spinal fractures Flashcards
what to check for on initial assessment of spinal injury
motor / sensory
PR
reflexes (UMN / LMN)
ASIA scale of A ? E ?
A complete loss of function
E normal
findings in spinal bone injury?
oedema, tenderness, bruising, STEP / GAP, muscle spasms
findings in spinal cord injury?
UMN signs
hyperreflexia, hypertonia, spastic paralysis
findings in nerve root injury?
LMN signs
flaccid paralysis, hypotonia
indications for C spine imaging
neck pain midline neck tenderness mental state less than normal near signs distracting injury
imaging options in spinal trauma
x ray - ap, lateral, peg view
ct - pan whole body CT.
MRI - if ligamentous injury
mri visualises spinal cord very well
analysis of c spine ABCDE
adequacy bone abnormality contours disc spacing and spaces extra axial soft tissues
contours?
anterior vertical line - ALL
posterior vertical line - PLL
spinolaminar line - facets
posterior spinous line - spinous processes
what is antelithesis
dislocation of a facet
<50% vertebral body is unilateral facet dislocation
>50% vertebral body is bilateral facet dislocation
how to know if there is a odontoid peg fracture? what measurement?
predental space >3mm
<3mm is normal
5 indications of unstable injury
- more than 1 column damaged
- <50% anterior vertebral height kept
- multiple level fracture
- nerve / spinal cord damage - UMN / LMN signs
- pain uncontrolled with simple analgesia
what is a Jefferson fracture? MOI?
C1 compression fracture
transverse ligament tears
least stable type of odontoid fracture?
type II - between dens and body
what is a hangman’s fracture?MOI?
C2 fracture
hyperextension axial fracture
occurs during high impact eg RTC, windshield strike
what is a wedge fracture? who does it occur in? why is it severe?
severe anterior compression
occurs in elderly
severe because more than 50% vertebral body height loss
what is a Burst fracture?
fragments push back into vertebral column
neuro damage
how does a chance injury occur?
seatbelt injury
what kind of injury happens with C spine? vs T/L spine?
C spine lesion = tetraplegia
T/L spine lesion = paraplegia
what is complete cord syndrome?
complete loss of sensory, autonomic and motor function (including perineum) below lesion
why does respiratory dysfunction occur sometimes in spinal cord lesions?
affects intercostal muscles (T1-T11) or phrenic nerve (C3-5)
what is central cord syndrome? what causes it? what is lost?
lesion in middle of spinal cord
C spine hyperextension injury
motor weakness upper > lower
variable sensory loss
what is brown sequard syndrome? what causes it? what are symptoms?
hemisection lesion of spinal cord
due to penetrating trauma
ipsilateral loss of motor and proprioception IMP
contralateral loss of pain and temperature
what is anterior cord syndrome? what causes it? what symptoms?
flexion injury eg burst fracture, herniated disc
variable loss of motor pain temp
preserved proprioception vibration touch
consequences of spinal cord injury?
SPINAL SHOCK
symptoms of spinal shock?
resolves over hours - days loss of sensory, motor, proprioception flaccid paralysis loss of reflexes bradycardia hypotension respiratory failure cardiac arrest bladder incontinence
