spinal fractures

Question 1

what to check for on initial assessment of spinal injury

Answer 1

motor / sensory
PR
reflexes (UMN / LMN)

Question 2

ASIA scale of A ? E ?

Answer 2

A complete loss of function

E normal

Question 3

findings in spinal bone injury?

Answer 3

oedema, tenderness, bruising, STEP / GAP, muscle spasms

Question 4

findings in spinal cord injury?

Answer 4

UMN signs

hyperreflexia, hypertonia, spastic paralysis

Question 5

findings in nerve root injury?

Answer 5

LMN signs

flaccid paralysis, hypotonia

Question 6

indications for C spine imaging

Answer 6

neck pain
midline neck tenderness
mental state less than normal 
near signs 
distracting injury

Question 7

imaging options in spinal trauma

Answer 7

x ray - ap, lateral, peg view
ct - pan whole body CT.
MRI - if ligamentous injury

mri visualises spinal cord very well

Question 8

analysis of c spine ABCDE

Answer 8

adequacy
bone abnormality
contours 
disc spacing and spaces
extra axial soft tissues

Question 9

contours?

Answer 9

anterior vertical line - ALL
posterior vertical line - PLL
spinolaminar line - facets
posterior spinous line - spinous processes

Question 10

what is antelithesis

Answer 10

dislocation of a facet
<50% vertebral body is unilateral facet dislocation
>50% vertebral body is bilateral facet dislocation

Question 11

how to know if there is a odontoid peg fracture? what measurement?

Answer 11

predental space >3mm

<3mm is normal

Question 12

5 indications of unstable injury

Answer 12

1. more than 1 column damaged
2. <50% anterior vertebral height kept
3. multiple level fracture
4. nerve / spinal cord damage - UMN / LMN signs
5. pain uncontrolled with simple analgesia

Question 13

what is a Jefferson fracture? MOI?

Answer 13

C1 compression fracture

transverse ligament tears

Question 14

least stable type of odontoid fracture?

Answer 14

type II - between dens and body

Question 15

what is a hangman’s fracture?MOI?

Answer 15

C2 fracture
hyperextension axial fracture
occurs during high impact eg RTC, windshield strike

Question 16

what is a wedge fracture? who does it occur in? why is it severe?

Answer 16

severe anterior compression
occurs in elderly
severe because more than 50% vertebral body height loss

Question 17

what is a Burst fracture?

Answer 17

fragments push back into vertebral column

neuro damage

Question 18

how does a chance injury occur?

Answer 18

seatbelt injury

Question 19

what kind of injury happens with C spine? vs T/L spine?

Answer 19

C spine lesion = tetraplegia

T/L spine lesion = paraplegia

Question 20

what is complete cord syndrome?

Answer 20

complete loss of sensory, autonomic and motor function (including perineum) below lesion

Question 21

why does respiratory dysfunction occur sometimes in spinal cord lesions?

Answer 21

affects intercostal muscles (T1-T11) or phrenic nerve (C3-5)

Question 22

what is central cord syndrome? what causes it? what is lost?

Answer 22

lesion in middle of spinal cord
C spine hyperextension injury
motor weakness upper > lower
variable sensory loss

Question 23

what is brown sequard syndrome? what causes it? what are symptoms?

Answer 23

hemisection lesion of spinal cord
due to penetrating trauma
ipsilateral loss of motor and proprioception IMP
contralateral loss of pain and temperature

Question 24

what is anterior cord syndrome? what causes it? what symptoms?

Answer 24

flexion injury eg burst fracture, herniated disc
variable loss of motor pain temp
preserved proprioception vibration touch

Question 25

consequences of spinal cord injury?

Answer 25

SPINAL SHOCK

Question 26

symptoms of spinal shock?

Answer 26

resolves over hours - days 
loss of sensory, motor, proprioception 
flaccid paralysis
loss of reflexes
bradycardia
hypotension
respiratory failure 
cardiac arrest
bladder incontinence