Neck and Spinal Trauma Flashcards
How long is the spinal column on average?
70-72 cm long
What are the 4 curvatures of the spine?
2 anteriorly concave- cervical and lumbar
2 convex posteriorly- Thoracic and sacral
what are the different regions of the spine and how many vertebrae are in each?
7 cervical 12 thoracic 5 lumbar 5 sacral 4 coccygeal
What supports the vertebral column?
- Cartilage discs
- Strong ligaments
- Other structures such as ribs and sternum
- Natural cures to prive balance
What is the function of the spinal column?
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
How long is the spinal chord?
42-45cm approximately
where does the spinal chord fit in the spinal column? where does it start and finish?
in the vertebral foramen from the superior boarder of C1 to L 1/2
How many spinal nerves are there and where do they exit the spinal column?
31 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal
What is the Cauda equina?
The nerves from L2-5, S1-5 and C-1 that arise from the conus medullaris (horses tail)
what protective layers surround the cauda equina?
The Pia mater, arachnoid mater and dura mater
where is is most likely to fracture the spinal column?
in the cervical region above C4 particularly
What are the major MOI for SCI?
Hyperextension Hyperflexion vertical compression Flexation/rotation Penetrating trauma
What occurs if the sin undergo hyperextension?
tearing of intervertebral disc and stretching of the spinal chord and may result in Central chord syndrome
What is the common MOI and demographic of hyperextension spinal chord injuries?
Usually in elderly patients with osteoarthritic or spondylosis changes
What is spinal chord hyeprflexion?
Sudden forcible flection usually in the cervical region or lumbar region
What injuries would you expect to see in a spinal chord hyperflexion injury?
Accompanying bilateral dislocation and associated ligamentous damage
What is the common MOI for spinal hyeprflexion injuries?
MCAs and domestic falls
what injuries would you expect to see in a compression spinal chord injury?
Body of vertabre burst and displaces bone particles and disc into spinal canal
Where do compression injuries usually occur in the spine?
Cervical and lumbar regions
What is a common MOI for compression spinal chord injuries?
Diving, falling objects
What is the neurological damage caused compression SCI?
Burst fractures
Jefferson at c1
Where are Rotation (flexion) injuries usually seen in the spin?
cervical/ lower thoracic and lumbar region
What injuries are seen with a rotation injuries?
Unilateral fracture- dislocation
Postieiror ligaments and vertebral body fractures- highly unstable
MOI common with rotation SCI?
Back seats in MCA, lap belts, side impacts
What are some types of Direct penetrating trauma SPI?
Violent blow to vertebral column or chord
Major assault
What are the different types of spinal chord injuires that might occur?
Transient concussion Contusion Laceration Compression of chord substance Transection of chord
What is a transient concussion of the spinal chord?
Due to extreme acceleration/de-ce;eration forces. May cause temporary neurological changes lasting less than 48 hors leaving no structural changes
What is a spinal chord contusion?
Is a bruise that includes bleeding, subsequent oedema, and possible necrosis from the oedematous compression
What are the classification of SCI?
Quadriplegia/ tetraplegia- T1 and above
Paraplegia- T2 and below
These can be complete or incomplete
What is central chord syndrome?
Associated with cervical injury and chord compression leading to ischaemia
Who is Central Chord syndrome most likely to affect?
the elderly
What is the prognosis for central chord syndrome?
Can be good for recovery as spinal column may not be injured.
What is Brown-Sequard Syndfrom?
Motor loss on same side of chord damage
Sensory loss of pain and temp on opposite side
Where do the sensory fibres cross over in the spinal column?
At the level of entry to the spinal chord
Where to the motor fibres cross over in the spinal column?
Above the spinal chord in the medulla oblongata
What is anterior chord syndrome?
Commonly associated with injury to the anterior spinal column and interruption of the anterior spinal artery supply
Where is the damage in anterior chord syndrome?
In the anterior two thirds with the posterior third unaffected
What is preserved and altered with anterior chord syndrome?
Preservation of position, vibration and touch with motor function usually more altered
What can Spinal chord injury result in?
Loss of movement and sensation, decreased circulation, altered respiratory function, inability to control body temperature, altered bladder and bowel control and altered sexual function
What is the primary MOI for SCI?
Initial crush, shear impingement of chord as result of trauma
What are the secondary SCIs?
Odeama, ischeamia, electrolyte dysregulation
Contributing to exaggerated stimulation and cell death
What are the consequences of a SCI dependent on?
Type of primary injury
The degree of secondary injure and the neurological level
What is SCIWORA?
Spinal chord abnormality without radiological abnormality. Trauma damages spinal chord and the bones reset in the wrong position
How do we asses a SCI?
MOI
Modified NEXUS Criteria
What are the categories for the modified NEXUS criteria?
Risk of SCI?
Assess the patient
Actual evidence of structural injury
Neck range of motion
What are some signs and symptoms that you may see in a SCI?
Hypotension with no associated tachycardia
External signs on internal heamoraage may be absent
Pink, Warm skin with hypotension and bradycardia
What is spinal shock?
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.
Why does hypotension result from neurogenic shock?
The result of sympathetic denervation that causes loss of arteriolar tone and results in venous pooling
Why does bradycardia result from neurogenic shock?
Because o the interruption of cardiac sympathetics allowing unopposed vagal response
Why does hypothermia develop after neurogenic shock?
Due to the inability to redirect blood from the peripheral circulation and inability to shiver
What may cause partial or complete paralysis of the diaphragm?
Injury to C5 or higher
What level of lessons may cause breathing compromise?
Any session above the level of T12 - intercostal and abdominal muscles are affected from T1 to T12
