Spinal Trauma

Question 1

Who? Cause?

Answer 1

• DUDES!!! Males (life of adventure…)
• MC auto-accident
• blunt trauma
• often PREVENTABLE

Question 2

Long-term spinal injury effects

Answer 2

• less employment
• divorce
• shorter life expectancy

Question 3

how many vertebrae?

Answer 3

33

Question 4

Fracture through cervical vertebral foramen?

Order

Answer 4

CT w/ contrast = spinal cord injury

*blunt force

Question 5

Thoracic vertebral fracture?

Investigate

Answer 5

Spleen/liver lac, etc.

*HUGE force needed

Question 6

Lumbar vertebral fracture

MC?

Answer 6

Compression

Question 7

Spinal Injury

Initial Management

Answer 7

*ABCs
*Immobilization (C-spine collar, etc.)
*High cervical Injury = Early Intubation
Jaw thrust - NO HEAD tilt/chil lift
*Transport

Question 8

Spinal immobilization

Answer 8

*Rigid cervical collar
*supportive blocks
*backboard w/ straps
(Exam b/f and after)

Question 9

Focused Neuro / Spine exam

Answer 9

• Palpate spine (tenderness, stepoffs)
• Motor level assess
• Neurosurgery rectal (Tone, Sensation, Contraction, Blood)
• sensory : light touch + pinprick
• reflexes = MC initially absent
• ASIA score

Question 10

ASIA score

Answer 10

A = nothing
B= Sensory , NO MOTOR
C= Sensory/Motor, WEAKNESS +1/2 
D= Sensory/Motor, WEAKNESS -1/2
E = normal

REVIEW OTHERS

Question 11

Spinal Imaging

NEXUS Criteria

Answer 11

NO IMAGE if:

NO

• midline cervical tenderness
• focal neuro s/s
• abnormal alertness
• intoxication
• painful distracting injury

Question 12

Minimum Required Imaging

Answer 12

1st = thin cut axial C from OCCIPITAL –> T1 + sag/coronal reconstructions

• w/ pan-scan of body w/ reformatting =all 3 planes
• also MRI, CT Myelogram, Flexion/Extension

Question 13

Types of Injury

Answer 13

• Blunt Injury
• Falls
• Sports Injury
• Penetrating Trauma

Question 14

ANY Cervical Spine fracture =

• Compression Fracture
• Burst fracture
• Flexion-distraction (seatbelt)
• Fracture dislocation

Surgery?

Answer 14

SURGERY REQUIRED

Question 15

Minor injuries

Answer 15

Transverse,spinal, articulating processes

Question 16

4 point burst fracture of ring of C1

Answer 16

Jefferson Fracture

Question 17

• Bilateral Pars fractures = C2
• Traumatic sublixation of C2 on C3

?

Answer 17

Hangman’s Fracture

Question 18

Odontoid fracture

where in spine?

Answer 18

Cervical fracture

Question 19

Injuries w/ foramen transversarium

Consider…

Answer 19

Vascular injury

Question 20

Assess Injury Morphology, Neuro status, PLC Integrity

Answer 20

TLICS score

<3 = Non-OP
4 = Grey Zone
5< = Surgical

Question 21

Compression fracture

possible surgery?

Answer 21

Fusion

W/ corpectomy

Question 22

Don Juan fracture

Answer 22

Double calcaneal fracture

Check back!

Question 23

Car crash

Spine flexes, damaging facet/ligs/ etc.

Answer 23

Flexion-distraction

Question 24

Spinal Injury

Long-term care = must refer to

Answer 24

Spinal Rehab PT/OT

Question 25

PT
OT
Speech language
Case manager
Psyc/Social Worker
Therapeutic recreation 
Transportation specialist
Pastoral care
Peer mentor

Answer 25

Spinal injury ancillary report

Question 26

Spinal Injury RED ALERTS

Send to SCAN

Answer 26

• Ankylosing Spondylitis (DISH) - bamboo CT/fusing
• Osteoporosis
• Steroid use

Question 27

Initial Hospital Assessment

Answer 27

• ABCs
• Trauma team activation
• Focused Neuro assess
• Other injuries = ATLS