Spinal Injury Flashcards
Give 4 functions of the spine
Support the axial skeleton
Movement of the trunk
Protect the spinal cord
Haematopoeisis
What spinal fractures are most common and why?
Thoracolumbar fractures most common
Majority L1 and T12
- Transition between fixed thoracic spine and free lumbar spine
- Fewer further from junction
When assessing a spinal fracture where else should you check?
THE WHOLE SPINE
10% of spinal fractures will have another spinal injury
-Remember distracting injuries
Give signs and symptoms of spinal injury
Pain
Flaccidity, paralysis, numbness
Paraesthesia, paresis, weakness
Priapism, incontinence etc
Need to rule out abdominal trauma
Spinal shock versus neurogenic shock
Hypotension, bradycardia, vasodilation
What is the difference between spinal and neurogenic shock?
Spinal shock is transient
-Flacid areflexic paralysis
Neurogenic shock effects autonomic NS
-Vascularities dilate
What are the 5 ASIA assessment groups for spinal injury
A B C D E
What is ASIA A
A = “complete” spinal cord injury
-No motor or sensory function
What is AISA B
B = “incomplete” spinal cord injury
-Sensory but not motor function preserved bewlow neurological level
iIncludes the sacral segments S4-S5
-Transient phase and if recovers motor incomplete i.e. ASIA C or D
What is ASIA C
C = “incomplete” spinal cord injury
- Motor function preserved below the neurological level
- More than half of key muscles below the neurological level have a muscle grade of less than 3
What is ASIA D
D = “incomplete” spinal cord injury
-Motor function is preserved below the neurological level and at least half of key muscles below the neurological level have a muscle grade of 3 or more
What is ASIA E
E = “normal” where motor and sensory scores are normal.
Can have spinal cord injury and neurological deficits with completely normal motor and sensory scores
What segmental spinal cord levels control neck flexors and extensors?
C1-C6 = Neck flexors
C1-T1 = neck extensors
What segmental spinal cord levels control diaphragm?
C3,C4 and C5
mostly C4
What segmental spinal cord levels control shoulder movement and flexion of elbow joint?
C5 and C6
Shoulder movement, raise arm (deltoid); flexion of elbow (biceps)
What segmental spinal cord levels externally rotate the arm (supinate)?
C6
What segmental spinal cord levels extend elbow and wrist (triceps and wrist extensors); pronates wrist
C6 and C7
What segmental spinal cord levels flex wrist and supply the small muscles of the hand?
C7 and T1
What segmental spinal cord levels supply intercostals and trunk above the waist?
T1-T6
What segmental spinal cord levels supply abdominal muscles?
T7-L1
What segmental spinal cord levels control thigh flexion?
L1-L4
What segmental spinal cord levels control thigh abduction and adduction?
Abduction = L4, L5 and S1
Adduction = L2, L3 and L4
What segmental spinal cord levels control extension of the leg at the hip (Gluteus maximus)?
L5, S1, S2
What segmental spinal cord levels control extension of the leg at the knee (quadriceps femoris)?
L2, L3 and L4
What segmental spinal cord levels control flexion of the leg at the knee (hamstrings)?
L4, L5, S1 and S2
What segmental spinal cord levels control dorsiflextion of the foot (tibialis anterior)?
What about plantar flexion of foot?
L4, L5, S1
Plantarflexion = L5, S1 and S2
What segmental spinal cord level controls extension of the toes?
What about flexion of the toes
L4, L5 and S1
Flexion = L5, S1 and S2
What are the features of anterior cord syndrome?
Both motor and sensory pathways
Crude sensation, movement and fine sensation lost
What are the features of central cord syndrome?
Weakness and paralysis of both arms and some sensory loss
Legs less effected
What are the features of Brown-Sequard syndrome?
Injury to half of cord
Movement and some sensory loss below injury
Pain and temperature on opposite side
How do you initially manage someone who may have attained a spinal injury?
Mechanism of injury
Other associated injuries
Prevent secondary injury
Immobilise the spine
Spinal injury only part of the picture
Immediate life threatening injuries
Haemorrhage
What is a chance fracture?
It consists of a compression injury to the anterior portion of the vertebral body and a transverse fracture through the posterior elements of the vertebra and the posterior portion of the vertebral body. It is caused by violent forward flexion, causing distraction injury to the posterior elements.
What are burst fractures?
A vertebra breaks from a high-energy axial load (e.g., traffic collisions or falls from a great height or high speed, and some kinds of seizures), with sharps of vertebra penetrating surrounding tissues and sometimes the spinal canal.
Burst fractures are considered more severe than compression fractures because long-term neurological damage can follow. The neurologic deficits can reach their full extent immediately, or can progress for a prolonged time.
What is a wedge compression fracture?
A compression fracture is a common fracture of the spine. It implies that the vertebral body has suffered a crush or wedging injury.
This may cause the front part of the vertebral body to crush forming a wedge shape. This is known as a compression fracture. If the entire vertebral body breaks, this is considered a burst fracture.
What does SCIWORA stand for?
Spinal Cord Injury Without Radiographic Abnormality
What is a Clay Shoveler’s fracture?
Clay-shoveler’s fracture is a stable fracture through the spinous process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae, classically at C6 or C7
What is a Jefferson fracture?
A Jefferson fracture is a bone fracture of the anterior and posterior arches of the C1 vertebra, though it may also appear as a three- or two-part fracture. The fracture may result from an axial load on the back of the head or hyperextension of the neck (e.g. caused by diving), causing a posterior break, and may be accompanied by a break in other parts of the cervical spine.
What is a hangman’s fracture?
A hangman’s fracture is the colloquial name given to a fracture of both pedicles or pars interarticularis of the axis vertebra (C2) (or epistropheus).
