SPINAL INJURIES

Question 1

Vertebral fractures occur most commonly in what part of the spine?

Answer 1

Cervical – 55%

Question 2

If a patient has a fracture, dislocation, of disruption of the disc – what type of injury is this?

Answer 2

Primary

Question 3

If a patient has tearing of the ligaments in the c-spine is it a primary or secondary injury?

Answer 3

Primary

Question 4

What type of spinal cord injury will affect proprioception or vibration on the SAME side at the injury?

Answer 4

Dorsal column injury

Question 5

What type of spinal cord injury involves impairment to sensation on the OPPOSITE side of the injury?

Answer 5

Anterior column injury

Question 6

Where do we begin with evaluating a patient with a potential spinal cord injury?

Answer 6

ABCD!

Then look at gross motor, sensation, and reflexes

Question 7

A biker comes in with his helmet still on, with a collar on the spine board, what do you do about the headgear?

Answer 7

Leave it on! You might need to remove/cut clothing

Question 8

After you have completed ABCD, what do you do?

Answer 8

Secondary survey – with the patient off the board

Question 9

Walk me through the log-roll process to maintain spinal immobilization & complete your secondary survey?

Answer 9

Person at the head calls out 1, 2, 3 – then simultaneous roll the patient onto their side

When on side = Evaluate back, palpate thoracic, lumbar, and sacral spine. Look for injuries!

Move the patient back into the supine position on the board → now removal the collar and palpate along the spinous processes, make sure there’s no pain

Question 10

According to the Canadian c-spine rules, there are 3 major steps with subsequent questions to rule in/out the need for radiographs. What are the questions?

Answer 10

1. High-Risk Factors – Age >65; dangerous mechanism; paresthesia in extremities
2. Low-Risk Factors – Simple MVA; Sitting position; Ambulatory at any time; Delayed onset of neck pain***; Absence of midline c-spine tenderness.
3. Able to Actively Rotate Neck – 45 degrees to right & left

Question 11

If a patient has a loss of spontaneous breathing – what level?

Answer 11

C4

Question 12

If a patient can’t flex their fingers – what level?

Answer 12

C8/T1

Question 13

If a patient can’t flexion at the elbows/biceps – what level?

Answer 13

C6

Question 14

If a patient has a loss of intercostal muscle & abdominal muscle use – what level?

Answer 14

T1/T2

Question 15

If a patient can’t shrug their shoulders – what level?

Answer 15

C5

Question 16

Do normal radiographs rule out significant injury?

Answer 16

Nope; best for “low risk” patients

Question 17

If a patient has a c-spine fracture with a mechanism of diving – what vertebrae is most likely involved, what is it called?

Answer 17

C1 = Jefferson fracture

Question 18

Will a patient have sxs with a Jefferson fracture?

Answer 18

Not really (ring gets huge & spreads out)

Question 19

What c-spine fracture accounts for more than ½ of all cervical fractures and is extremely unstable?

Answer 19

C2 = Odontoid fracture

Question 20

What other type of fracture occurs at C2? What is the mechanism?

Answer 20

Hangman’s fracture

- Forced hyperextension

Question 21

Will fractures of C2 (hangman’s or odontoid) have symptoms?

Answer 21

Most likely not

- Especially Hangman’s

Question 22

What type of complication can arise with a Hangman’s fracture?

Answer 22

Central cord syndrome (more weakness in the UE than LE)

Question 23

What type of cervical fracture often presents with the patient hearing a pop, followed by sudden pain between the shoulder blades?

Answer 23

Clay shoveler’s fracture

Question 24

What is the NEXUS criteria for spine trauma?

Answer 24

• Absence of midline cervical tenderness
• Normal level of alertness and consciousness
• No evidence of intoxication
• Absence of focal neurological deficit
• Absence of painful distracting injury
• A no in any one of the 5 indicates no need for plain c-spine imagine

Question 25

If a patient has complete paralysis below a certain level with loss of pain & temperature sensation, however, vibration, position, and tactile sensation are preserved – what diagnosis? What are the most likely MOI’s?

Answer 25

Anterior cord syndrome (damage to the corticospinal & spinothalamic pathways, with preservation of the posterior column function)

MOI = Direct anterior cord compression, flexion of c-spine, or thrombosis of anterior spinal artery

Question 26

If a patient presents with decreased strength and only mild decreased pain & temperature sensation in the UE more than the LE; with vibratory & position sensation preserved along with bowel/bladder control – what diagnosis? What MOI?

Answer 26

Central cord syndrome

MOI = hyperextension, disruption to blood flow in the spinal cord, and cervical spinal stenosis (these have a good prognosis)

Question 27

If a patient presents after a trauma with ipsilateral loss of motor function (spastic paresis), loss of proprioception and vibratory sensation; contralateral loss of pain and temperature sensations – what diagnosis? What MOI?

Answer 27

Brown-Sequard syndrome

MOI = Penetrating injury! Transverse hemisection of the spinal cord, unilateral cord compression (disc protrusion, hematoms, spine fracture, infections, or tumors)

Question 28

If a patient presents with sxs of bowel/bladder dysfunction, decreased rectal tone, and saddle anesthesia – what diagnosis?

Answer 28

Cauda equina syndrome

Question 29

If a patient presents with motor & sensory loss in the LE, with decreased LE reflexes, and sciatica – what diagnosis?

Answer 29

Cauda equina syndrome