Spinal trauma

Question 1

What percentage of spinal fractures result in spinal cord injury?

Answer 1

15%

Question 2

Fractures below which vertebral level will cause LMN patterns of deficit?

Answer 2

Fractures below L1 cause LMN patterns of deficit, whereas fractures above cause UMN patterns.

Question 3

What are the most common causes of spinal injury?

Answer 3

Road traffic accidents 
Falls (from height)
Sport and recreational activities
Assault
Other (unspecified) trauma

Question 4

What is spinal shock?

Answer 4

Transient depression of cord function below level of injury; lower motor neurone signs
• Flaccid paralysis
• Areflexia
Last several hours to days after spinal cord injury

Question 5

What are the features in neurogenic shock?

Answer 5

Hypotension
Bradycardia (due to loss of sympathetic tone)
Hypothermia
Injuries above T6
Secondary to disruption of sympathetic outflow

Question 6

What is quadriplegia?

Answer 6

Partial or total loss of use of all four limbs and the trunk. Caused by loss of motor/sensory function in the cervical segments of the spinal cord.

Question 7

What is paraplegia?

Answer 7

Partial or total loss of use of the lower-limbs. Caused by impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord. Arm function is spared by there may be impairment of function in the trunk.

Question 8

What is central cord syndrome?

Answer 8

Classically occurs in older patients with arthritis of the neck. Tends to be a hyperextension injury, e.g. due to a low velocity fall. Centrally located cervical tracts more affected, causing greater weakness in the arms than the legs. Perianal sensation and lower extremity power is preserved.

Question 9

What is anterior cord syndrome?

Answer 9

Hyperflexion injury, usually caused by an anterior compression fracture. Anterior spinal artery is damaged; similar to a stroke of the spinal cord. Fine touch and proprioception is preserved. Profound weakness. Poor prognosis of recovery. Often occurs in patients who already have a narrowed central canal due to arthritis.

Question 10

What is Brown-Sequard syndrome?

Answer 10

Hemisection of the cord is affected. Tends to be caused by penetrating injuries to the spine. Causes paralysis on the affected side (corticospinal tracts), loss of proprioception and fine touch (dorsal columns) and pain and temperature loss on the opposite side below the lesion (spinothalamic tracts).

Question 11

Describe the surgical options for the management of spinal fractures

Answer 11

Surgery may be indicated for unstable fractures
Mostly fixed from posteriorly
Preferably use pedicle screws