MDT spinal cord injury and radiculopathy

Question 1

Injury to the spinal cord results in characteristic ______ . Related to the pattern of tracts that are present in spinal cord anatomy

Answer 1

neurologic symptoms.

Question 2

Largest demographic for spinal chord injury

Answer 2

young male (drunk)

Question 3

Most traumatic spinal cord injuries occur with injury to vertebral column which
leads to _______ of the spinal cord. Which can lead to _________ and ______

Answer 3

mechanical compression,

can lead to ischemia and inflammation

Question 4

\_\_\_\_\_\_\_after injury there may be complete physiologic loss of all spinal cord
function below level of injury
(a) Flaccid paralysis
(b) Anesthesia
(c) Absent bowel or bladder control
(d) Loss of reflex activity

Answer 4

Immediately

Question 5

Delayed symptom onset can occur due to ________

Answer 5

spinal cord swelling

Question 6

When dealing with a spinal chord injury what should you focus on first?

Answer 6

ABCS

Question 7

you want to immobilize the C-spine with _______ ASAP

Answer 7

Cervical Collar

Question 8

Insert a ______ if bladder paralysis is suspected

Answer 8

Foley catheter

Question 9

Patient with high cervical injury may have poor respiratory function and may require
______ if necessary

Answer 9

intubation

Question 10

Steroid use is ______, consult with _______ prior to administration

Answer 10

controversial

Medical Officer

Question 11

Steroid use for spinal injuries can theoretically____________________

Answer 11

decrease swelling and inflammation after cord injury

Question 12

What imaging would be your go to for a spine injury if you have the resources

Answer 12

CT

Question 13

NEXUS Criteria for C-Spine XR

NSAID

Answer 13

1) N: Focal Neurological deficit
2) S: Midline Spinal tenderness
3) A: Altered mental status
4) I: Intoxicated
5) D: Distracting injuries

Question 14

Lumbar disk herniation is usually due to ______ or ______ with the back in flexion, causing _______ of disk contents into the spinal cord area.

Answer 14

bending or heavy loading

herniation or extrusion

Question 15

Disk herniations often occur from degenerative disk disease (desiccation of the annulus fibrosis) in patients between ____ and ___ years old.

Answer 15

30 and 50

Question 16

The _____ disk is affected in 90% of cases.

Answer 16

L5-S1

Question 17

Compression of neural structures, such as the sciatic nerve, causes ______

Answer 17

radicular pain

Question 18

Severe compression of the spinal cord can cause the _____ , a surgical emergency.

Answer 18

cauda equina syndrome

Question 19

Clinical Presentation of these suggest….

(a) Pain with back flexion or prolonged sitting
(b) shooting or radiating pain into the leg due to compression of neural structures
(c) Lower extremity numbness and weakness
(d) discogenic pain
(e) sciatica

Answer 19

Radiculopathy

Question 20

_______ pain typically is localized in the low back at the level of the affected disk and is worse with activity.

Answer 20

Discogenic pain

Question 21

_______ causes electric shock- like pain radiating down the posterior aspect of the leg often to below the knee.

Answer 21

sciatica

Question 22

Level of herniation, Clinical presentation

-Pain, paresthesia(pins and needles) and sensory loss in the inguinal region

Answer 22

L1

Question 23

Level of herniation, Clinical presentation
-Acute back pain that radiates around anterior aspect of thigh to knee and may have weakness of hip flexion, knee extension and hip adduction

Answer 23

L2, L3, L4

Question 24

Level of herniation, Clinical presentation
-Most common radiculopathy; back pain radiating down lteral aspect of
the leg into the foot and decreased strength in foot dorsiflexion, toe extension,
foot inversion, foot eversion

Answer 24

L5

Question 25

Level of herniation, Clinical presentation
-Pain radiating down posterior aspect of leg into the foot. Weakness in
plantar flexion due to gastrocnemius(calf muscle).

Answer 25

S1

Question 26

What should be ruled out should be ruled out if the patient complains of perianal numbness or bowel or bladder incontinence.

Answer 26

The cauda equina syndrome

Question 27

presence or worsening of radicular pain with straight leg maneuver

Answer 27

Lasegue’s sign

Question 28

Straight leg testing

Lay patient supine and ____ patients extended leg on the _____ side with foot dorsiflexed

Answer 28

raise

symptomatic

Question 29

Imaging
_________ are helpful to assess spinal alignment (scoliosis, lordosis), disk
space narrowing, and OA changes.

Answer 29

Plain radiographs

Question 30

Imaging

_____ is the best method to assess the level and morphology of the herniation and is recommended if surgery is planned.

Answer 30

MRI

Question 31

What is first line treatment for spine injury?

Answer 31

modified activities; NSAIDs and other analgesics

Question 32

What type of med can also be used to help with acute symptomatic relief

Answer 32

Muscle relaxants

Cyclobenzaprine (Flexeril) 5mg PO Q8Hr and can increase dose to 7.5 – 10mg

Question 33

Treatment

Reevaluation of the patient at about _____ weeks should occur

Answer 33

4-6

Question 34

Treatment

If pain is persistent at reevaluation then ___________________________

Answer 34

further adjunctive treatments should be considered (physical therapy)

Question 35

Treatment
If physical therapy is unsuccessful then ____________ or _____________ should be considered depending on severity of symptoms

Answer 35

consult to pain management or surgery

Question 36

Spine injury red flags

Answer 36

Urinary or bowel disfunction
saddle anesthesia
loss of feeling in an extremity or loss of movement