Spinal Trauma Flashcards
how is the spine connected to the upper and lower limbs?
The spine acts as the central axis of the skeleton
Linked to the upper limbs via the thoracic cage and pectoral girdle.
Linked to the lower limbs via the pelvis
what is the function of the spine?
Supports the skull
Protects the neural elements
The strength of column is due to:
the size and architecture of the bony elements
strength of the ligaments and muscle that support it
what are 3 anatomical landmarks of the spine?
Spinal cord: runs from C1-T12
Conus medullaris: lies at T12-L1
(tapered end of the lower spinal cord)
Cauda equina: runs from L2-Sacrum
what is a dermatomal map used for?
Where the pain lies on the body can tell us what nerve roots are being compressed
how and why are muscles grouped together into “muscle groups” ?
Some muscle groups are supplied by individual nerves.
Therefore muscle abnormalities can also tell us what nerves are being compressed.
what does the following important terminology mean?
Radiculopathy
Myelopathy
Quadriplegia
Paraplegia
Paraparesis
Radiculopathy: nerve root injury
Myelopathy: cord injury
Quadriplegia: loss of function in upper and lower limbs
Paraplegia: loss in function of lower limbs
Paraparesis: weakness in legs due to cord or root compression
what are the implications of neural compressions at different spinal levels?
Neural compressions:
Above C4 –> loss of ventilation
C5 –> quadriplegia
C5 - T1 –> decreasing arm function
T1 - L1 –> paraplegia
L2 - L5 –> decreasing leg function
L5 and below:
- Impaired sphincter and sexual function
- Foot + ankle weakness
Cervical and thoracic cord compression leads to:
Spastic paresis/paralysis
Paresis: muscular weakness (partial paralysis) caused by nerve damage or disease.
Increased tone and clonus
Clonus: involuntary, rhythmic, muscular contractions and relaxations
Brisk reflexes
Extensor plantar response
When the sole of the foot is stimulated you would expect a plantar response. However an extensor (dorsiflexion) response is produced.
Retention, overflow and automatic bladder
Cauda equina and compression below L1 leads to:
Radicular weakness
Muscle wasting and fasciculation
Autonomous dribbling bladder
Decreased tone and loss of reflexes
Impotence
Inability to achieve an erection
what are the causes of spinal trauma?
Road traffic accidents – 50%
Falls from a height – 20%
Violent assault – 15%
Sport and recreation – 15%
What is the initial assessment that is carried out for spinal trauma?
Advanced trauma life support (ATLS) protocol:
Airway assessment
Cervical spine control
Asses Breathing
Asses Circulation
Hypovolemic shock: loss of more than 20% of blood
Neurogenic shock - results in low blood pressure
Not volume depleted, they are vasodilated
Treat with vasopressors
Bradycardic due to unopposed vagal activity
what factors increase suspicion of a spinal cord injury?
Mechanism of injury:
- Blunt trauma above the clavicle
- Facial fractures
Altered consciousness
Ankylosing spondylitis: inflammation of spine
Flaccid areflexia
Loss of anal tone
Priapism: Prolonged erection
Spinal shock: loss of reflex, motor and sensory function
Test for bulbo-cavernosus reflex
how do you clear the cervical spine (determine whether cervical spine injuries exist) if the patient is alert?
If there is no tenderness and full ROM (range of movement) then no x-rays needed
If there is pain and reduced ROM perform a cervical spine series (a set of radiographs taken to investigate the bony structures of the cervical spine) and potentially CT scans/MRI.
how do you clear the cervical spine (determine whether cervical spine injuries exist) if the patient is non-cooperative?
Always perform C-spine series
If these are normal then retain the collar until they become cooperative or an MRI has been performed.
what would a radiograph of a spine look like?
Always get coronal (font on) and sagittal view (side on)
They are very good at identifying bony injury
Not very good at picking up soft tissue injuries
what is the systematic approach of looking at Xray of spine?
A – adequacy and alignment
B – bony abnormality
C – contours and cartilage
D – disc spaces
what is the percentage of fractures that are missed?
15% cervical and 5% thoracolumbar
10% incidence of subsequent neurological deficit in missed fractures
Up to 75% of fractures are missed in patients with ankylosing spondylitis
Ankylosing spondylitis with trauma and pain is a fracture until proven otherwise
Fractures are commonly missed due to:
Polytrauma (other fractures distract)
Inadequate x-ray
Head injury (distract)
Non-contiguous fracture (injuries at more than one site)
how does instability of the VC occur?
Dennis divided the vertebral column into 3 vertical parallel columns.
These are the anterior column, the middle column and the posterior column.
Instability occurs when 2 or more columns are disrupted due to injury.
what are the 4 types of injuries to the spine?
Wedge compression
Flexion distraction type injuries
Burst fracture
Fracture dislocation
what is wedge compression?
in which the front of the vertebral body collapses due to crushing, but the back does not, meaning that the bone assumes a wedge shape.
- Anterior column fails
- Usually stable
- Mildest fracture
- Potentially unstable
- 50% loss of height
- 30O degree kyphosis
what is a Flexion distraction type injury?
Example: ‘Seat-belt’ or ‘chance’ fracture
- Unstable injury – all three columns fail
- Facet joint dislocation
- Treated via reduction and surgical fusion:
- Patients remain neurologically intact as spinal cord gets decompressed as it opens up.
what is a burst fracture?
vertebral body is crushed in all directions
- Unstable - Anterior and middle columns fail.
- Usually requires surgery
- Need to assess posterior ligamentous complex (PLC)
