Spinal cord injuries

Question 1

Most likely spinal injury level in adults and children

Answer 1

Adults: half in C6/7
Children: more likely in C1/2 because head heavier and ligaments more lax

Question 2

Methods of spinal injury

Answer 2

Hyperflexion
Hyperextension
Lateral stress rotation
Compression
Distraction (pulling apart of vertebrae)

Question 3

Causes of complete spinal cord transection

Answer 3

Trauma
Infarction
Transverse myelitis
Abscess 
Tumour

Question 4

Features of complete cord transection

Answer 4

Complete sensory loss below lesion
Complete motor loss below lesion
Priapism (prolonged sustained erection) 
Spinal shock
Autonomic dysfunction

Question 5

Causes of Brown Sequard syndrome

Answer 5

Penetrating trauma
Vertebral fracture
Tumour
Abscess
MS

Question 6

Features of Brown Sequard syndrome

Answer 6

Ipsilateral motor loss below lesion
Ipsilateral dorsal column modalities loss below lesion
Contralateral spinothalamic modalities loss below lesion

Question 7

Causes of central cord syndrome

Answer 7

Hyperextension in elderly
Hyperflexion in younger people
Ischaemia of spinal cord
Cervical spine stenosis
Ddgernatuve spinal disease (ligamentum flavum compresses cord causing central contusion)
Syringomyelia 
Central canal ependymoma

Question 8

Causes of anterior cord syndrome

Answer 8

Hyperflexion

Anterior spinal artery occlusion (atherosclerosis or secondary to cross clamping aorta)

Question 9

Features of anterior cord syndrome

Answer 9

Flaccid paralysis below lesion
Loss of spinothalamic modalities below lesion
Autonomic dysfunction

Question 10

Features of central cord syndrome

Answer 10

Cape distribution of spinothalamic modalities loss
Bilateral motor loss
Urinary retention

Upper limb>lower limbs as medial aspects of tracts affected more
Dorsal columns usually preserved

Question 11

Causes of posterior cord syndrome

Answer 11

Spondylosis
Spinal stenosis
Infections
B12 deficiency 
Occlusion of both posterior spinal arteries

Question 12

Features of posterior cord syndrome

Answer 12

Bilateral dorsal column modalities loss below lesion

Question 13

Immediate management of spinal cord injury

Answer 13

ABCDE
Stabilise C spine - log roll, backboard, rigid C collar
Monitor HR, RR and BP
Correct hypoxia, hypotension and hypothermia
Insert urinary catheter to assess bladder distension

Question 14

When should spinal cord injuries be suspected

Answer 14

HIs
Spinal tenderness
Focal neurological deficit
Impaired consciousness

Question 15

How to manually stabilise C spine

Answer 15

Above: hands on mastoid processes while cradling occiput
Side: rest forearms on patient’s chest, hands on sides of head

Question 16

Why do people with spinal cord injuries get hypoxia and how do you correct this

Answer 16

Lose innervation to respiratory muscles

Intubation if injury is C1-5

Question 17

Why do people with spinal cord injuries get hypothermia

Answer 17

Vasodilation as unopposed parasympathetic action
Hairs flat
Can’t shiver

Question 18

What is the NEXUS method for clearing the spine

Answer 18

GCS 15 and orientated to TPP
No language barrier
Not intoxicated
No posterior midline tenderness
No focal neurological deficit 
No painful distracting injuries
X-ray cervical and prox thoracic spine

Question 19

Late management for spinal cord injuries

Answer 19

C spine restriction for 6 weeks
PT/OT
Surgery if there is progressive neurological deficit or unstable spinal fracture