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Orthotic Study > Spinal Injuries > Flashcards

Spinal Injuries Flashcards

1
Q

Mechanisms of Injury

A

1) Penetrating Injury (gunshot, knife wound etc.)

2) Blunt Injury - most common, involves number of forces that occur in combination

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2
Q

Types of Blunt Injury

A

1) Forced flexion (anterior) or flexion with rotation
2) Forced extension (hyperextension)
3) Vertical compression (axial loading)

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3
Q

The most mobile regions of the spine are

A

Cervical and the thoracolumbar junction

Are also most common sites of injury

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4
Q

Types of Vertebral Fracture /(7)

A 
Simple
Compression or Wedge
Communicated or Burst Fracture
Teardrop
Dislocation
Subluxation
Fracture Dislocation
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5
Q

Simple Fracture

A

Generally involves elements of the neural arch (spinous or transverse process)

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6
Q

Compression or Wedge

A

Anterior compression to the vertebral body

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7
Q

Communicated or Burst

A

Shattering injury to vertebral body
Likelihood of fragments impinging on spinal cord
Resultant severe damage

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8
Q

Teardrop

A

Small fragment chipped away from vertebral body
Free to lodge in the spinal canal

Associated with posterior dislocation of the vertebral body
Neurological deficit
Removal of bone fragment if in canal

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9
Q

Subluxation

A

Partial or incomplete dislocation of one vertebral over another

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10
Q

Fracture Dislocation

A

Fracture or dislocation with ligament and cord injury

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11
Q

Unstable Spinal Injury

A

Vertebral and ligamentous structures are not able to support or protect the injured spine

Moment may increase pressure on spinal cord and further neurological deficit

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12
Q

Stable Spinal Injury

A

Bony and/or ligamentous structures support the injured area sufficiently to prevent progression of the neurological deficit and prevent bony deformity

If posterior elements (ligament between neural arch and the articulating facet joints) survive the injury, it is considered stable

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13
Q

Stability Classification system (Column Concept)

A

Anterior, Middle and Posterior Columns

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14
Q

Anterior Column

A

Anterior Longitudinal ligament and anterior 2/3 vertebral body and intervertebral disc

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15
Q

Middle Column

A

Posterior Longitudinal ligament, posterior 1/3 of the intervertebral disc and posterior wall of the the vertebral body

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16
Q

Posterior Column

A

Neural arch (lamina, pedicles, and ligamentum flavum), the articular processes and facet joint capsules, the spinous processes and the interspinal ligaments

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17
Q

4 Major Categories of Spinal injuries

A

Forward flexion (anterior compression fractures)

Flexion- axial compression (burst)

Flexion- distraction injuries (seat belt injuries and chance fractures)

Fracture-dislocation (sheer injuries that cause sagittal or coronal plane translation)

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18
Q

Spinal Injuries with disruption of all 3 columns

A

are considered to be unstable

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19
Q

C1 Fractures/ Atlas/ Jefferson Fractures

A

Axial loading through top of the head

Most common cause of disruption of the ring of the C1 vertebra

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20
Q

C2 Fractures / Axis

A

Most commonly, odontoid process or posterior element damage

Flexion typically the mechanism

Hangman’s fracture is through posterior elements, caused by forced hyper extension

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21
Q

Are C1, C2 fractures commonly associated with neurological deficit?

A

No

22
Q

Common Injuries to Sub Axial Cervical Spine (C3-C7)

A

Most commonly axial load flexion fractures with burst type of injury

OR

Flexion distraction with uni or bilateral locking of the facet joint depending on amount of rotation that occured

Subluxation and relocation without fracture may result in neurological deficit without visual damage, this is more commonly caused by hyperextension injury

23
Q

Common Injuries to the Thoracic Spine

A

Usually a fracture or fracture dislocation

Various mechanisms, but most commonly axial loading and flexion with rotation

Anterior compression results in varying degree of posterior protrusion or kyphosis

24
Q

Thoracolumbar Junction

A

Susceptible area for spinal injury

Area of stress and increased mobility below rigid rib cage

Associated with flexion and rotational forces with resultant conus and/or cauda equina lesion

A fall will often result in a compression fracture

25
Q

Lumbar and Sacral

A

Fractures within these regions resemble those of the thoracolumbar junction

26
Q

Chance Fractures

A

Lap belt injury unique to lumbar spine (most commonly L1, L2)

Caused by severe flexion and rotation around a fixed axis (pelvis secured by belt)

Leads to bony and ligamentous disruption to the lumbar spine

Anterior compression to vertebral body
Transverse fracture through posterior elements of the vertebrae

Associated with internal abdominal injuries

27
Q

Determining Neurological Impairment

A

Examinations of dermatomes and myotomes together, level of injury may be established, determine what functions remain

28
Q

Insult to spinal cord, several mechanisms cause progressive damage

A

Related to mechanical insult

Biochemical responses

Hemodynamic changes, often associated with multiple trauma

29
Q

Primary Pathological changes after injury

A

Bleeding and swelling at site of injury can cause severe necrosis of gray matter

30
Q

Secondary Pathological changes

A

Associated Biochemical and hemodynamic changes alter physiological response to injure

Changes in systemic blood flow and oxygen tension

May cause impaired CNS function/systemic blood loss, damaging delicate structure of spinal cord

31
Q

Quad/tetraplegia

A

Impairment or loss of motor and/or sensory function in cervical segments of spinal cord due to damage of neural elements within canal

Impaired function of 
arms
trunk
pelvic organs
legs

Does not include brachial plexus lesions or injury to peripheral nerves outside the neural canal

32
Q

Paraplegia

A

Impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord

Secondary to damage of neural elements within the canal

Arm function spared depending on level of injury

Trunk, pelvic organs, and legs maybe involved

Term used in referring to cauda equina and conus medullaris injuries

Does not involve lumbosacral plexus lesions or peripheral nerves outside the canal

33
Q

Complete Transverse Syndrome

A

Below level of injury there is loss of all motor and sensory nerve transmissions

34
Q

Causes of complete paraplegia or quadraplegia

A

Complete severence of spinal cord

Complete breakage of nerve fibers by stretching of the cord, coverings may still be intact with normal appearance

Complete ischemia of the cord, interruption of the total blood supply

35
Q

Incomplete Syndromes

A

Central Cord

Anterior Cord

Brown-Sequard

Conus and Cauda Equina Injuries

36
Q

Central Cord Syndrome Cause

A

Damage to central portion of cervical cord

Corticospinal tract fibres are organized with arms most central, trunk immediately, and legs laterally

36
Q

Brown - Sequard Syndrome Cause

A

Damage to one side of the cord only

36
Q

Conus and Cauda Equina Results

A

Loss of motor function
Sensory function not markedly impaired
Extremely variable pattern with asymmetrical involvement
Roots have some recovery potential, causing outlook to be favorable
Lower motor neuron (flaccid) invovlement of bowels, bladder and sexual function because those reflexes are controlled within the conus

36
Q

Central Cord Syndrome Results

A

Fibres located most centrally are damaged with those more laterally spared

Arms affected but legs may not be

Some distal nerve transmission is intact

36
Q

Anterior Cord Syndrome Results

A

Loss of function below injury level to cord portion responsible for voluntary motor pathways and major sensory tract

Sparing of posterior column due to alternate blood supply

Position, vibration, and touch sense are preserved

36
Q

Conus and Cauda Equina Injuries Cause

A

Damage to the conus medullaris or spinal nerves forming the cauda equina

37
Q

Anterior Cord Syndrome Cause

A

Usually caused by damage due to infarction from main artery

Resultant blood loss to anterior 2/3 of the cord

Posterior cord is unaffected

37
Q

Factors in determining appropriate management of cervical injury

A

Type of fracture and/or associated dislocation

Stability

Alignment

38
Q

Cervical Fracture or Fracture/Dislocation requires reduction

A

Patient put in traction with weights applied to CB tongs or a halo ring

Generally 20-30 lbs are used to reduce and maintain the alignment of a fracture

Up to 120 lbs can be used to reduce locked facet joints

39
Q

Cervical orthosis provides 3 primary functions

A
  1. Motion restriction to protect or prevent pain
  2. Motion restriction to protect spinal instability pre-post surgery
  3. Emergency protection - immediately following trauma
40
Q

Spinal mobility

A

Cervical > Lumbar > Thoracic

Thoracic spine possess greater flexion than extension

Lateral flexion increases in the caudal direction, while axial rotation decreases

41
Q

Brown- Sequard Results

A

Ipsilateral loss of function below injury level, ipsilateral motor paralysis

Loss of pain and temperature sensation on the contralateral side of the body

42
Q

Biomechanical Principles of Orthotic Design

A

Balance horizontal forces

Fluid compression

Distraction

Construction of cage around patient

Placement of irritant = kinesthetic reminder

Skeletal fixation

Increase intra-abdominal pressure to decrease vertebral load

Restriction of motion:
Damage to posterior element, instability increases with flexion
Damage to the anterior element, instability increases with extension

43
Q

Surgical Management

A

Posterior Wiring

Anterior decompression

Contoured anterior spinal plate

44
Q

Neutral head position

A

Alignment of patient head with respect to the body is crucial for device success

Know neutral head position in the coronal and sagittal plane

Be aware that this position may vary with each patient according to pain and comfort

Orthotic Study (45 decks)

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