Spinal Injury

Question 1

What are the curvatures of the vertebral column and distinct parts of the vertebrae, articulations and muscles of the spine?

Answer 1

Curvatures

• cervical = lordosis
• thoracic = kyphosis
• lordosis = lordosis

Parts of vertebrae

Articulations:

• superior articular process
• inferior articular process
• intervertebral disc
• costovertebral joints

Muscles of the spine

• psoas
• erector spinae
• multifidus

Question 2

What is a myotome and a dermatome?

Answer 2

Myotome is the group of muscles that a single spinal nerve innervates

Dermatome is an area of skin that is mainly supplied by a single spinal nerve

Question 3

What is the classification of spinal injury?

Answer 3

Fractures & Spinal cord injuries:
Complete
Incomplete

Classified via the ASIA scale A (worst) to E (normal)

Question 4

What are the main causes of spinal injury in the UK?

Answer 4

Road traffic accidents
Sport and recreational activities
Falls

Question 5

What is spasticity, quadriplegia and paraplegia?

Answer 5

Quadriplegia: partial or total loss of use of all four limbs and the trunk

Spasticity: increased muscle tone, upper motor neurone lesion, spinal cord and above, injuries above L1

Paraplegia: partial or total loss of use of the lower limb, impairment or loss of motor/sensory function in T, L or S segments of the spinal cord, arm function spared

Question 6

What are the clinical features of cervical, thoracic, lumbar and sacral injury?

Answer 6

Cervical = quadriplegia, respiratory failure, spasticity

Thoracic/lumbar = associated chest or abdominal injuries, spasticity if injury of spinal cord eg above L1, bladder/bowel function affected

Question 7

What are the initial stages of management in spinal injury?

Answer 7

Prevent secondary insult 
- ABCD: airway (control c spine), breathing (oxygen and ventilation, concomitant chest injuries) circulation (IV fluids, consider neurogenic shock, low BP and HR, loss of sympathetic tone, vasopressors) disability (assess neurological function including PR and perianal sensation, log rolling, document)
- ATLS 
Imaging: x ray, ct, mri 
Surgical fixation for unstable fractures

Question 8

What are the surgical options and long term rehabilitation in spinal injury?

Answer 8

Spinal cord injury unity
Physiotherapy
Occupational therapy
Psychological support
Urological/sexual counselling

Question 9

What is neurogenic and spinal shock?

Answer 9

Spinal shock is transient depression of cord function below level of injury, flaccid paralysis, areflexia, lasts several hours to days.

Neurogenic shock is hypotension, bradycardia, hypothermia, injuries above T6, secondary to the disruption of sympathetic outflow.