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PHM BSc - Applied Science > Spine And Cord > Flashcards

Spine And Cord Flashcards

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1
Q

What are the high risk factors for spinal cord injury

A

Over 65
Dangerous mechanism of injury
Parasthesia of the upper or lower limbs

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2
Q

What are the low risk factors for a c-spine injury allowing for ROM testing

A

No midline spinal tenderness
Ambulatory at any point
Sitting comfortably
Simple rear ended

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3
Q

What does in line immobilisation involve

A

Collar, scoop, headblocks

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4
Q

What happens to bladder function with a lesion above T12

A

Empties as it fills
You have afferent fibres to the brain so no conscious awareness of filling and have lost descending control over the urethral sphincter meaning it is constantly relaxed
Spinal reflex is still intact though: stretch transmitted by sensory afferent to synapse of interneurones which synapse of pelvic nerve and cause detrusor contraction

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5
Q

What happens to the bladder with a lesion below T12

A

Parasympathetic outflow is damaged so no spinal reflex and a paralysed detrusor muscle
Bladder fills, distends and there is overflow incontinence

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6
Q

What is spinal shock?

A

Muscle flaccidity and diminished reflexes below the level of spinal cord injury lasting1-3 days

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7
Q

What is the cause of priapism

A

Abrupt loss of sympathetics and unopposed parasympathetics leads to uncontrolled blood flow into the penile sinusoids

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8
Q

Why do UMN lesions lead to spastic paralysis

A

Lost the many descending inhibitory pathways as well as any voluntary input from corticospinal however still have the reflex arc which is excitatory

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9
Q

What is neurogenic shock

A

Type of distributive shock due to a lesion above T6.
No output to adrenal glands so no adrenaline.
Loss of sympathetic drive and unopposed vagal activity.
Hypotension + bradycardia + peripheral vasodilation

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10
Q

What is sacral sparing

A

Some degree of sensation preserved in the sacral dermatomes (even if higher dermatomes are more impaired) is associated with a better outcome

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11
Q

Where do spinal EDH most commonly occur

A

Cervical region ad anteriorly

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12
Q

What are risk factors for spinal EDH

A

Burst or compression fracture
Anticoagulated
Spinal spondylosis

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13
Q

Where does the bleeding come from in spinal EDH

A

Venous (lots of valveless anastamoses)

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14
Q

How does spinal EDH present

A

Compressive myelopathy

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15
Q

How does cauda equina present

A 
Back pain
Lower limb motor weakness
Saddle parasthesia 
Urinary retention 
Bowel incontinence
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16
Q

What needs to be given to warfarinised patients with INR >2

A

Prothrombin complex concentrate

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17
Q

What is a facet dislocation

A

Anterior displacement of one vertebrae on the underlying one

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18
Q

Why do facet dislocations most often occur in the c-spine

A

The orientation of the facet joints here is far more horizontal than further down the spine where they are more vertical which would make a “jump” harder
C5/C6 is the most common as it’s the junction of mobile to immobile so carries increased strain

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19
Q

What might be damaged in facet dislocations

A

PLL

Vertebral arteries

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20
Q

Which tracts decussate at the level, which at the medulla and which don’t

A

At the level: spinothalamic
At the medulla: DCML, corticospinal
Don’t: spinocerebellar

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21
Q

How does Brown Sequrd present

A

Ipsilateral spastic paralysis and loss of DCML

Contralateral loss of spinothalamic

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22
Q

What can cause anterior cord syndrome and how does it present

A

ASA thromboembolism, retropulsion of bony fragments

Bilateral loss of motor function and spinothalamics

23
Q

What can cause posterior cord syndrome and how does it present

A

PSA damage, B12 deficiency, spinal stenosis

Bilateral loss of DCML

24
Q

What causes central cord syndrome and how would it present

A

Hyper-extension injury with inward buckling of ligamentum flavum
Spondylosis (ligamentum flavum compresses)
Cape like distribution of motor and spinothalamic loss
Motor >sensory and arm>leg

25
Q

Where do spinal fractures most commonly occur and why

A

Junction of C-T and T-L because this is the junction of immobile to mobile

26
Q

What can a fracture of the pars interarticularis lead to

A

Body slipping forward and compressing the cord

27
Q

Where do pars interarticularis fractures most commonly occur

A

L4 and L5

28
Q

What happens in a C1 Jefferson/burst fracture

A

Axial loading leads to occipital condyles being driven into C1. There are 4 breaks, 2 in the anterior arch and 2 in the posterior arch

29
Q

When is a C1 Jefferson/burst fracture associated with spinal cord injury

A

If there is also rupture of the transverse ligament or if there is retropulsion of bony fragments

30
Q

How should a C1 Jefferson/burst fracture be managed

A

Continue allowing them to hold their head

31
Q

What is the outcome of a atlanto-occipital dissociation

A

Often fatal due to brainstem destruction leading to apnoea

32
Q

What are the types of ondontoid/peg/dens fractures

A
  1. Tip of the peg
  2. Base of the peg below the transverse ligament
  3. Base of the peg extending into the body
33
Q

Which type of peg fracture is the most common and which is the most unstable

A

2

34
Q

What 3 views are needed to diagnose a peg fracture

A

AP, lateral and open mouth

35
Q

Aside from radiographs, what other imaging is needed with high cervical trauma

A

CTA!! Both the vertebral and carotids are at risk of dissection, thrombosis and spasm with the potential of causing stroke

36
Q

What happens in a hangman’s fracture

A

Bilateral pars interarticularis fracture of C2 leading to sponylolisthesis of C2 on C3 (C2 slips forward)

37
Q

What are the forces involved in a Hangman’s fracture

A

Neck extension + axial load + distraction (i.e high impact under the chin)
This can be followed by secondary flexion which tears the PLL increasing instability

38
Q

What injury pattern is see with a Hangman’s fracture

A

There is expansion of the spinal canal so often good survival

39
Q

What injuries can be seen following hangings

A

Pulmonary oedema (neurogenic due to sympathetic drive and also due to negative inspiratory pressures)
Cricoid, hyoid and larynx damage and swelling- airway obstruction
Cardiac arrhythmias due to stimulated vagus nerve inhibiting the SA node causing ventricular escape rhythms
Carotid artery dissection

40
Q

How should a patient found hanging be managed

A

Manually support them, maintain c-spine immobility, cut the cord, lower to the ground

41
Q

Describe a typical anterior wedge fracture (patient, force, fracture appearance)

A

Often in osteoporotic elderly people
Axial loading in flexion
Anterior portion of the vertebra is shorter than the posterior

42
Q

Describe a typical thoracolumbar burst fracture (patient, force, fracture appearance)

A

Patient landing on feet giving vertical axial loading

Vertebrae loses height at the front and back and there can be retropulsion of bony fragments into canal

43
Q

Describe a typical thoracolumbar chance fracture (patient, force, fracture description, associated injuries)

A

Lap belt
Flexion about an axis that is anterior to the vertebral body leads to compression of the anterior column and distraction/opening up at the posterior
CT them because retrperitoneal duodenum can become compressed leading to bleeding/peritonitis

44
Q

What forces could cause a thoracolumbar fracture dislocation

A

Extreme flexion

45
Q

You see a transverse process fracture of L4/L5 on imaging, what should this make you suspect

A

Pelvic or sacral fracture

46
Q

What are the types of sacral fracture

A

1 - lateral to neural foramina
2 - involve foramina but not canal
3 - medial to the foramina involving the canal

47
Q

How would a sacral fracture present

A

Lower limb deficit, urinary, bowel and sexual dysfunction, S2-5 sensory loss

48
Q

What is spondylolysis

A

Stress fracture of the pars interarticularis of L5 due to repetitive hyperextension

49
Q

What can spondylolysis progress too

A

Spondylolisthesis (vertebrae slip out of place)

50
Q

What is the progression of osteoporosis

A
  1. Loss of horizontal trabeculae resulting in prominent vertical striation
  2. Striated pattern lost all together leading to radiolucency
  3. Collapsed bodies become wedge shape and bioconcave leading to exhagerated thoracic kyphosis
51
Q

What are some causes of spinal stenosis

A

Osteoarthritis - bony spurs and synovial cysts
Sponylolisthesis
Disc bulging
Thickened ligaments

52
Q

How does a spinal cord injury causing spinal shock affect breathing

A

Flaccid paralysis of intercostals and abdominal muscles leads to paradoxical movements of ribs depressing inwards on inspiration

53
Q

Relate spinal cord injury levels to the ability of the diaphragm and intercostal muscles to work

A

C3 - neither work so ventilator dependant
C4/5 - weak diaphragm so ventilator may be needed
C6/8 - diaphragm working but weak intercostals so can breathe but weak cough and sneeze

PHM BSc - Applied Science (12 decks)

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