Medical and Surgical Management

Question 1

What is the emergency care of a person?

Answer 1

treat as if SCI has occurred
immobilize entire spine
ensure circulation/ventilation are adequate
(do not use chin lift tech)

Question 2

What are the hospital care goals?

Answer 2

treat life threatening conditions
preserve neuro function
ventilation/circulation
(neurological assessment after life-threatening conditions- motor/sensory/reflexes, LOC, cranial nerves)

Question 3

What imaging is used for SCI?

Answer 3

CT entire spine
MRI of areas known or suspected of SCI
evaluate other systems
methylprednisolone

Question 4

What is methylprednisolone?

Answer 4

steroid that is given between 8-48 hours to reduce secondary damage
increase risk of infection, sepsis, pneumonia, GI bleed, ulcers, iliius

Question 5

What is the fracture management in a SCI?

Answer 5

reduce and stabilize
could be combo of traction, positioning, surgery and/or orthoses (C-spine usually traction, fusion usually for T/L)
non-surgical
surgical

Question 6

What are tongs and how are they used?

Answer 6

tongs are used with traction for closed reduction of fracture
immobilized patient and pulley system is attached by 4 screws in the skull
temporary solution

Question 7

Why are turning frames/beds used for?

Answer 7

immobilization during acute phase

allows for positional changes

Question 8

What is the roto-rest system?

Answer 8

turns patient off of supine but not all of the way prone

Question 9

What is the stryker frame?

Answer 9

turns patient completely 360

Question 10

What are the indications for surgical management of a fracture in SCI?

Answer 10

unstable fracture
evidence of cord compression
deteriorating neuro function
(optimal timing is up for debate and is usually fused)

Question 11

What is atlanto-occipital disassociation?

Answer 11

head slides forward on the atlas from sever flexion injury

usually fatal

Question 12

What is a burst (Jefferson) fracture of C1?

Answer 12

fracture of the superior and inferior arches

from vertical compression force transmitted through occipital condyles to lateral masses (diving and landing on head)

Question 13

What are the types of odontoid fractures?

Answer 13

type 1: tip is broken (5%)
type 2: base is fractured (65%) most common
type 3: subdentate-into body (30%)

Question 14

What is a hangman’s fracture?

Answer 14

fracture through C2 pedicles and C2 slides anterior from C3
most common C-spine fracture
forced hyperextension (under chin)
usually unrestrained passenger

Question 15

What is a flexion tear drop fracture?

Answer 15

severe flexion causes vertebral body to collide with one below fracturing anterior wedge

Question 16

What is an extension tear drop fracture?

Answer 16

ALL pulls anterioinferior corner from vertebral body when there is abrupt neck extension

Question 17

What is a compression fracture?

Answer 17

fracture of the anterior portion of vertebral body
doesn’t usually cause neurological damage
solution- vertebroplasty

Question 18

What is a wedge fracture?

Answer 18

fracture wedge shaped from anterior portion of vertebral body
more damage than normal compression fracture
patient put in brace that prevents flexion

Question 19

What is a burst fracture?

Answer 19

vertebral body fractures into pieces
increased vertical compression force
increased risk of neurological damage
decompress fracture and stabilize spine

Question 20

What is a chance fracture?

Answer 20

transverse fracture of vertebral body
increase forced deceleration injury
usually from wearing only lap belt

Question 21

What are the indications for use of spinal orthoses?

Answer 21

spinal immobilization surgery
spinal immobilization needed after trauma
compression fracture management
pain relief
mechanical unloading of a joint
kinesthetic reminder to avoid movement

Question 22

What are the characteristics of orthoses you need to take into consideration?

Answer 22

weight, adjustability, functional use, cosmesis, durability, ease of don/doff, access to: trach tube, drain sites and surgical sites, aeration

Question 23

What is the Halo brace?

Answer 23

most drastic way of stabilizing C-spine
4 steel screws into skull attached to body jacket
allows early mobilization and upright posture
applied bedside with local anesthetic

Question 24

What are some complications of the Halo brace?

Answer 24

moves COG superiorly drastically

pins could loosen or become infected

Question 25

What is the Minerva brace?

Answer 25

stabilizes mandible and jaw anteriorly and posteriorly above the occiput
allows for full shoulder ROM
better stabilization than halo except at C1-C2

Question 26

What is the SOMI brace?

Answer 26

sternal, occipital, mandibular immobilization
transition from Halo when they don’t need stabilization in bed
lower trim line than Minerva
wear upright

Question 27

What is a cervical collar?

Answer 27

collar that cups mandible and occiput

Miami J and Philadelphia

Question 28

What is a TLSO?

Answer 28

thoracic lumbar sacral orthotic
body jacket: bivalve for bathing/inspection, trim line can prevent ROM
Jewett brace (opening in center) reminder to not flex
Cash brace (rods that create cross on anterior)

Question 29

What are the physical complications of spinal orthotics?

Answer 29

discomfort, skin breakdown, nerve compression, muscle atrophy, decreased pulmonary capacity, increase energy consumption, increase difficult don/doff

Question 30

What are the complications with using a spinal orthoses?

Answer 30

difficult transfers
psychological/physical dependence (fear avoidance)
increased segmental motion above and below
patient compliance