SPINAL INJURIES Flashcards
What types of fracture of petrous temporal bone has got the highest chance of facial nerve paralysis? A. Longitudinal B. Transverse C. Oblique D. All have equal incidence
Answer- B. Transverse fracture
Transverse fracture of petrous temporal bone is associated with the highest chance of facial nerve paralysis.
Incase of longitudinal fracture, which is the most common type, classically presents with ear canal laceration, tympanic membrane perforation, ossicular disruption leading to conductive hearing loss and facial nerve paralysis(10-20% cases)
Motorcyclist's fracture: A. Ring fracture B. Comminuted fracture C. Separation of suture between anterior and posterior half of skull D. Fracture base of skull
Answer- A. Ring fracture
Motorcyclist’s fracture is a ring fracture of base of skull, separating the rim of foramen magnum from rest of the base. it usually results due to sudden anteroflexion of cervical spine without impact on occiput caused usually by vertical deceleration injury or rarely motorcycle accident.
The commonest cause of spinal cord injuries in our country is A. Road traffic accident B. Fall from a height C. Fall into well D. House collapse
Answer- B. Fall from a height
In developing countries the commonest mode of spinal injuries is fall from height.
Whereas in developed countries, the commonest mode of spinal injuries results from RTA
Dislocation without a fracture is seen in A. Sacral spine B. Lumbar spine C. Cervical spine D. Thoracic spine
Answer- C. Cervical spine
The upper five cervical spine rely primarily on intact ligamentous system for stability. The alar ligaments (key structure), tectorial membrane (rostral extension of posterior longitudinal ligament) serve as important stabilizer of craniocervical junction.
Upper cervical spines has the highest chances of dislocation without fracture as their zygapophyseal joints slope almost in antero-posterior horizontal plane. Whereas in thoracic & lumbar region facet joints are oriented vertically and interlocked.
Whip-lash injury is caused due to A. A fall from height B. Acute hyperextension of the spine C. A blow on top of the head D. Acute hyperflexion of the spine
Answer- B. Acute hyperextension of the spine
Whip-lash injury is mostly caused by sudden hyperextension of neck occurring due to rear end collisions. It most commonly presents as cervical strains and sprains (without fracture)
Jefferson's fracture is A. C1 B. C2 C. C2 C1 D. C2 C3
Answer- A. C1
Jefferson’s fracture is a burst fracture of ring of atlas C1 vertebrae. In most cases it doesn’t lead to neurological deficit. With the exception of pain or loss of sensation in the greater occipital nerve distribution, neurological sequelae are uncommon and more likely to be related to associated injuries.
Hangman's fracture is A. Subluxation of C5 over C6 B. Fracture dislocation of C2 C. Fracture dislocation of ankle joint D. Fracture of the odontoid
Answer- B. Fracture dislocation of C2
Hangman’s fracture is traumatic spondylolisthesis of C2 vertebrae on C3 due to fracture line passing through the neural arch (pedicle/ pars interarticularis)
Dennis stability concept is based on which of the following A. 2 Columns B. 3 Columns C. 4 Columns D. 5 Columns
Answer-B. 3 Columns
Dennis classification system for Thoracolumbar fractures, assigns thoracolumbar osseous and soft tissue structures into 3 columns - Anterior column, middle column and posterior column.
Any injury extending into middle column (i.e. involvoing>2 columns) is considered unstable.
Advanced imaging and status of PLC is no taken into account.
Seatbelt injury is A. Tear drop fracture B. Wedge fracture C. Chance fracture D. Whip-lash injury
Answer- C. Chance fracture
Chance fracture is the flexion-distraction failure of mid-lumbar spine (L1-L3) due to seat belt injury
Spinal shock is associated with A. Increased spinal reflexes B. Absent spinal reflexes C. Loss of autonomic reflexes D. Bizzare reflexes
Answer- B. Absent spinal reflexes > C. Loss of autonomic reflexes
The presence of spinal shock causes the absence of all reflexes; it typically lasts for 24-48 hrs after the injury.
The bulbocavernous reflex is the reflex that returns first, thus marking the end of spinal shock. This point has prognostic importance because recovery from a complete neurological deficit that is still present at the end of spinal shock is extremely unlikely. In other words, a total absence of sensation and voluntary motor functions caudal to the level of spinal injury in the absence of spinal shock is indicative of complete spinal cord injury and there is virtually no likelihood of functional spinal cord recovery.
Disc prolapse commonly occurs at A. L4-L5 B. L5-S1 C. C5-C6 D. C4-C5 E. C3-C4
Answer- A. L4-L5 and B. L5-S1
The commonest site of disc prolapse occurs at the lumbar spine. in more than 90% of cases lumbar disc herniation are localized at L4-L5 (more common) and L5-S1. The next most commonest site of intervertebral disc prolapse is lower cervical spine C6-C7
Substance that is used for vertebroplasty A. Poly methyl methacrylate B. Poly ethyl methacrylate C. Poly methyl ethacrylate D. Poly ethyl ethacrylate
Answer- A. Poly methyl methacrylate
Vertebroplasty or kyphoplasty is percutaneous injection of bone cement (PMMA = Poly methyl methacrylate) into vertebral body.
It can be used in osteolytic spinal mestases, multiple myeloma, aggressive hemangioma, osteoporotic vertebral compression fractures. It is contraindicated in infections. e.g. TB, osteomyelitis, discitis, etc.
A patient involved in RTA presents with quadriparesis, sphincter dysfunction, sensory level up to the upper border of sternum and a respiratory rate of 35/min. The likely level of lesion is A. C1-C2 B. C4-C5 C. T1-T2 D. T3-T4
Answer- B. C4-C5
Level of injury determination
a. Motor level
b. Respiration
c. Sensory level
d. Sphincter dysfunction maybe seen in all levels of injuries.
MOTOR LEVEL - Presence of quadriparesis rules out possibility of lesion below cervical spine. The lesions of thoracic spine will only affect two lower limbs and produce paraparesis or paraplegia.
RESPIRATION - Lesion above C3 result in a total loss of ventilatory function and requires immediate respiratory support or mechanical ventilation d/t paralysis of diaphragm and other intercostal muscles. Lesions of C4-C5 may lead to preserved respiratory function, increased respiratory rate and compensatory use of auxiliary muscles of respiration such as platysma, trapezius and sternocleidomastoid.
SENSORY LEVEL - C2 dermatomes supplies the occiput and upper part of neck; C3 dermatome supplies lower part neck and clavicles; C4 dermatome supplies infraclavicular area upto upper border of sternum.
Other important sensory landmarks are nipple line(T4),xiphoid process (T7), Umbilicus (T10), inguinal region (T12, L1) and perineum and perianal area (S2,S3 & S4)
