Spinal Trauma Flashcards
what are the causes of cervical spine fractures?
commonly because of high energy injuries
potential issues with cervical spine fractures?
might be associated with head injury
potentially dangerous unstable fractures can be missed in unconscious or confused patients - can lead to spinal cord injury
How is c-spine injury managed?
C-spine immobilisation (low threshold for this) - hard collar, sand bags, blocks on a spinal cord
can remove the c-spine collar after confirming that c-spine is okay - clinically cleared
what are the causes of thoracolumbar spine fractures?
commonly due to high energy injuries
can cause ‘wedge’ insufficiency fractures in elderly people with osteoporosis (treated symptomatically)
what indicates a need for surgery in someone with a thoracolumbar fracture?
a neurological deficit - esp. if it’s a progressive/very unstable injury
unstable injury pattern with a significant loss in vertebral height
displacement or involvement of the posterior ligamentous structures
how are spinal cord injuries managed?
may need immobilisation - spinal board, cervical collar and sandbags
surgery - to relieve pressure on cord/stabilise instable injuries
can get special spinal beds which help prevent the development of pressure sores from paralysis
may need ventilatory support if there is a loss of intercostal muscle function (T1-T12)
what can damage the spinal cord or nerve roots?
contusion (bruise)
compression
stretch
laceration (deep cut/tear)
vascular disruption and oedema can cause further ischaemic damage and hypotension
can get 2ndry damage from hypoxia and inflammatory responses
what is spinal shock?
physiologic response to injury
How does spinal shock present?
complete loss of sensation and motor function
loss of reflexes below the level of injury
usually resolves within 24 hrs with return of reflexes
How do you know spinal shock is over?
the bulbocavernous reflex (contraction of the anal sphincter with either a squeeze of the glans penis or tapping the mons pubis or pulling on a ureteral catheter) is lost in spinal shock so when this comes back it can indicate the shock is over
the extent of spinal injuries can often not be seen until the shock has left
what is neurogenic shock?
occurs 2ndry to temporary shutdown of sympathetic outflow from the cord from T1 to L2
usually due to injury in the cervical/upper thoracic leading to hypotension and bradycardia
how does neurogenic shock present?
hypotension and bradycardia (this resolves in within 24-48 hrs)
priapism (persistent and painful erection of the penis - unopposed parasympathetic stimulation
how is neurogenic shock managed?
IV fluid therapy
need to differentiate neurogenic shock from other forms of shock
- hypovolaemic much more common in trauma & should respond to fluid replacement
signs of complete spinal cord injury
causes no sensory/voluntary motor function below the level of injury
reflexes should return
level of injury determined by the most distal spinal level with partial function - once there is resolution of the spinal shock
partial function is determined by the presence of dermatomal sensation and myotomal skeletal muscle voluntary contraction
poor prognosis for recovery
signs of incomplete spinal cord injury
some neurologic function (sensory &/or motor function) present distal to the level of injury
greater the function present - faster the recovery is and better the prognosis
