Spinal Fractures and Cord Injuries Flashcards
How can a potential C-spine injury be radiologically cleared?
- X-ray (AP, lateral and potentially also odontoid peg open mouth view)
- CT
High C spine fractures or dislocations may be fatal especially when above whih vertebral level?
C3
How can most stable C-spine injuries be treated?
Firm cervical collar
Excluding surgery, how can unstable C-spine injuries be treated?
Halo vest (for immobilisation)
In the elderly with osteoporosis, which type of fractures commonly occur in the spine?
Insufficiency wedge fractures
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?
Chance fractures
Chance fractures involve failure of the ____________ ligaments in the spine
Posterior
What are the two main indications for surgery in the thoracolumbar spine?
- Neurological deficit
- Unstable injury
Which types of surgery can be utilised in a thoracolumbar spinal fracture?
- Pedicle screws and rods
- Spinal fusion
- Spinal decompression
When would spinal decompression be most utilised?
Neurological deficit
What types of secondary damage affect the spinal cord after trauma?
- Vascular disruption
- Oedema
- Hypotension
- Hypoxia
- Inflammatory response
What is spinal shock?
Sensation, motor function and reflexes lost below level of injury
Does spinal shock ever resolve?
Yes
(after 24 hours usually)
Which reflex is absent in spinal shock?
Bulbocavernous reflex
What does the bulbocavernous reflex involve?
Contraction of the anal sphincter
How is neurogenic shock treated?
IV fluid therapy
What is complete spinal cord injury?
No sensory or motor function below injury level
What is incomplete spinal cord injury?
Some neurological function remains below level of trauma
If there is loss of motor function at T1 to T12, what may be essential for the survival of a patient?
Ventilatory support
What is the most common injury pattern to the spine?
Central cord syndrome
How does central cord syndrome occur?
Hyperextension injury in a cervical spine with OA
What is the most common area to be paralysed with central cord syndrome?
Arms
Why are the arms affected more than the legs in central cord syndrome?
Corticospinal motor tracts of the upper limb are more central in the cord
In anterior cord syndrome which neurological deficits occur?
- Motor function
- Coarse touch
- Pain
- Temperature sensation
In anterior cord syndrome, which neurological aspects are preserved?
- Proprioception
- Vibration sense
- Light touch
Posterior cord syndrome is ________
Rare
Posterior cord syndrome involves a loss of ________ column function
Dorsal
If there is dorsal column damage in the spinal cord, which neurological aspects are impacted?
- Proprioception
- Vibration sense
- Light touch
What is Brown-Séquard syndrome
Damage to one half of the spinal cord
Brown-Séquard syndrome usually results from what?
Hemisection of the spinal cord from penetrating injury
What occurs in Brown-Séquard syndrome?
- Paralysis of the ipsilateral side
- Loss of dorsal column function
- Contralateral loss of pain, coarse touch and temperature sensation
Why is there contralateral loss of pain, coarse touch and temperature sensation in Brown-Séquard syndrome?
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)
