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ATLS > Spine and Spinal Cord tauma > Flashcards

Spine and Spinal Cord tauma Flashcards

1
Q

Spinal anatomy (specifically where are lamina and pedicles)

A
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2
Q

Upper cervical vs lower cervical fractures risk to the spinal cord

A

Upper cervical fractures (above C3), the spinal canal is much wider, similar to the foramen magnum, so damages to spinal canal may not necessarily translate to damage to the spinal cord

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3
Q

Difference between in child and adult cervical spine

A

Differences decline slowly between the age of 8 and 12

  • more flexible joint capsules and vertebral bodies
  • flat facet joints
  • vertebral bodies wedged anteriorly and tend to slide forward with flexion
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4
Q

Why is the thoracolumbar junction vulnerable

A

The junction between the inflexible thoracic region and mobile lumbar region

15% of spinal injuries occur here

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5
Q

Spinal cord anatomy

A

Originates at the caudal end of the medulla oblongata at the foramen magnum

Ends near L1 as conus medullaris

Below this level becomes cauda equina

Ends as filum terminale

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6
Q

3 spinal tracts that could be tested clinically

A

Corticospinal

Spinothalamic

Dorsal column

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7
Q

Location of the main tracts in the spinal cord

A

Corticospinal: anterolateral

Spinothalamic: anterolateral

Dorsal columns: posteromedial

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8
Q

Function of corticospinal tract

A

Motor

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9
Q

Function of the spinothalamic tract

A

Pain and temperature

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10
Q

The function of the dorsal column

A

Proprioception, vibration, light touch

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11
Q

How to test spinothalamic tract clinically

A

pinprick

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12
Q

How to test dorsal column clinically

A

Proprioception in toes

Vibration sensation with tuning fork

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13
Q

Dermatome level for nipple, xiphisternum, umbilicus and symphysis pubis

A

Nipple T4

Xiphisternum T8

Umbilicus T10

Pubic symphysis T12

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14
Q

Complete vs incomplete spinal cord injury

A

Complete: no sensory or motor function below that level

Incomplete: partial loss of function

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15
Q

Myotomes of upper limb

A
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16
Q

Muscle function grading

A

0- no movement

1- flickering

2- movement when gravity eliminated

3- against gravity

4- reduced power

5- normal power

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17
Q

Neurogenic shock definition

A

Loss of vasomotor tone and sympathetic innervation to heart

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18
Q

Spinal shock definition

A

Flaccidity (loss of muscle tone) and loss of reflexes that occur immediately after spinal cord injury

Spasticity follows this after sometime

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19
Q

Level of injury to cause neurogenic shock

A

T6 or above

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20
Q

Mx of neurogenic shock

A

Fluid replacement (/ r/o haemorrhagic shock)

Vasopressors

Atropine (to inhibit parasympathetic)

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21
Q

What level of spinal cord injury could lead to hypoventilation?

A

Paralysis of intercostal muscles (lower cervical/upper thoracic)

Paralysis of diaphragm (C3-C5)

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22
Q

How to determine the motor level of injury

A

The most proximal level with a muscle strength grade of 3 or more (can work against gravity)

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23
Q

Paraplegia vs quadriplegia

A

Paraplegia: loss of power to both legs (eg by thoracic injury)

Quadriplegia or tetraplegia: loss of power to both legs and arms (eg by cervical injury)

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24
Q

Central cord syndrome sx

A

Greater loss of motor in the upper limb than lower limb with varying levels of sensory loss

25
Q

Mechanism of acquiring central cord syndrome

A

Typically by hyperextension injury in a patient with pre-existing cervical canal stenosis

eg elderly falling forward landing on face

26
Q

Prognosis of central cord syndrome

A

Somewhat better than other incomplete injuries

27
Q

Anterior cord syndrome sx

A

Paraplegia and bilateral loss of spinothalamic

Dorsal column intact

28
Q

Cause of anterior cord syndrome

A

Following cord ischaemia

29
Q

Prognosis of anterior cord syndrome

A

Poorest prognosis out of incomplete injuries

30
Q

Brown-Sequard syndrome sx

A

ipsilateral corticospinal and dorsal column loss

contralateral spinothalamic loss

31
Q

Cause of Brown-Sequard syndrome

A

Direct penetrating trauma

32
Q

Atlanto-occipital dislocation mechanism of injury

A

Severe traumatic flexion and distraction

eg shaken baby syndrome

33
Q

Atlanto-occipital dislocation prognosis

A

Most die of brainstem destruction and apnoea

Or end up with significant neurological impairment (quadriplegia)

34
Q

Jefferson fracture features

A

burst fracture of atlas C1

disruption of anterior and posterior rings of C1

lateral displacement of lateral masses

35
Q

Mechanism of injury for Jefferson’s fracture

A

A large force from above the head

or

Falling on the head

36
Q

Investigations for Jefferson fractures

A

Open mouth view of C1/C2

Axial CT

37
Q

Initial management of Jefferson fractures

A

They are unstable fractures need to be stabilised with a cervical collar

38
Q

C1 rotatory subluxation aka

A

torticollis (neck rotated to one side)

39
Q

Causes of C1 rotatory subluxation

A

Spontaneous

Minor or major trauma

URTI

rheumatoid arthritis

40
Q

Management of torticollis

A

Do not force the patient to overcome the rotation, restrict motion in rotated position and refer to ortho

41
Q

Odontoid process anatomy

A

Held in the anterior arch of the atlas by transverse ligament

42
Q

Odontoid peg fracture types

A

Type 1: the tip of the odontoid

Type 2: through the base of dense

Type 3: at the base of dense, into the body of axis

43
Q

Hangman’s fracture features

A

Pars interarticularis fracture (posterior part of axis)

44
Q

Initial management of hangmans fracture

A

rigid cervical collar

45
Q

Most common cervical fracture

A

C5

46
Q

Types of thoracic spinal fractures

A

Anterior wedge compression

Burst

Chance

47
Q

Cause of anterior wedge compression

A

axial loading

48
Q

Cause of burst fracture

A

vertical axial compression

49
Q

Chance fracture features

A

transverse fracture through vertical body

50
Q

Mech of injury for a chance fracture

A

RTA where a passenger was restrained by an improperly placed lap belt causing a flexion about an axis anterior to vertebral column

51
Q

Management of thoracic fractures

A

Compression: stable, treated with a rigid brace

Burst, chance, fracture-dislocations: unstable, internal fixation

52
Q

Causes of thoracolumbar junction fractures

A

Fall from height

Restrained drivers who sustain severe flexion

53
Q

Canadian c spine rule (CCR) use

A

Alert patients (GCS=15) and stable trauma patient with concern over spinal injury

54
Q

Criteria for the dangerous mechanism of injury for CCR

A

Fall from >1m/5stairs

Axial load to head

RTA:

  • >100km/hr
  • rollover
  • ejection

Bicycle collision

55
Q

CCR pathway

A
56
Q

NEXUS criteria for imaging for spinal injury

A
57
Q

Investigations for ? cervical spine fractures

A

CT occiput to T1

If not available: Lateral, AP and open mouth odontoid views of occiput to T1

58
Q

Imaging for patients with cervical tenderness despite having normal initial CT/x-rays

A

Flexion-extension films or MRI to r/o ligamentous injury

59
Q

The log-rolling technique for assessment of the spine

A

ATLS (14 decks)

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