spinal Flashcards
What factors are assoc. with preventable neurological deterioration?
- The injury not being recognised initially, e.g. not being specifically examined for, occult or masked by other injuries 2. The onset of the secondary effects of the spinal cord injury involving oedema and/or ischaemia 3. Aggravation of the initial spinal cord lesion by- inadequate oxygenation and/or hypotension or- inadequate vertebral immobilisation.
Where do vertebral and spinal cord injuries most commonly occur?
Vertebral injuries
- Cervical 60%,
- thoracic 30%,
- lumbar 4% and
- sacral 2%
Spinal cord injuries
- 5th, 6th and 7th cervical vertebrae, largely because of the greater mobility of these regions.
- The C5–6 and C6–7 levels account for almost 50% of all subluxation injury patterns in blunt cervical spinal trauma
What are the 3 notworthy observations of assoc. injuries with spinal injuries?
- Approximately 8–10% of patients with a vertebral fracture have a secondary fracture of another vertebra, often at a distant site.2. Often have other associated injuries, including head, intrathoracic or intra-abdominal injuries, which may modify management priorities3. Patients may complain of pain from other injuries and hence a back or neck injury may go unnoticed
With respect to the autonomic nervous system, what are the cardiovasculareffects of spinal cord damage?
In complete quadriplegia, sympathetic denervation causes relaxation of resting vasomotor tone, resulting in generalized systemic vasodilatation.- It is recognised by dry extremities with variable warmth and colour during initial assessment.- In males, there may be penile engorgement or priapism.- Owing to the peripheral vasodilatation, there is a drop in total peripheral resistance, with consequent hypotension (neurogenic shock).
With respect to the autonomic nervous system, what are thegastrointestinaleffects of spinal cord damage?
- a paralytic ileus develops but it is usually self-limiting and recovers over 3–10 days.- passive regurgitation of stomach contents precipitates an aspiration risk- complicated by a reduced capacity to cough and clear aspirated secretions.
With respect to the autonomic nervous system, what are theurinaryeffects of spinal cord damage?
- Urinary retention is partly the consequence of acute bladder denervation and, in the early post-injury phase, due to spinal shock.- Catheter insertion is required to prevent over distension of the bladder in order to optimise recovery.
With respect to the autonomic nervous system, what are thethermoregulatoryeffects of spinal cord damage?
Following cervical or upper thoracic spinal cord injury, the spinal patient effectively becomes poikilothermic.- In a cold environment, they are unable to vasoconstrict to conserve heat or shiver to generate heat. The patient is already peripherally vasodilated which promotes loss of heat and lowering of body temperature.- In the warm environment, although the patient is already peripherally vasodilated,the capacity to sweat is sympathetically controlled and therefore lost.
How is muscle power assessed and reported?
Grade 0/5 No movement Grade 1/5 Flicker Grade 2/5 Movement present, but not a full range against gravity Grade 3/5 Full range of movement against gravity with no added resistance Grade 4/5 Full range of movement against gravity with added resistance but with reduced power Grade 5/5 Normal power
How is the dorsal column sensation assessed?
Using a peice of cotton wool and testing for light touch.
How is spinothalamic sensation assessed
- using a pin or sharp object. - proprioception, vibration and temp can also be assessed.
What mechanisms are assoc. with cervical spine fractures?
- hyperflexion, hyperextension and flexion–rotation 2. vertebral compression3. lateral flexion or distraction.
What is the role of corticosteroids in spinal injury?
- methylprednisolone given within 8 hours of injury can have a significant effect on recovery of motor function- consider its role carefully in those with contaminated injuries such as perforated bowel or established sepsis.- the initial dose is 30mg/kg over 15mins then 5.4mg/kg over 24hrs if <3hrs from injury or over 47 hours if 3-8 hrs after injury
What injuries does hyperflexion produce?
- a simple, stable wedge fracture2. a fracture with an anterior teardrop 3. bilateral anterior subluxation or bilateral facet dislocation. 4. clay shoveller’s fracture
What is a clay shoveller’s fracture?
A clay shovelers fracture is an avulsion of the C6, C7 or T1 spinous processes assoc. with sudden load on a flexed spine
Flexion injuries with anteroinferior extrusion teardrop fracture are assoc. with what?
This is often associated with retropulsion of a vertebral body fracture fragment or fragments into the spinal canal
What are the features and consequences of hyperextension injuries?
- Anterior widening of disc spaces, prevertebral swelling, avulsion of a vertebral body by the anterior longitudinal ligament,2. subluxation and crowding of the spinous processesEncroachment on the canal by an extruded disc or a posterior osteophyte may occur in patients with osteoarthritis of the cervical spine.
What is common with flexion-rotation injuries of the cervical spine?
Unilateral facet dislocation or forward subluxation of the cervical spine.
What is assoc. with vertebra compression injuries?
Vertebral compression injuries are assoc. with burst fractures.- The intervertebral disc is disrupted and driven into the vertebral body below and disc material may be extruded anteriorly into prevertebral tissues and posteriorly into the spinal canal.- The vertebral body may be comminuted to varying degrees, with fragments being extruded anteriorly and posteriorly into the spinal canal.
What injuries are assoc. with lateral flexion injuries?
- Uncinate fractures,2. isolated pillar fractures,3. transverse process injuries and4. lateral vertebral compression.
What is a distraction cervical spine injury and what injuries is it assoc. with?
- Adistraction injuryis separation or pulling apart of two adjacent vertebrae withhigh chance ofcord injuryas its osseous and ligamentous supporting structures are pulled apart.- Adistraction injuryon the posterior side can lead to a compression fracture on the anterior sidegross ligamentous and intervertebral disc disruption.- A hangman’s fracture may also occur by combined distraction and hyperextension mechanisms.
What are key features of C1 injuries?
- C1 fractures of the atlas comprise 4% of cervical spine injuries and mechanisms generally involve hyperextension or compression. 2. Around 15–20% of fractures may be associated with a C2 injury and 25% may be associated with a lower cervical injury.3. The Jefferson fracture is a blowout fracture of the ring. Other fractures include isolated injuries of the posterior arch, the anterior arch and the lateral mass.
What are key features of C2 injuries?
Axis fractures comprise 6% of cervical spine injuries, with an association with concurrent C1 injury in the majority of cases. There are three types of odontoid fracture:
- Type 1 is an avulsion of the odontoid tip. It is generally a stable injury and accounts for 5–8% of odontoid fractures - Type 2 injury is a fracture through the base of the dens and is generally unstable. It comprises 55–70% of odontoid injuries. In younger children, the epiphysis may be present and confused with a type 2 fracture - Type 3 is a subdental fracture of the odontoid extending into the vertebral body. It comprises 30–35% of odontoid fractures. .
Describe a hangmans fracture
A hangman’s fracture is a bilateral neural arch fracture of C2.- It is a hyperextension injury and is associated with prevertebral soft tissue swelling, anterior subluxation of C2 on C3 and avulsion of theanteroinferior corner of C2.
