Spinal trauma Flashcards
List two patient groups at inc’d risk of c-spine injury.
- Down’s Syndrome - inc’d risk atlanto-occipital dislocation
- Rheumatoid arthritis - inc’d risk of rupture of C2 transverse ligement
Outline the NEXUS Low-risk Criteria for c-spine injury.
- Absence of posterior midline cervical tenderness
- No abnormal neurologic findings
- Normal level of alertness
- No evidence of intoxication
- No painful distracting injuries
What is the name and classification system of C1 #’s?
What is the mechanism associated with each type and state whether they are stable or unstable.
- Jefferson #
- Type 1 - Posterior arch # - Hyperextension - stable
- Type 2 - Anterior arch # - Hyperflexion - stable
- Type 3 - Type 1 + Type 2 #s - Axial load -> burst fracture - stable if transverse ligament intact, otherwise unstable
- Type 4 - # through the lateral mass - Axial load + rotational force - unstable
How is a Jefferson’s # id’d on odontoid plain film?
Lateral displacement of the lateral masses of C1 with respect to the body of C2 - ie, they should line up.
What is a Hangman’s #?
List the types.
Traumatic anterior spondylolisthesis of C2. Best seen on lateral views (CT or XR).
- Levine & Edwards
- Type 1: <3mm horizontal displacement of C2 on C3
- Type 2: >3mm w/ >11deg angulation
- Type 2a: No displacement but severe angulation
- Type 3: Severe angulation + displacement + facet dislocation
Outline the classification system of odontoid #s.
What are the mechanisms of this type of #?
Anderson and D’Alonso System:
- Type 1: Tip of odontoid
- Type 2: Base of odontoid
- Type 3: Through the lateral masses
List 8 unstable C-spine injuries.
Mnemonic?
Jumping Off Awnings Nearly Warrants Frank Spinal Trauma!
- Jefferson’s
- Odontoid
- Atlanto-occipital dislocation
- Neural arch
- Wedge #
- Facet dislocation
- Spinal subluxation
- Teardrop
What is the Canadian C-Spine Rule? What is its sens + spec?
Sens 99.7% Spec 50%
- Applies to patients with:
- GCS 15 AND
- Head or neck pain OR
- No neck pain PLUS
- Injury above the clavicles AND non-ambulatory AND dangerous mechanism
STEP 1: Are there ANY high-risk factors? If yes -> CT. If no -> STEP 2
- Age >65
- Dangerous mech’m
- Extremity paraesthesia
STEP 2: Are there ANY low-risk factors. If no -> CT. If yes -> STEP 3
- Simple rear-end MVA
- Sitting in ED
- Ambulatory at any time
- Delayed onset of neck pain
- Absence of midline c-spine tenderness
STEP 3: Able to actively rotate the neck 45deg bilaterally? If yes, C-spine cleared. If no -> CT
Compare the NEXUS C-spine Rule and the Canadian C-Spine Rule.
- Similar, very high sensitivity - 99.6 & 99.7%
- CCSR has better specificity - 50% vs 12%
- Nexus is simpler one-step process - if all criteria are met, no CT
- CCSR is a three-step process - Presence of high risk factors -> CT. Presence low risk factors -> range neck. If OK, no CT
List the 3 most common incomplete spinal cord syndromes. What is the common mechanism that results in each?
- Anterior cord syndrome - hyperflexion
- Central cord syndrome - hyperextension
- Brown-Sequard - hemisection of cord due penetrating trauma or mass
Describe the central cord syndrome.
- Damage to the centre of the spinal cord, usually from hyperextension injuries
- Results in:
- Motor weakness and sensory loss in all extremities
- Upper extremities affected more than lower - see cord anatomy pic
Describe the anterior cord syndrome.
- Damage to the anterior segment of the spinal cord, usually as the result of hyperflexion injuries -> retropulsed fragments.
- Results in:
- Compression of the anterior spinal artery
- Paraesthesia
- Hyperalgesia
- Preservation of dorsal columns -> proprioception, vibration
- NROS emmergency due irreversible damage after 24h
Describe Brown-Sequard syndrome.
- Hemisection of the cord, usually as the result of penetrating trauma or a mass.
- Results in:
- ipsilateral loss of dorsal columns -> position, vibration and motor.
- Contralateral loss of pain and temperature.
Describe Wallenberg’s Syndrome - why does it occur in spinal trauma?
Mnemonic?
LeMI PICcup MIself, eye am tIPSI and my other side is numb.
- LeMI: Lateral Medullary Infarct
- PIC: PICA occlusion
- MI: Miosis
- eye: ptosis (Miosis + ptosis = Horner’s)
- and my other side is numb: contralateral paraesthesia of body and limbs w/ ipsilateral facial paraesthesia
In high cervical spinal trauma, injuries can damage the vertebral artery which supplies PICA -> Wallenberg’s or Lateral Medullary Syndrome
Describe Horner’s Syndrome. What causes it?
Horny PAM
Horner’s Syndrome:
- Ptosis
- Anhydrosis
- Miosis
Occurs due to ipsilateral sympathetic cervical chain injury in spinal and neck trauma.
