Spinal Fractures and Cord Injuries

Question 1

How can a potential C-spine injury be radiologically cleared?

Answer 1

1. X-ray (AP, lateral and potentially also odontoid peg open mouth view)
2. CT

Question 2

High C spine fractures or dislocations may be fatal especially when above whih vertebral level?

Answer 2

C3

Question 3

How can most stable C-spine injuries be treated?

Answer 3

Firm cervical collar

Question 4

Excluding surgery, how can unstable C-spine injuries be treated?

Answer 4

Halo vest (for immobilisation)

Question 5

In the elderly with osteoporosis, which type of fractures commonly occur in the spine?

Answer 5

Insufficiency wedge fractures

Question 6

What is the term given to the type of spinal fracture which commonly occurs in the thoracic region of younger people involved in a high energy flexion-distraction injury?

Answer 6

Chance fractures

Question 7

Chance fractures involve failure of the ____________ ligaments in the spine

Answer 7

Posterior

Question 8

What are the two main indications for surgery in the thoracolumbar spine?

Answer 8

1. Neurological deficit
2. Unstable injury

Question 9

Which types of surgery can be utilised in a thoracolumbar spinal fracture?

Answer 9

1. Pedicle screws and rods
2. Spinal fusion
3. Spinal decompression

Question 10

When would spinal decompression be most utilised?

Answer 10

Neurological deficit

Question 11

What types of secondary damage affect the spinal cord after trauma?

Answer 11

1. Vascular disruption
2. Oedema
3. Hypotension
4. Hypoxia
5. Inflammatory response

Question 12

What is spinal shock?

Answer 12

Sensation, motor function and reflexes lost below level of injury

Question 13

Does spinal shock ever resolve?

Answer 13

Yes

(after 24 hours usually)

Question 14

Which reflex is absent in spinal shock?

Answer 14

Bulbocavernous reflex

Question 15

What does the bulbocavernous reflex involve?

Answer 15

Contraction of the anal sphincter

Question 16

How is neurogenic shock treated?

Answer 16

IV fluid therapy

Question 17

What is complete spinal cord injury?

Answer 17

No sensory or motor function below injury level

Question 18

What is incomplete spinal cord injury?

Answer 18

Some neurological function remains below level of trauma

Question 19

If there is loss of motor function at T1 to T12, what may be essential for the survival of a patient?

Answer 19

Ventilatory support

Question 20

What is the most common injury pattern to the spine?

Answer 20

Central cord syndrome

Question 21

How does central cord syndrome occur?

Answer 21

Hyperextension injury in a cervical spine with OA

Question 22

What is the most common area to be paralysed with central cord syndrome?

Answer 22

Arms

Question 23

Why are the arms affected more than the legs in central cord syndrome?

Answer 23

Corticospinal motor tracts of the upper limb are more central in the cord

Question 24

In anterior cord syndrome which neurological deficits occur?

Answer 24

1. Motor function
2. Coarse touch
3. Pain
4. Temperature sensation

Question 25

In anterior cord syndrome, which neurological aspects are preserved?

Answer 25

1. Proprioception
2. Vibration sense
3. Light touch

Question 26

Posterior cord syndrome is ________

Answer 26

Rare

Question 27

Posterior cord syndrome involves a loss of ________ column function

Answer 27

Dorsal

Question 28

If there is dorsal column damage in the spinal cord, which neurological aspects are impacted?

Answer 28

1. Proprioception
2. Vibration sense
3. Light touch

Question 29

What is Brown-Séquard syndrome

Answer 29

Damage to one half of the spinal cord

Question 30

Brown-Séquard syndrome usually results from what?

Answer 30

Hemisection of the spinal cord from penetrating injury

Question 31

What occurs in Brown-Séquard syndrome?

Answer 31

1. Paralysis of the ipsilateral side
2. Loss of dorsal column function
3. Contralateral loss of pain, coarse touch and temperature sensation

Question 32

Why is there contralateral loss of pain, coarse touch and temperature sensation in Brown-Séquard syndrome?

Answer 32

Nerve fibres of spinothalmic tracts cross to the contrelateral side 1-2 levels above their entry into the cord

(nerve fibres of of other tracts cross higher in the medulla)