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Surgery II - OSCE > L9: Spinal Trauma > Flashcards

L9: Spinal Trauma Flashcards

1
Q
A
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2
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A
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3
Q

Spinal nerve roots Exit through the intervertebral foramen …….

  • C1- C7
A

Above

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4
Q

Spinal nerve roots Exit through the intervertebral foramen …….

  • C8 - S5
A

Below

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5
Q

Spinal cord ends below lower border of …..

A

L1.

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6
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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7
Q

Level of Cauda Equina

A
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8
Q

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

A
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9
Q

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

A

Add 1+

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10
Q

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

A

Add 2+

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11
Q

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

A

Add 3+

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12
Q

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

A

L1, L2

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13
Q

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

A

L3, L4

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14
Q

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

A

L5

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15
Q

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

A

Sacrococcygeal Segments

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16
Q

Denis Column Model

A
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17
Q

Denis Column Model

  • Anterior Column
A
  1. Anterior longitudinal ligament.
  2. Anterior annular ligament.
  3. Anterior half of VB.
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18
Q

Denis Column Model

  • Middle Column
A
  1. Posterior long. Lig.
  2. Posterior annular ligament.
  3. Posterior half of VB.
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19
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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20
Q

What is an Unstable Fracture?

A

Middle column
+
either anterior or Posterior column is damaged.

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21
Q

Rupture of interspinous ligament

  • Characters
A
  • Associated with avulsion of spinous process.
  • Unstable spin
  • Further flexion → increase neurological injury
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22
Q

Mechanisms (Causes) of Spinal Trauma

A
  • Direct Injury
  • Indirect Injury
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23
Q

Mechanisms (Causes) of Spinal Trauma

  • Direct Injury
A
  • Penetrating injuries to the spine: e.g., firearms and knives.
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24
Q

Mechanisms (Causes) of Spinal Trauma

  • Indirect Injury
A
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25
Q

When to suspect Spinal Injury?

A
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26
Q

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

A
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27
Q

Sensory Assessment in Spinal Trauma

  • C5
A
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28
Q

Sensory Assessment in Spinal Trauma
- C6

A
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29
Q

Sensory Assessment in Spinal Trauma
- C7

A
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30
Q

Sensory Assessment in Spinal Trauma
- C8

A
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31
Q

Sensory Assessment in Spinal Trauma

  • T1
A
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32
Q

Sensory Assessment in Spinal Trauma

  • T3
A
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33
Q

Sensory Assessment in Spinal Trauma

  • T4
A
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34
Q

Sensory Assessment in Spinal Trauma

  • T8
A
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35
Q

Sensory Assessment in Spinal Trauma

  • T10
A
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36
Q

Sensory Assessment in Spinal Trauma

  • T12
A
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37
Q

Sensory Assessment in Spinal Trauma

  • L2
A
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38
Q

Sensory Assessment in Spinal Trauma

  • L3
A
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39
Q

Sensory Assessment in Spinal Trauma

  • L4
A
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40
Q

Sensory Assessment in Spinal Trauma

  • L5
41
Q

Sensory Assessment in Spinal Trauma

  • S1
42
Q

Sensory Assessment in Spinal Trauma

  • S2
43
Q

Sensory Assessment in Spinal Trauma

  • S3
44
Q

Sensory Assessment in Spinal Trauma

  • Grading
45
Q

Motor Assessment in Spinal Trauma

46
Q

Motor Assessment in Spinal Trauma

  • C5
A

Deltoids / biceps

47
Q

Motor Assessment in Spinal Trauma

  • C6
A

Wrist extensors

48
Q

Motor Assessment in Spinal Trauma

  • C7
A

Elbow extensors

49
Q

Motor Assessment in Spinal Trauma

  • C8
A

Finger flexors

50
Q

Motor Assessment in Spinal Trauma

  • T1
A

Finger Abductors

51
Q

Motor Assessment in Spinal Trauma

  • L2
A

Hip flexors

52
Q

Motor Assessment in Spinal Trauma

  • L3
A

Knee extensors

53
Q

Motor Assessment in Spinal Trauma

  • L4
A
  • Knee extensors
54
Q

Motor Assessment in Spinal Trauma

  • L5
A
  • Ankle Dorsiflexion
  • Long toe extensors
55
Q

Motor Assessment in Spinal Trauma

  • S1
A
  • Ankle Plantar Reflex
  • Long Toe Plantar Reflex
56
Q

Motor Assessment in Spinal Trauma

  • Grading
57
Q

Rectal Assessment in Spinal Trauma

  • Bulbocavernous Reflex
58
Q

Stimulus for Bulbocavernous Reflex

A
  • Squeezing the glans penis or clitoris.
  • Tugging on an indwelling Foley catheter
59
Q

Center of Bulbocavernous Reflex

60
Q

Response of Bulbocavernous Reflex

A

Anal Sphincter Contraction

61
Q

Significance of Present Bulbocavernous Reflex

62
Q

Significance of Absent Bulbocavernous Reflex

63
Q

Sacral Sparing in complete Spinal Cord Injury

  • Right or Wrong?
A

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

64
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.
65
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’.
66
Q

Neurogenic Shock Causes ……

A

Hemodynamic instability.

67
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.
68
Q

Neurogenic Shock

  • CP
A
  • Bradycardia
  • Hypotension
  • Hypothermia
69
Q

Degrees of Spinal Trauma

A
  • Complete
  • Incomplete
70
Q

Degrees of Spinal Trauma

  • Complete
A
  • Flaccid paralysis
  • total loss of sensory & motor functions.
71
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.

72
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.
73
Q

CP of Anterior Cord Syndrome

A
  • Loss of power
  • reduced pain and temperature below the lesion.
74
Q

Etiology of Posterior Cord Syndrome

A
  1. Hyperextension injuries.
  2. Posterior vertebral body fracture.
75
Q

CP of Posterior Cord Syndrome

A
  1. Loss of proprioception and vibration sense.
  2. Severe ataxia.
76
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.
77
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)

78
Q

Etiology of Brown Sequard Syndrome

A
  1. Hemisection of the cord
  2. Stab injury and lateral mass fractures.
79
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.
80
Q

Radiological Tool of Choice in Spinal Trauma

81
Q

Radiological Tool of Choice in Spinal Trauma

  • Suspectimg Level
A

Suspect the level from
- Examination
- Mode of trauma.

82
Q

Radiological Tool of Choice in Spinal Trauma

  • What to Start With?
83
Q

Radiological Tool of Choice in Spinal Trauma

  • If Suspicious
84
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.
85
Q

Def of Whiplash Injury

A

Sudden hyperextension and flexion.

86
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.
87
Q

Recovery in Whiplash Injury

A

90% are asymptomatic after 2 years.

88
Q

Types of Vertebral Fractures

A
  • Compression Fractures
  • Burst Fractures
  • Seatbelt Type Fracture
  • Dislocation Fracture
89
Q

Compression Fractures

90
Q

Compression Fractures

  • Types
91
Q

Burst Fractures

  • Types
92
Q

How to Suspect Spinal instability?

A
  • SLICS
  • TLICS
93
Q

SLICS

94
Q

TLICS

  • Morphology (Immediate Stability)
95
Q

Surgical Intervention in Spinal Trauma

  • techniques
96
Q

Surgical Intervention in Spinal Trauma

  • Fusion
97
Q

Surgical Intervention in Spinal Trauma

  • Internal Fixation
A

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

  • Screws, hooks, cages.
98
Q

Surgical Intervention in Spinal Trauma

  • Decompression
A

of spinal canal

(Laminectomy)

Surgery II - OSCE (20 decks)

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