss of sensation accompanied by motor paralysis with initial loss but gradual recovery of reflexes.
  • Transient physiological reflex depression of cord function
    ‘concussion of spinal cord’.
88
Q

Neurogenic Shock Causes ……

A

Hemodynamic instability.

89
Q

Neurogenic Shock

  • Etiology
A
  • Rostral cord injuries related to the loss of sympathetic tone to the peripheral vasculature and heart.
  • Lesions above D6 → Disruption of sympathetic outflow from D1-L2 → Unopposed vagal tone → Peripheral vasodilatation.
90
Q

Neurogenic Shock

  • CP
A
  • Bradycardia
  • Hypotension
  • Hypothermia
91
Q

Every patient with:

  • blunt injury above the clavicle.
  • head injury.
  • Loss of consciousness.
A

Should be considered to have a cervical spine injury until proven otherwise.

92
Q

Every patient who is involved in:
- a fall from a height.
- a high-speed deceleration accident.

A

Should similarly be considered to have a thoracolumbar injury.

93
Q

All patients with multiple injuries ……

A
  • Consider the presence of a vertebral column injury.
94
Q

Lesser injuries if they are followed by:
- Pain in the neck or back.
- Neurological symptoms in the limb.

A

Arouse Suspicion

95
Q

Degrees of Spinal Trauma

A
  • Complete
  • Incomplete
96
Q

Degrees of Spinal Trauma

  • Complete
A
  • Flaccid paralysis
  • total loss of sensory & motor functions.
97
Q

Degrees of Spinal Trauma

  • Incomplete
A

Incomplete - Mixed loss:
1. Anterior cord syndrome.
2. Posterior cord syndrome.
3. Central cord syndrome.
4. Brown Sequard’s syndrome.
5. Cauda equina syndrome.

98
Q

Etiology of Anterior Cord Syndrome

A
  • Flexion rotational force to spine.
  • Due to Compression fracture of vertebral body or anterior dislocation.
  • Anterior spinal artery compression.
99
Q

CP of Anterior Cord Syndrome

A
  • Loss of power
  • reduced pain and temperature below the lesion.
100
Q

Etiology of Posterior Cord Syndrome

A
  1. Hyperextension injuries.
  2. Posterior vertebral body fracture.
101
Q

CP of Posterior Cord Syndrome

A
  1. Loss of proprioception and vibration sense.
  2. Severe ataxia.
102
Q

Etiology of Central Cord Syndrome

A
  • Older age with cervical spondylosis.
  • Hyperextension with minor trauma.
  • Cord is compressed by osteophytes from vertebral body against thick ligamentum flavum.
  • Damages the central cervical tract.
103
Q

CP of Central Cord Syndrome

A
  1. UMN lesion to legs (spastic).
  2. LMN to arms (flaccid paralysis).

(NB: It affects Upper limbs more than lower limbs)

104
Q

Etiology of Brown Sequard Syndrome

A
  1. Hemisection of the cord
  2. Stab injury and lateral mass fractures.
105
Q

CP of Brown Sequard Syndrome

A
  • Contralateral (Uninjured) side has good power but absent pinprick and temperature 2-3 segments below the lesion.
  • Ipsilateral side has motor paralysis below the lesion.
106
Q

Spinothalamic tracts cross to opposite side of the cord 3 segments below.

A

…

107
Q

Pathophysiology in 1ry Neurological Damage

A
  • Direct trauma, haematoma and SCIWORA < 8 yrs old.
  • In 4hrs - Infarction of white matter
  • In 8hrs - Infarction of grey matter and irreversible paralysis.
108
Q

Pathophysiology in 2ry Neurological Damage

A
  1. Hypoxia.
  2. Hypoperfusion.
  3. Neurogenic shock.
  4. Spinal shock.
109
Q

SCIWORA

A

Spinal Cord Injury Without Radiographic Abnormality

110
Q

Radiological Tool of Choice in Spinal Trauma

A
111
Q

Radiological Tool of Choice in Spinal Trauma

  • Suspectimg Level
A

Suspect the level from
- Examination
- Mode of trauma.

112
Q

Radiological Tool of Choice in Spinal Trauma

  • What to Start With?
A

X-Ray

113
Q

Radiological Tool of Choice in Spinal Trauma

  • If Suspicious
A

CT

114
Q

Radiological Tool of Choice in Spinal Trauma

  • Indications of MRI
A
  1. Positive CT.
  2. high suspicion even with negative CT.
  3. Planning of surgery.
115
Q

Immobilization in Spinal Trauma

A
116
Q

Def of Whiplash Injury

A

Sudden hyperextension and flexion.

117
Q

CP of Whiplash Injury

A
  • Increasing neck pain for the first 24 hours.
  • Anterior longitudinal ligaments are torn causes dysphagia.
  • Forward flexion against resistance is painful.
118
Q

Recovery in Whiplash Injury

A

90% are asymptomatic after 2 years.

119
Q

Types of Vertebral Fractures

A
  • Compression Fractures
  • Burst Fractures
  • Seatbelt Type Fracture
  • Dislocation Fracture
120
Q

Compression Fractures

A
121
Q

Compression Fractures

  • Types
A
122
Q

Burst Fractures

  • Types
A
123
Q

Seatbelt Type Injury

A
124
Q

Dislocation Fracture

A
125
Q

Compare between Stable & Instable Injury in terms of

  • Displacment of vertebral components by normal movements
  • Risk of neural damage
A
126
Q

Treat as unstable until proven otherwise.

A

…

127
Q

Def of Spinal Instability

A
  • The loss of the ability of the spine under physiologic loads to maintain relationships between vertebrae
  • in such a way that there is neither damage nor subsequent irritation to the spinal cord or nerve roots.
128
Q

How to Suspect Spinal instability?

A
  • SLICS
  • TLICS
129
Q

SLICS

A
130
Q

SLICS

  • Morphology (Immediate Stability)
A
131
Q

SLICS

  • Discoligamentous Complex (DLC)

(Long-term Stability)

A
132
Q

SLICS

  • Neurological status
A
133
Q

SLICS

  • Interpretation
A
134
Q

TLICS

  • Morphology (Immediate Stability)
A
135
Q

TLICS

  • Posterior Ligamentous Complex (PLC)

(Integrity Long-term stability)

A
136
Q

TLICS

  • Neurological Status
A
137
Q

TLICS

  • Interpretatiion
A
138
Q

Objectives of Defenitive TTT of Spinal Trauma

A
  1. To preserve neurological function.
  2. To stabilize the spine.
  3. To rehabilitate the patient.
139
Q

indications for urgent surgical stabilization in spinal Trauma

A
  • An unstable fracture with Progressive neurological deficit

and/or

  • MRI signs of likely further neurological deterioration.
140
Q

Emergency TTT in Spinal Trauma

A
141
Q

Emergency TTT in Spinal Trauma

  • ABCDE
A

…

142
Q

Emergency TTT in Spinal Trauma

  • Methylpednisolone
A

Loading:
- 30mg/kg iv bolus over 15 min immediately.

Maintainence:
- 5.4 mg/kg/h infusion over 23 hrs.

143
Q

Acute Management of Spinal Cord Injury

A
  • Immobilization
144
Q

Emergency TTT in Spinal Trauma

  • Immobilization
A

Cervical & Thoracolumbar

145
Q

Emergency TTT in Spinal Trauma

  • Cervical Immobilization
A
146
Q

Indications of Cervical Immobilization

A
  • Known or suspected cervical spine injury
  • Comatose or intoxicated at the scene of injury
147
Q

Methods of Cervical Immobilization

A
  • Cervical Orthrosis (Or Sandbags)
  • Gardber-Wells Tongs
148
Q

Methods of Thoracolumbar Immobilization

A
  • Backbord
  • Logrolling
149
Q

Thoracolumbar Immobilization

A
150
Q

Objectives (Indications) of surgical Intervention in Spinal Trauma

A
  1. Stabilization of fractures not likely to heal.
  2. Decompression of neural elements.
  3. Early mobilization:
151
Q

Objectives (Indications) of surgical Intervention in Spinal Trauma

  • Stabilization
A

of fractures not likely to heal.

152
Q

Objectives (Indications) of surgical Intervention in Spinal Trauma

  • Decompression
A

of neural elements.

153
Q

Objectives (Indications) of surgical Intervention in Spinal Trauma

  • Early Mobolization
A
154
Q

Early surgical stabilization of the unstable spine may help to ……

A

A. Prevent prolonged bed rest complications (atelectasis, pneumonia, DVT, etc.)

B. It also allows the patient to begin rehabilitation earlier.

155
Q

Surgical Intervention in Spinal Trauma

  • techniques
A
156
Q

Surgical Intervention in Spinal Trauma

  • Fusion
A

…

157
Q

Surgical Intervention in Spinal Trauma

  • Internal Fixation
A

(instrumentation).
* Internal fixation is not a substitute for fusion.

  • Screws, hooks, cages.
158
Q

Surgical Intervention in Spinal Trauma

  • Decompression
A

of spinal canal

(Laminectomy)

159
Q

Done

A

…

Y4R4 - Surgery II 👨‍⚕️ (33 decks)

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