Spine and Spinal Cord Trauma

Question 1

How do you rule our spinal injury in the awake and intact patient? How about the comatose patient?

Answer 1

Awake and neurologically intact: if no spinal tenderness then virtually excluded
Comatose: need X-rays and if not conclusive then continue to protect the spine

Question 2

What region of the spine is most vulnerable to injury?

Answer 2

C-spine

Question 3

Why does a fracture-dislocation of thoracic spine almost always lead to complete spinal cord injury?

Answer 3

The spinal canal is very narrow at thoracic region

Question 4

What is the definition of a sensory level and a motor level?

Answer 4

Sensory: most caudal dermatome level with normal sensation
Motor: most caudal dermatome level with at least 3/5 strength

Question 5

What type of injury leads to central cord syndrome? How does it commonly present and why?

Answer 5

Hyperextension of neck injury
Loss of muscle tone in UE > LE, thought to be due to vascular compromise of anterior spinal artery which compromises UE > LE due to topographical arrangement of fibers

Question 6

What is a Jefferson fracture?

Answer 6

Burst fracture of C1 (Atlas)

*Anterior and posterior rings are disrupted with lateral displacement of lateral masses

Question 7

What is a Hangman’s fracture?

Answer 7

Fracture of pars interarticularis of C2

Question 8

What are the different types of odontoid fractures?

Answer 8

Type I: through tip of odontoid
Type II: through base of dens (most common)
Type III: through base of dens and extend obliquely into body of axis

Question 9

What is a Chance fracture and what type of accident often causes it?

Answer 9

Transverse fracture through vertebral body often caused by a flexion injury (e.g. MVA with lapbelt restraint)

Question 10

How are burst fractures, Chance fractures, and fracture-dislocations often managed?

Answer 10

They are very unstable and need internal fixation

Question 11

When resuscitating a patient with suspected spinal cord injury if they do not get better with fluids and demonstrate bradycardia what may be going on? What additional meds might you consider administering?

Answer 11

Neurogenic shock

Consider pressors

Question 12

Should steroids be used in spinal cord injury?

Answer 12

At present, there is insufficient evidence to give steroids