Neck and Spinal Trauma

Question 1

How long is the spinal column on average?

Answer 1

70-72 cm long

Question 2

What are the 4 curvatures of the spine?

Answer 2

2 anteriorly concave- cervical and lumbar

2 convex posteriorly- Thoracic and sacral

Question 3

what are the different regions of the spine and how many vertebrae are in each?

Answer 3

7 cervical 
12 thoracic 
5 lumbar
5 sacral 
4 coccygeal

Question 4

What supports the vertebral column?

Answer 4

• Cartilage discs
• Strong ligaments
• Other structures such as ribs and sternum
• Natural cures to prive balance

Question 5

What is the function of the spinal column?

Answer 5

To support the trunk 
serves as an attachment for muscles 
to articulate with the pelvis
to provide attachment for lower limb muscles
and to protect the spinal chord

Question 6

How long is the spinal chord?

Answer 6

42-45cm approximately

Question 7

where does the spinal chord fit in the spinal column? where does it start and finish?

Answer 7

in the vertebral foramen from the superior boarder of C1 to L 1/2

Question 8

How many spinal nerves are there and where do they exit the spinal column?

Answer 8

31
8 cervical
12 thoracic
5 lumbar
5 sacral 
1 coccygeal

Question 9

What is the Cauda equina?

Answer 9

The nerves from L2-5, S1-5 and C-1 that arise from the conus medullaris (horses tail)

Question 10

what protective layers surround the cauda equina?

Answer 10

The Pia mater, arachnoid mater and dura mater

Question 11

where is is most likely to fracture the spinal column?

Answer 11

in the cervical region above C4 particularly

Question 12

What are the major MOI for SCI?

Answer 12

Hyperextension
Hyperflexion
vertical compression
Flexation/rotation
Penetrating trauma

Question 13

What occurs if the sin undergo hyperextension?

Answer 13

tearing of intervertebral disc and stretching of the spinal chord and may result in Central chord syndrome

Question 14

What is the common MOI and demographic of hyperextension spinal chord injuries?

Answer 14

Usually in elderly patients with osteoarthritic or spondylosis changes

Question 15

What is spinal chord hyeprflexion?

Answer 15

Sudden forcible flection usually in the cervical region or lumbar region

Question 16

What injuries would you expect to see in a spinal chord hyperflexion injury?

Answer 16

Accompanying bilateral dislocation and associated ligamentous damage

Question 17

What is the common MOI for spinal hyeprflexion injuries?

Answer 17

MCAs and domestic falls

Question 18

what injuries would you expect to see in a compression spinal chord injury?

Answer 18

Body of vertabre burst and displaces bone particles and disc into spinal canal

Question 19

Where do compression injuries usually occur in the spine?

Answer 19

Cervical and lumbar regions

Question 20

What is a common MOI for compression spinal chord injuries?

Answer 20

Diving, falling objects

Question 21

What is the neurological damage caused compression SCI?

Answer 21

Burst fractures

Jefferson at c1

Question 22

Where are Rotation (flexion) injuries usually seen in the spin?

Answer 22

cervical/ lower thoracic and lumbar region

Question 23

What injuries are seen with a rotation injuries?

Answer 23

Unilateral fracture- dislocation

Postieiror ligaments and vertebral body fractures- highly unstable

Question 24

MOI common with rotation SCI?

Answer 24

Back seats in MCA, lap belts, side impacts

Question 25

What are some types of Direct penetrating trauma SPI?

Answer 25

Violent blow to vertebral column or chord | Major assault

Question 26

What are the different types of spinal chord injuires that might occur?

Answer 26

``` Transient concussion Contusion Laceration Compression of chord substance Transection of chord ```

Question 27

What is a transient concussion of the spinal chord?

Answer 27

Due to extreme acceleration/de-ce;eration forces. May cause temporary neurological changes lasting less than 48 hors leaving no structural changes

Question 28

What is a spinal chord contusion?

Answer 28

Is a bruise that includes bleeding, subsequent oedema, and possible necrosis from the oedematous compression

Question 29

What are the classification of SCI?

Answer 29

Quadriplegia/ tetraplegia- T1 and above Paraplegia- T2 and below These can be complete or incomplete

Question 30

What is central chord syndrome?

Answer 30

Associated with cervical injury and chord compression leading to ischaemia

Question 31

Who is Central Chord syndrome most likely to affect?

Answer 31

the elderly

Question 32

What is the prognosis for central chord syndrome?

Answer 32

Can be good for recovery as spinal column may not be injured.

Question 33

What is Brown-Sequard Syndfrom?

Answer 33

Motor loss on same side of chord damage | Sensory loss of pain and temp on opposite side

Question 34

Where do the sensory fibres cross over in the spinal column?

Answer 34

At the level of entry to the spinal chord

Question 35

Where to the motor fibres cross over in the spinal column?

Answer 35

Above the spinal chord in the medulla oblongata

Question 36

What is anterior chord syndrome?

Answer 36

Commonly associated with injury to the anterior spinal column and interruption of the anterior spinal artery supply

Question 37

Where is the damage in anterior chord syndrome?

Answer 37

In the anterior two thirds with the posterior third unaffected

Question 38

What is preserved and altered with anterior chord syndrome?

Answer 38

Preservation of position, vibration and touch with motor function usually more altered

Question 39

What can Spinal chord injury result in?

Answer 39

Loss of movement and sensation, decreased circulation, altered respiratory function, inability to control body temperature, altered bladder and bowel control and altered sexual function

Question 40

What is the primary MOI for SCI?

Answer 40

Initial crush, shear impingement of chord as result of trauma

Question 41

What are the secondary SCIs?

Answer 41

Odeama, ischeamia, electrolyte dysregulation | Contributing to exaggerated stimulation and cell death

Question 42

What are the consequences of a SCI dependent on?

Answer 42

Type of primary injury | The degree of secondary injure and the neurological level

Question 43

What is SCIWORA?

Answer 43

Spinal chord abnormality without radiological abnormality. Trauma damages spinal chord and the bones reset in the wrong position

Question 44

How do we asses a SCI?

Answer 44

MOI | Modified NEXUS Criteria

Question 45

What are the categories for the modified NEXUS criteria?

Answer 45

Risk of SCI? Assess the patient Actual evidence of structural injury Neck range of motion

Question 46

What are some signs and symptoms that you may see in a SCI?

Answer 46

Hypotension with no associated tachycardia External signs on internal heamoraage may be absent Pink, Warm skin with hypotension and bradycardia

Question 47

What is spinal shock?

Answer 47

loss of reflect and sensory function below the level of a spinal chord injury. It manifests as flaccid paralysis, including loss of bowl and bladder reflexes.

Question 48

Why does hypotension result from neurogenic shock?

Answer 48

The result of sympathetic denervation that causes loss of arteriolar tone and results in venous pooling

Question 49

Why does bradycardia result from neurogenic shock?

Answer 49

Because o the interruption of cardiac sympathetics allowing unopposed vagal response

Question 50

Why does hypothermia develop after neurogenic shock?

Answer 50

Due to the inability to redirect blood from the peripheral circulation and inability to shiver

Question 51

What may cause partial or complete paralysis of the diaphragm?

Answer 51

Injury to C5 or higher

Question 52

What level of lessons may cause breathing compromise?

Answer 52

Any session above the level of T12 - intercostal and abdominal muscles are affected from T1 to T12