Spine and spinal cord trauma Flashcards
Most common region for spinal injuries
Cervical
Signs of neurogenic shock
Bradycardia with low BP
Neurological deficit
Warm extremities
Neurogenic shock is associated with spinal cord injuries above what level
T6
Mechanism of neurogenic shock
Injury to sympathetic fibres that maintain tone of vasculature and heart rate
Distributive shock from dilation of peripheral vessels
Most common thoracic spine fracture
Wedge compression fractures
- not associated with spinal cord injury
Three spinal cord tracts you can assess clinically
Lateral corticospinal tract
Spinothalamic tract
Dorsal columns
Cervical nerve roots C5-8 and T1 clinical testing
C5/6 - elbow flexion(biceps)
C6 - wrist extension
C7 - elbow extension (triceps)
C8 - finger flexion
T1 - finger abductors
Lumbar -sacral nerve roots clinical testing
L2 - hip flexion
L3 - knee extension
L4- ankle dorsiflexion
L5 - long toe extension or knee flexion
S1 - ankle plantar flexion
Spinal shock is
the loss of muscle tone and reflexes immediately after spinal cord injury
(not neurogenic shock, which refers to to the heart and vasomotor tone)
Brown sequard syndrome
Penetrating injury, partial spinal cord
Ipsilateral motor loss
Loss of positional sesnse
Loss of pain contralaterally, two levels below injury site
Neuro level of spinal cord injury
Most caudal segment of the spinal cord with normal sensory and motor function on both sides of the body
Sensory level of spinal cord injury
Most caudal segment of the spinal cord with normal sensory function
Motor level of spinal cord injury
Lowest key muscle that has a muscle strength grade of at least 3
Paraplegia is injury at which spinal cord region
Thoracic
Quadriplegia / tetraplegia is injury at which spinal cord region
Cervical
Central cord syndrom
Disproportionately greater loss of motor strength in upper limbs than lower limbs
Anterior cord syndrome
Paraplegia and a loss of pain and temperature sensation
Which vertebrae in cervical spine have the greatest flexion and extension?
C5-6
C5 most common spinal fracture
C5 on C6 most common subluxation
Thoracic spine fracture caused by axial loading with flexion
Anterior wedge compression
Thoracic spine fracture caused by vertical-axial compression
Burst injuries
Chance fractures in thoracic spine caused by
Flexion about an axis anterior to the vertebral column
- often with improperly placed lap belts
- can have retroperitoneal and abdo visceral injuries
Fracture dislocations of thoracic spine caused by
extreme flexion or severe blunt trauma to the spine
Thoracolumbar junction fractures (T11 through L1)
Typically combo of acute and hyperflexion and rotation
- usually unstable
- bladder and bowel dysfunction, dec sensation and strength in lower extremities
- vulnerable to rotational movement
C spine injuries concerning for associated vascular neck injury
C1-3 fractures
C spine fracture with subluxation
Fractures involving foramen transversarium