Spinal Trauma Lecture Powerpoint

Question 1

What drug class is contraindicated in spinal trauma

Answer 1

Steroids

Question 2

Motor pathway corticospinal tracts crosses at the ___, spinothalamic (pain, temp, crude touch) crosses at the ___, posterior column (position, vibration, fine touch) crosses at the ___

Answer 2

• medulla (travels down contralateral side)
• Spinal cord to then travel up the contralateral side
• medulla (travels up ipsalateral side where signal entered)

Question 3

How to palpate a posterior C spine in suspected trauma patient without external assistance

How is T and L spine palpated?

Answer 3

• Place pressure pushing their forehead down into bed
• with other hand unvelcro cervical collar and palpate down the C spine

-log roll

Question 4

Hypotension in a trauma setting is…

Answer 4

….blood loss until proven otherwise

Question 5

Neurogenic shock

Answer 5

Spinal cord injury taht causes loss of alpha adrenergic tone seeing dilation of arteries and veins to areas the cord innervates, patient will retain their bradycardia

Question 6

Spinal shock vs neurogenic shock

Answer 6

Neurogenic is shock of entire nervous system, spinal shock is of the spinal cord - injury just to the spinal cord resulting in absence of neurologic activity below the level of the injury, immediate transient loss of spinal cord function below level of injury

Question 7

Grading of motor exam scale

Answer 7

0 - paralysis
1 - insufficient to produce joint motion even with elimination of gravity
2 - muscle can move the joint it crosses thru full range without gravity
3 - can move against gravity but not with any resistance
4 - can move against gravity and moderate resistance
5 - can move against gravity and full resistance

Question 8

Spinal cord mechanisms of injury (4)

Answer 8

• Transection (either complete or partial)
• compression (wedge is stable, burst is unstable)
• Contusions (bruising from bony dislocations or sublaxations)
• vascular compromise (high risk carotid and vertebral arteries)

Question 9

Nexus criteria

Answer 9

Decision to determine if imaging necessary in cervical spine injury, includes

• younger than 60 years
• absence of posterior midline cervical tenderness
• normal level of alertness
• no evidence of intoxication
• no abnormal neurlogic findings
• no painful distracting injuries

Question 10

Gold standard for imaging of cervical injuries

Study used to check for ligamentous injury causing instability in cervical injury

Answer 10

CT without contrast

MRI

Question 11

Why is spinal cord injury risk greater in the thorax?

Answer 11

Canal narrower and cord diameter is wider

Question 12

Spinal cord ends at what level

Answer 12

L1

Question 13

When a calcaneal fracture presents in trauma unit, get this imaging study

Answer 13

T/L spine (force can be transmitted up the spine

Question 14

Complete spinal cord injury

Answer 14

Absence of both motor and sensory function in the lowest sacral segments of the spinal cord

Question 15

Central cord syndrome

Answer 15

Most common type of cord syndrome, due to injury of corticospinal tract causing loss of motor function, can occur with hyperextension injury with cervical stenosis, can see with falling forward onto face, typically caused by vascular compromise of the anterior spinal artery, lower extremity less effected than upper and tends to recover before upper but typically permanent hand disability at least

Question 16

Anterior cord syndrome

Answer 16

Injury to ventral 2/3 of spinal cord psaring posterior column, see paraplegia (loss of motor) and sensory loss of pain/temp (spinothalamic), posterior column is still intact, due to infarction of cord in anterior spinal artery territory, has poor prognsis

Question 17

Brown sequard syndrome

Answer 17

Hemidissection of spinal cord typical with penetrating trauma causing ipsalateral motor loss, ipsalateral loss of posterior column and contralateral loss of spinothalamic 1-2 levels below injury, some recovery seen

Question 18

Conus medullaris syndrome

Answer 18

Injury to transition area around L1 from CNS to PNS, symptoms include mix of upper motor neuron and lower motor neuron involvement, sees lower extremity weakness, saddle anesthesia

Question 19

Cauda equina syndrome

Answer 19

Damage to the lumbar, sacral, and coccygeal nerve roots (distal to L2), peripheral nerve injury with lower motor neuron injury only, motor and sensory loss of lower extremity, sciatica, bowel and bladder dysfunciton, bladder anesthesia, prognosis is better than other incomplete injuries but requires good workup to prevent litigation

Question 20

Management of spinal injuries (6)

Answer 20

• Bracing in stable injuries
• Immobilization with hospital admission in unstable
• surgery within 24 hours or transfer to hospital with resources
• halo
• closed reduction
• avoid steroids but provide adequate pain control