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Trauma Course > Spinal Trauma > Flashcards

Spinal Trauma Flashcards

1
Q

What is the function of the spine?

A

To allow spinal motion while protecting the enclosed neural elements from injury. The spinal column forms the foundation of the axil skeleton of the body from the base of the skull to the pelvis

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2
Q

What is the spinal column composed of?

A

7 cervical, 12 thoracic, 5 lumber, 5 sacral and 4-5 coccygeal vertebral segments

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3
Q

What is the basic anatomy for the vertebra?

A

Has an opening (spinal central canal) and multiple processes that serve as level arms for the ligament and muscular attachments

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4
Q

Why is the cervical spine the most vulnerable part of the spine to injury?

A

Because of its mobility and exposure

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5
Q

What provides additional support to the thoracic spine?

A

The rib cage

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6
Q

What is different about the atlas compared to other vertebra?

A

It doesn’t have a body

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7
Q

What is different about the axis compared to other vertebra?

A

It has the dens which goes into the atlas

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8
Q

Where does the spinal cord originate and end in an adult?

A

Originates at the caudal end of the medulla oblongata at the foramen magnum and ends near the L1 bony level at the conus medullaris

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9
Q

What are the 3 tracts of the spinal cord that can be assessed clinically?

A

The lateral corticospinal tract
The spinothalamic tract
The dorsal columns

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10
Q

What is a dermatomes?

A

The area of the skin innervated by the sensory axons within a particular segmental nerve root

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11
Q

What is a sensory level?

A

The lowest dermatome with normal sensory function and can often differ on 2 sides of the body

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12
Q

What are the different mechanisms that can result in a c-spine injury?

A

Atlanto-occipital dislocation
Atlas (C1) fracture
C1 rotary subluxation
Axis fracture

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13
Q

What is the mechanism that results on a atlanto-occipital dislocation?

A

Severe traumatic flexion and dislocation

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14
Q

What happens to most patients that have a Atlanto-occipital dislocation?

A

They die of brain stem destruction and apnoea or have profound neurological impairments.

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15
Q

What is a common causes of death in shaken baby syndrome?

A

Atlanto-occipital dislocation

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16
Q

What are fractures of the atlas commonly associated with?

A

Fractures of the axis (C2)

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17
Q

What is the most common fracture of the C1?

A

Burst / Jefferson fracture

18
Q

What is the typical mechanism that causes a Jefferson/burst fracture?

A

Axial loading: a large load falls on the head or the patient lands on top of their head in a relatively neutral position

19
Q

Are Jefferson/burst fractures commonly associated with spinal cord injuries and are the stable or unstable?

A

Not associated with spinal cord injuries but they are unstable

20
Q

Why is the axis susceptible to a multitude of fractures of note: the pronto is and posterior element fractures?

A

It is the largest cervical vertebra and is the most unusual shape

21
Q

What do a large volume of C2 fractures involve?

A

The odontoid process (a peg shaped protuberance that projects upwards and is normally positioned in contact with the anterior arch of C1)

22
Q

What is a type 1 odontoid fracture?

A

Involves the tip of the odontoid and is relatively uncommon

23
Q

What is a type 2 odontoid fracture?

A

Occurs through the base of the dens and is the most common fracture

24
Q

What is a type 3 odontoid fracture?

A

Occurs at the base of the dens and extends obliquely into the body of the axis

25
Q

What is a hangman’s fracture?

A

The posterior element fracture of C2

26
Q

What is the mechanism of a posterior element fracture?

A

Extension type injury

27
Q

What are the 3 regions of the thoracolumbar spine?

A

Thoracic spine (T1-10)
Thoracolumbar junction (T10-L2)
Lumbar spine (L3-L5)

28
Q

What part of the spine requires a huge amount of energy to produce fractures and dislocations due to it functionally rigid structure?

A

The thoracic spine

29
Q

Why is there a high risk of spinal cord damage if a patients gets a thoracic spinal injury?

A

The narrow spinal canal

30
Q

What % of thoracolumbar region fractures are unstable and can result in significant disability, deformity and neurological deficit?

A

50%

31
Q

How are burst fractures characterised?

A

Disruption of the anterior and middle column of the spine with some degree of compromise of the spinal canal from the retro pulsed bony fragments

32
Q

What part of the spinal column is involved in a compression fracture and what is the typical mechanism for them?

A

The anterior column and as a result of axial loading

33
Q

What do a the most common fracture of the thoracolumbar spine and are the stable or unstable?

A

Compression fractures and they are stable - rarely associated with any neurological deficit

34
Q

What are flexion-distraction injuries also know as?

A

Chance injuries and seatbelt injuries

35
Q

What part of the spinal column is involved in a flexion-distraction injury and what is the centre of rotation for these injuries?

A

Middle and posterior column
The anterior longitudinal ligament or anterior to the vertebral body

36
Q

Are fracture dislocations of the spinal column stable or unstable fractures and what part of the spinal column do they effect?

A

Extremely unstable and involve all 3 columns of the spine

37
Q

How do fracture dislocations of the spine occur?

A

Through a combination of rotation, flexion and translations

38
Q

What is the the result of a fracture dislocation for the patient?

A

They usually result in neurological deficit, 50% are complete lesions

39
Q

What are primary spinal cord injuries a direct result of?

A

Mechanical forces - shear, laceration, distraction, compression

40
Q

What causes secondary spinal cord injury?

A

As a response of the initial insult haemorrhage, oedema and ischeamia rapidly follow extending to surrounding neural tissue. A subsequent biochemical cascade leads to delayed or secondary cell death that evolves over days to weeks

41
Q

What is used to classify spinal cord lesions as neurologically complete of incomplete?

A

The American Spinal Injury Association Scale (ASIA)

42
Q

Why is it important that spinal cord injuries are classified as being neurologically complete or incomplete?

A

It is important prognosticator as incomplete injuries have a chance at neurological recovery whereas motor recovery is rarely achieved in patients with a complete injury during the first 24 hours after injury

Trauma Course (17 decks)

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