Spinal Cord Injuries

Question 1

What are the mechanisms of spinal injury

Answer 1

Hyperflexion
Hyper extension 
Lateral stress 
Rotation 
Compression 
Distraction

Question 2

What are common causes of spinal injuries

Answer 2

Trauma: car accidents, contact sports, falls, alcohol

Head injuries: 20% have c spine injury

Question 3

Where are common sites of spinal injury

Answer 3

C6/7 (50%)
C2 (30%)

C1/2 in children (heavy head + lax ligaments)

Question 4

What are the types of spinal cord injuries

Answer 4

Complete transection 
Hemisection 
Anterior cord injury 
Central cord injury 
Posterior cord injury

Question 5

What are the causes of complete transection

Answer 5

Trauma
Infarction 
Transverse myelitis
Abscess
Tumour (metastasis)

Question 6

What are the clinical features of complete transection

Answer 6

Spinal shock
Neurological shock
Bilateral paralysis below level of injury
Bilateral sensory loss of all modalities below level of injury
Priapism

Question 7

What is spinal shock

Answer 7

Paralysis of bladder and rectum

Question 8

What is neurological shock

Answer 8

Hypotension and bradycardia due to loss of sympathetics in cervical spine lesions

Question 9

What is priapism

Answer 9

Prolonged sustained erection due to unopposed parasympathetic activity

Question 10

What are the causes of spinal cord hemisection

Answer 10

Penetrating trauma
Fractured vertebrae
Tumour
Abscess
Multiple sclerosis

Question 11

What are the features in Brown Sequard Syndrome

Answer 11

Ipsilateral loss of proprioception at+below level of lesion
Ipsilateral loss of motor function at+below level of lesion
Contralateral loss of pain sensation below level of lesion

Question 12

What are the causes of anterior cord injury

Answer 12

Flexion injury: fracture, dislocation, herniation

Anterior spinal artery injury: atherosclerosis, iatrogenic (clamping, dissection)

Question 13

What are the clinical features of anterior cord injury

Answer 13

Complete paralysis at+below lesion
Complete loss of pain sensation below lesion
Sparing of proprioception, fine touch, vibration
Autonomic dysfunction: bladder, bowel, sexual

Question 14

What are the causes of central cord injuries

Answer 14

Trauma: hyperextension (elderly), hyperflexion (young) 
Disruption to spinal blood flow 
Cervical spinal stenosis 
Degenerative spinal disease 
Syringomyelia 
Central canal ependymoma

Question 15

What are the clinical features of central cord injury

Answer 15

Initial Loss of pain + temp in cape like distribution
Followed by paralysis in cape like distribution
Motor>sensory
Upper extremity > Lower extremity
Distal>proximal

Bladder dysfunction
Sparing of proprioception, fine touch, vibration

Question 16

What are the causes of posterior cord injury

Answer 16

Chronic pathological processes: 
Spondylosis
Spinal stenosis 
Infection 
Vitamin B12 deficiency 

Posterior spinal arteries occlusion

Question 17

What are the clinical features of posterior cord injury

Answer 17

Loss of proprioception, fine touch, vibration
Sparing of motor function
Sparing of pain + temp sensation

Question 18

What are the principles of management of spinal injuries

Answer 18

Intubation + icu admission 
Early c spine immobilisation 
C spine restriction for 6 weeks
PT/OT long term
Surgery - progressive neurological deficit, unstable fractures

Question 19

What is the initial management of spinal cord injuries

Answer 19

ABCDE assessment 
Intubation 
Log-roll and Backboard
Rigid C collar 
Manual stabilisation 
Treat: hypoxia, shock, hypothermia 
Catheterise

Question 20

Why is intubation important

Answer 20

Spinal injuries above C5 loss of diaphragm innervation, intercostal muscle’s will tire out

Question 21

When do you assume spinal injury

Answer 21

Head injury present
Focal neurological deficit
Altered level of consciousness/GCS
Spinal tenderness

Question 22

What is log roll

Answer 22

Manoeuvre to transfer patient onto backboard as a team

Question 23

What is a backboard

Answer 23

Board to transport patients in pre-hospital trauma setting in supine position

Question 24

What is manual stabilisation

Answer 24

Technique used to minimise movement of head and neck

Question 25

What are the methods of manual stabilisation

Answer 25

Place hands on patients mastoid processes from above the patient

Place hands on sides of head from patients side with elbows on their chest

Question 26

In what position do you place patients head in manual stabilisation

Answer 26

ANY position comfortable for patient

You must not apply traction

Question 27

Why is catheterisation important

Answer 27

Possible bladder dysfunction and retention

Question 28

How do you “clear” spinal injuries

Answer 28

Communication:
Alert and oriented
No language barrier
Not intoxicated

Examination:
No focal neurological deficits
No posterior midline tenderness
No painful distracting injuries