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A1-G Surg Note Trauma > Spine and Spinal Cord Injuries > Flashcards

Spine and Spinal Cord Injuries Flashcards

1
Q

What are some overt signs of spinal cord injury during the secondary survey?

A

Flaccid paralysis
hemodynamic instability with bradycardia
priapism
lack of response to painful stimuli in the lower extremities
paradoxical breathing.

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2
Q

What are the immediate chief concerns in patients with spinal cord injury (SCI)?

A

1-Avoiding movement that could worsen the injury
2- maximizing blood oxygenation and tissue perfusion to minimize the secondary injury cascade.

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3
Q

What criteria are commonly used after the primary and secondary survey to determine if radiographic imaging is warranted for suspected cervical SCI?

A

The National Emergency X-Ray Utilization Study (NEXUS) criteria.

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4
Q

According to the NEXUS criteria, what characteristics allow a patient to avoid cervical spine imaging?

A

The patient must be alert and nonintoxicated
must lack midline cervical pain, neurologic symptoms, or distracting injury

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5
Q

Do validated criteria exist for ruling out imaging for suspected lumbar SCI?

A

No, there are no validated criteria for lumbar SCI, but similar concepts from NEXUS can apply to the thoracolumbar spine above the spinal cord level.

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6
Q

What is the most common incomplete SCI syndrome?

A

Central cord syndrome, accounting for 9% of all SCI cases.

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7
Q

What are the defining characteristics of central cord syndrome?

A

Tetraparesis with arms weaker than legs and a variable amount of sensory loss, sparing the face.

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8
Q

What is cervicomedullary syndrome and how does it present?

A

injury from the lower medulla to C4,
presenting with respiratory difficulty, spinal shock, sensory deficits between C1–C4, and facial sensory loss from damage to the spinal trigeminal nerve.

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9
Q

What causes anterior cord syndrome and how does it present?

A

It is caused by space-occupying lesions (disc fragments, hematoma, fractured vertebrae)

presents with complete paralysis (disruption of the corticospinal tract) while preserving vibration and light touch.

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10
Q

How does posterior cord syndrome present?

A

tetraparesis and profound sensory loss, but preservation of pain and temperature sensation.

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11
Q

What injury is associated with Brown-Séquard syndrome, and how does it present?

A

hemisection of the spinal cord, classically in patients with penetrating injury

Ipsilateral paralysis
Ipsilateral vibration and light touch loss
Contralateral pain and temperature loss

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12
Q

What causes Conus medullaris syndrome and what are the key symptoms?

A

burst fractures of T12 or L1 and presents with:

Paraparesis
Loss of bowel and bladder function
Sensory loss in the legs
Sparing of perianal sensation

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13
Q

What is cauda equina syndrome, and how does it present

A

with distal traumatic injury and presents with:

Saddle anesthesia
Bowel and bladder dysfunction

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14
Q

Besides traumatic injury, what other cause of SCI is mentioned?

A

SCI can also be caused by prolonged hypotension and watershed infarction

best diagnosed with MRI

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15
Q

What imaging method is supported by Level I evidence if high-quality CT is unavailable for cervical spine evaluation?

A

Three-view radiographs (anteroposterior, lateral, and odontoid views)

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16
Q

When might an MRI be useful in patients with neurological symptoms but no findings on CT scan

A

MRI may be useful to identify occult cord compression from time-sensitive pathologies like critical disc herniation or epidural hematoma.

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17
Q

What is the current recommendation regarding MRI before surgical intervention in SCI?

A

MRI may be performed, when feasible, before surgery for potential added benefit, but the evidence supporting this recommendation is weak

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18
Q

What is SCIWORA and who does it primarily affect?

A

Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) is a syndrome that presents almost exclusively in children.

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19
Q

How has the definition of SCIWORA evolved with current imaging technologies?

A

The most accepted definition of SCIWORA now encompasses CT and radiographs only, as MRI typically shows pathologic findings in cases of SCI

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20
Q

How are cervical spine injuries classified?

A

classified as craniocervical (occiput to C2) or subaxial (C3-T1) injuries.

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21
Q

What is the treatment for patients who survive atlanto-occipital dislocation?

A

occiput to cervical fusion, and may require decompression of damaged nerves.

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22
Q

How are unilateral fractures of the occipital condyle typically treated?

A

With a cervical collar for 6 to 12 weeks

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23
Q

What is a Jefferson fracture?

A

A burst-type fracture of the anterior and posterior arches of C1, treated with halo vest immobilization for 6 to 12 weeks

24
Q

How are C2 fractures classified?

A

divided into those affecting the odontoid process (Type I, II, and III) and all other fractures.

25
Q

How are Type I odontoid fractures treated?

A

They are stable and can be treated with immobilization using a cervical collar

26
Q

Why is the management of Type II odontoid fractures controversial?

A

high risk of nonunion without surgery, but surgical treatment is risky and invasive.

27
Q

What are the indications for surgical management of Type II odontoid fractures?

A

Instability, cord compression with neurologic deficits, and high risk of nonunion (e.g., in smokers, osteoporosis patients)

28
Q

Where do Type I,II,III odontoid fractures occur?

A

At the tip of the dens.
At the base of the dens.
In the body of the axis.

29
Q

What are the surgical treatment options for Type II odontoid fractures?

A

Odontoid screw fixation and posterior atlantoaxial arthrodesis

30
Q

What are the nonoperative management options for Type II odontoid fractures with less than 5 mm displacement and without symptoms?

A

Nonrigid orthosis (collar or cervicothoracic orthosis) or rigid cervical orthosis (halo vest)

31
Q

How are Type III odontoid fractures usually treated?

A

cervical collar immobilization.

32
Q

What defines a hangman’s fracture (HF)?

A

Bilateral fractures of the C2 pars interarticularis

33
Q

What characterizes a Type I hangman’s fracture (HF)?

A

Less than 3 mm translation of C2 on C3 and may be treated successfully with a cervical collar.

34
Q

What defines a Type II hangman’s fracture (HF)?

A

> 11 degrees of angulation and > 3 mm of translation

35
Q

What are the treatment options for Type II hangman’s fractures (HF) if deemed unstable?

A

Surgical fixation may be required

36
Q

What defines a Type III hangman’s fracture (HF)?

A

Severe angulation and facet dislocation of C2–C3

37
Q

What is the typical treatment for Type III hangman’s fractures (HF)?

A

Generally requires surgical fixation

38
Q

What are the nonoperative management options for hangman’s fractures (HF)?

A

Cervical collar or halo vest

39
Q

What are the surgical treatment options for hangman’s fractures (HF)?

A

Anterior C2–C3 interbody fusion, posterior C1–C3 fusion, and bilateral C2 pars screw osteosynthesis

40
Q

When should surgical decompression ideally be performed in cases of cervical spinal cord injury (SCI)?

A

Within 24 hours after injury

41
Q

What are the three groups in the classification of spinal injuries?

A

Compression injury (Group A), distraction injury (Group B), and translation/rotation injury (Group C).

42
Q

Which type of injury is generally limited to the anterior column in the spinal injury classification system?

A

Type A (compression) injuries.

43
Q

How are type A spinal injuries typically managed?

A

thoracic-lumbar-sacral orthotic (TLSO) brace, as they are generally stable

44
Q

Which types of spinal injuries are less stable and usually require operative management?

A

Type B (distraction) and Type C (translation/rotation) injuries, which affect two or three columns

45
Q

What structures make up the anterior column of the spine?

A

The anterior longitudinal ligament, anterior annulus, and anterior portion of the vertebral body

46
Q

What structures make up the middle column of the spine?

A

The posterior portion of the vertebral body, posterior annulus, and posterior longitudinal ligament

47
Q

What structures make up the posterior column of the spine?

A

The posterior ligamentous complex, facet joints, neural arch, and interspinous ligament

48
Q

What are indicators of treatment failure in spinal injury management?

A

Progressive kyphosis and loss of vertebral body height.

49
Q

What is the best evidence for the timing of surgical decompression in thoracolumbar spinal cord injury (SCI)?

A

within 72 hours after injury.

50
Q

What are the possible causes of bradycardia and arrhythmias in patients with SCI?

A

Injury to the autonomic nervous system

51
Q

What are potential causes of hypotension in patients with SCI?

A

Neurogenic shock, hemorrhage, tension pneumothorax, cardiac tamponade, or sepsis.

52
Q

What is the recommended mean arterial pressure (MAP) target for patients with SCI during the first 7 days after injury?

A

Between 85 and 90 mm Hg.

target a spinal cord perfusion pressure of 60 to 65 mm Hg in the acute setting.

53
Q

What should be considered early in the management of hypotension in SCI patients

A

Early consideration should be given to the use of vasoactive agents.

54
Q

What is the recommended dose of high-dose MPSS for SCI within 8 hours of injury?

A

A 30 mg/kg bolus followed by 5.4 mg/kg/h infusion for 23 hours

avoided after 8 hours of SCI

55
Q

What are common complications in SCI patients receiving mechanical ventilation in the ICU?

A

Dysphagia, venous thromboembolism, infections, and stress gastroduodenal ulcers

56
Q

What are the long-term complications due to immobility in SCI patients?

A

Pressure sores, leg edema, and obesity.

57
Q

What are the long-term complications due to denervation in SCI patients?

A

spasticity, urinary retention, constipation, temperature dysregulation, autonomic dysreflexia, and orthostatic hypotension.

A1-G Surg Note Trauma (26 decks)

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