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Orthotics2 > Spinal Injury > Flashcards

Spinal Injury 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 rotation2) 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 junctionAre also most common sites of injury

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4
Q

Types of Vertebral Fracture /(7)

A

SimpleCompression or WedgeCommunicated or Burst FractureTeardropDislocationSubluxationFracture 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 bodyLikelihood of fragments impinging on spinal cordResultant severe damage

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8
Q

Teardrop

A

Small fragment chipped away from vertebral bodyFree to lodge in the spinal canalAssociated with posterior dislocation of the vertebral bodyNeurological deficitRemoval 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 spineMoment 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 deformityIf 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 headMost 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 damageFlexion typically the mechanismHangman’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 ORFlexion distraction with uni or bilateral locking of the facet joint depending on amount of rotation that occuredSubluxation 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 dislocationVarious mechanisms, but most commonly axial loading and flexion with rotationAnterior compression results in varying degree of posterior protrusion or kyphosis

24
Q

Thoracolumbar Junction

A

Susceptible area for spinal injuryArea of stress and increased mobility below rigid rib cageAssociated with flexion and rotational forces with resultant conus and/or cauda equina lesionA 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 spineAnterior compression to vertebral body Transverse fracture through posterior elements of the vertebraeAssociated 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 insultBiochemical responsesHemodynamic 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 injureChanges in systemic blood flow and oxygen tensionMay 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 canalImpaired function of armstrunkpelvic organslegsDoes 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 cordSecondary to damage of neural elements within the canalArm function spared depending on level of injuryTrunk, pelvic organs, and legs maybe involvedTerm used in referring to cauda equina and conus medullaris injuriesDoes 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 cordComplete breakage of nerve fibers by stretching of the cord, coverings may still be intact with normal appearanceComplete ischemia of the cord, interruption of the total blood supply

35
Q

Incomplete Syndromes

A

Central CordAnterior CordBrown-SequardConus and Cauda Equina Injuries

36
Q

Central Cord Syndrome Cause

A

Damage to central portion of cervical cordCorticospinal tract fibres are organized with arms most central, trunk immediately, and legs laterally

37
Q

Brown - Sequard Syndrome Cause

A

Damage to one side of the cord only

38
Q

Conus and Cauda Equina Results

A

Loss of motor functionSensory function not markedly impairedExtremely variable pattern with asymmetrical involvementRoots have some recovery potential, causing outlook to be favorableLower motor neuron (flaccid) invovlement of bowels, bladder and sexual function because those reflexes are controlled within the conus

39
Q

Central Cord Syndrome Results

A

Fibres located most centrally are damaged with those more laterally sparedArms affected but legs may not beSome distal nerve transmission is intact

40
Q

Anterior Cord Syndrome Results

A

Loss of function below injury level to cord portion responsible for voluntary motor pathways and major sensory tractSparing of posterior column due to alternate blood supplyPosition, vibration, and touch sense are preserved

41
Q

Conus and Cauda Equina Injuries Cause

A

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

42
Q

Anterior Cord Syndrome Cause

A

Usually caused by damage due to infarction from main arteryResultant blood loss to anterior 2/3 of the cordPosterior cord is unaffected

43
Q

Factors in determining appropriate management of cervical injury

A

Type of fracture and/or associated dislocationStability Alignment

44
Q

Cervical Fracture or Fracture/Dislocation requires reduction

A

Patient put in traction with weights applied to CB tongs or a halo ringGenerally 20-30 lbs are used to reduce and maintain the alignment of a fractureUp to 120 lbs can be used to reduce locked facet joints

45
Q

Cervical orthosis provides 3 primary functions

A
  1. Motion restriction to protect or prevent pain2. Motion restriction to protect spinal instability pre-post surgery3. Emergency protection - immediately following trauma
46
Q

Spinal mobility

A

Cervical > Lumbar > ThoracicThoracic spine possess greater flexion than extensionLateral flexion increases in the caudal direction, while axial rotation decreases

47
Q

Brown- Sequard Results

A

Ipsilateral loss of function below injury level, ipsilateral motor paralysisLoss of pain and temperature sensation on the contralateral side of the body

48
Q

Biomechanical Principles of Orthotic Design

A

Balance horizontal forcesFluid compressionDistractionConstruction of cage around patientPlacement of irritant = kinesthetic reminderSkeletal fixationIncrease intra-abdominal pressure to decrease vertebral loadRestriction of motion: Damage to posterior element, instability increases with flexionDamage to the anterior element, instability increases with extension

49
Q

Surgical Management

A

Posterior WiringAnterior decompressionContoured anterior spinal plate

50
Q

Neutral head position

A

Alignment of patient head with respect to the body is crucial for device successKnow neutral head position in the coronal and sagittal planeBe aware that this position may vary with each patient according to pain and comfort

Orthotics2 (9 decks)

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