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5. Trauma and Accident > Spinal injuries > Flashcards

Spinal injuries Flashcards

1
Q

Describe the vertebral column

A 
7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae
5 fused sacral vertebrae
4 fused coccyx vertebrae
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2
Q

What is C1 called?

A

Atlas

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3
Q

What is C2 called?

A

Axis

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4
Q

Name the anatomical landmarks associated with the cervical vertebrae

A

The vertebral column is often used as a marker of human anatomy. This includes:

At C1, base of the nose and the hard palate
At C2, the teeth of a closed mouth
At C3, the mandible and hyoid bone
At C4, the common carotid artery bifurcates.
From C4–5, the thyroid cartilage
From C6–7, the cricoid cartilage

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5
Q

Where are the lumbar vertebrae located?

A

Between rib cage and pelvis

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6
Q 
She is tender on palpation of her lower thoracic vertebrae. There are no abnormal neurological findings.
Investigations:
Sodium 140 mmol/L (135-146)
Potassium 5.1 mmol/L (3.5-5.3)
Urea 7.6 mmol/L (2.5-7.8)
Creatinine 80 umol/L (60-120)
Calcium 2.4 mmol/L (2.2-2.6)
Vitamin D 60 ng/mL (25-80)
X-ray of thoracic spine: new fracture of T10

Which is the most appropriate management to reduce the risk of further fractures?

A) Calcium and vitamin D supplementation
B) Calcium and vitamin D supplementation with oral bisphosphonate
C) Calcium supplementation
D) High-dose vitamin D supplementation
E) Oral bisphosphonate
A

Needs calcium, vit D and oral bisphonates. Patient elderly and so at risk of low calcium and vitamin D so prescribe the three today.

Patient has a fragility fracture due to osteoporosis.

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7
Q

A 60 year old man is brought to the Emergency Department after a road traffic collision.
He is on a spinal board with cervical immobilisation, being treated with high flow oxygen and intravenous 0.9% sodium chloride. He flexes to painful stimuli, but has no gag reflex on suctioning. His pulse rate is 110 bpm and BP 100/70 mmHg.
Which is the most appropriate next intervention?

A) CT scan of head Exclude
B) Endotracheal intubation
C) Intravenous dexamethasone
D) Intravenous mannitol
E) X-ray of cervical spine
A

B - Endotracheal intubation. A to E, always airway first, no gag reflex, intubate this chap.

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8
Q

What structure can be found between vetrebrae?

A

Intervertebral discs, which function to absorb shock

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9
Q

What are primary spinal cord injuries?

A
  1. Compression
  2. Contusion
  3. Shear injury
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10
Q

What are secondary spinal cord injuries?

A
  1. Ischemia
  2. Inflammation
  3. Progressive neurological deterioration
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11
Q

What are causes of spinal cord compression?

A
  1. Trauma
  2. Tumours
  3. A prolapsed intervertebral disc
  4. Haematoma
  5. Inflammatory disease (RA)
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12
Q

How does spinal cord compression present?

A

Fatigue and disturbance of gait

Sensory symptoms can include sensory loss and paraesthesia. Light touch, proprioception and joint position sense are reduced.

Tendon reflexes are typically:

  1. Increased below the level of injury and/or compression.
  2. Absent at the level of injury and/or compression.
  3. Normal above the level of injury and/or compression
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13
Q

What cancers are most likely to give rise to bone metastases?

A

Breast
Prostate
Lung

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14
Q

How would you manage spinal cord compression?

A

Give a course of dexamethasone
Manage postural hypotension
Insert a catheter to manage bladder dysfunction

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15
Q

Where does the spinal cord originate and terminate?

A

The spinal cord extends from the base of the skull and terminates near the lower margin of the L1 vertebral body

Below L1, the spinal canal contains the lumbar, sacral and coccygeal spinal nerves that comprise the cauda equina

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16
Q

What are the characteristics of complete cord injury?

A

Absence of any motor or sensory function below the level of the injury.

Minimal chance of functional recovery.

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17
Q

What are the characteristics of anterior cord syndrome?

A

This is caused by direct anterior cord compression, flexion injuries of the cervical spine, or thrombosis of anterior spinal artery.

Leads to variable paralysis below the lesion level with loss of pain and temperature perception.

Dorsal columns (proprioception and vibration sense) are mainly preserved.

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18
Q

What are the characteristics of posterior cord syndrome?

A

Caused by penetrating trauma to the back or hyperextension injury associated with vertebral arch fractures.

Loss of proprioception and vibration sense.

Motor and pain/temperature sensation preserved.

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19
Q

What are the characteristics of Brown-Séquard’s syndrome?

A

Caused by hemi-transection or unilateral compression of the cord.

Ipsilateral spastic paresis and loss of proprioception and vibration sense.

Contralateral loss of pain and temperature perception.

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20
Q

What are the characteristics of central cord syndrome?

A

Caused by hyperextension injuries, spinal cord ischaemia and cervical spinal stenosis.

Usually involves a cervical lesion, with greater motor weakness in the upper extremities than in the lower extremities.

Sensory loss is variable, with pain and/or temperature sensation more likely to be affected than proprioception and/or vibration.

Burning sensation, especially in the upper extremities, is common.

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21
Q

What is the most common location for spinal cord injuries?

A

Cervical spine (55%)

22
Q

What are indicators for full spinal immobilisation?

A 
Spinal pain
Significant distracting injuries
Intoxication
Confused/ uncoorperative
reduced GCS
Hand or foot weakness
Priapism
23
Q

What are mechanisms for spinal injury?

A
  1. Compression
  2. Hyperextension
  3. Flexion
  4. Flexion-rotation
  5. Penetration
  6. Distraction
24
Q

In the context of spinal injuries, what is X-RAY imaging good for?

A

Cervical: 3 views (AP, lateral and open mouth Peg)

Thoraco-lumbar: 2 views (AP and lateral)

25
Q

In the context of spinal injuries, what is CT imaging good for?

A

Best for bony anatomy

Perform if:

  1. Suspected spinal injury/focal neurology with normal X-rays
  2. High suspicion
  3. Performing CT head
26
Q

In the context of spinal injuries, what is MRI imaging good for?

A

Best for soft tissues

27
Q

What is Jefferson fracture?

A

Burst fracture of C1

The fracture may result from an axial load on the back of the head or hyperextension of the neck (often diving)

28
Q

What are signs and symptoms of Jeffersons fracture?

A

Pain in upper neck without neurological signs

29
Q

What is fracture of Dens?

A

Fracture of the odontoid process

Type I Fracture - Extends through the tip of the dens. This type is usually stable.
Type II Fracture - Extends through the base of the dens. It is the most commonly encountered fracture for this region of the axis. This type is unstable and has a high rate of non-union.
Type III Fracture - Extends through the vertebral body of the axis. This type can be stable or unstable and may require surgery

30
Q

What is Hangman’s fracture?

A

A fracture of both pedicles, or partes interarticulares, of the axis vertebra (C2)

31
Q

What causes Hangman’s fracture?

A

Falls, rugby, motor accidents, hanging

32
Q

What is spinal shock?

A

Loss of reflexes below the level of spinal cord injury

Occurs immediately after injury

33
Q

How would you assess muscle strength?

A

0 - no muscle contraction
1 - muscle flickers
2 - Full range of motion, gravity eliminated
3. Full range of motion, against gravity
4. Full range of motion against resistance
5. Normal strength

34
Q

What is an incomplete spinal cord injury?

A

An “incomplete” spinal cord injury involves the preservation of motor or sensory function below the level of injury in the spinal cord

35
Q

What is the function of C1-C6?

A

Neck flexors

36
Q

What is the function of C1-T1?

A

Neck extensors

37
Q

What is the function of C3, C4, C5?

A

Supply diaphragm (mainly C4)

38
Q

What is the function of C5, C6?

A

Move shoulder, raise arm (deltoid); flex elbow (biceps)

39
Q

What is the function of C6?

A

Supination of arm

40
Q

What is the function of C6, C7?

A

Extend elbow and wrist (triceps and wrist extensors); pronate wrist

41
Q

What nerve innervates the diaphragm?

A

Phrenic nerve

42
Q

What is the function of C7, T1?

A

Flex wrist; supply small muscles of the hand

43
Q

What is the function of T1-T6?

A

Intercostals and trunk above the waist

44
Q

What is the function of T7-L1?

A

Abdominal muscles

45
Q

What is the function of L1-L4?

A

Flex thigh

46
Q

What is the function of L2, L3, L4?

A

Adduct thigh; Extend leg at the knee (quadriceps femoris)

47
Q

What is the function of L4, L5, S1?

A

abduct thigh; Flex leg at the knee (hamstrings); Dorsiflex foot (tibialis anterior); Extend toes

48
Q

What is the function of L5, S1, S2?

A

Extend leg at the hip (gluteus maximus); Plantar flex foot and flex toes

49
Q

What happens after complete cervical spine cord injury of C1-C4?

A

Full paralysis of the limbs

Cannot breathe without mechanical ventilation

50
Q

What happens after complete cervical spine cord injury of C5?

A

Paralysis of the wrists, hands, and triceps

51
Q

What happens after complete cervical spine cord injury of C6?

A

Paralysis of the wrist flexors, triceps, and hands

52
Q

What happens after complete cervical spine cord injury of C7-C8?

A

Some hand muscle weakness, difficulty grasping and releasing

5. Trauma and Accident (9 decks)

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