Spine Injuries—General Information, Neurologic Assessment, Whiplash and Sports-Related Injuries, Pediatric Spine Injuries Flashcards
“The ability of the spine under physiologic loads to limit displacement so as to prevent injury or irritation of the spinal cord and nerve roots (including cauda equina) and to prevent
incapacitating pain or deformity or pain due to structural changes” is the conceptual definition of clinical stability of spine from White and Punjabi. The level of injury is defined as the most caudal segment with motor function that is at least 3 out of 5 and if pain and temperature sensations are intact.
Which of the following is true representation of incomplete spinal cord injury?
● A. Any residual motor or sensory function more than three segments below the level of the injury
● B. Sensation (including position sense) or voluntary movement in the LEs in the presence of a cervical or thoracic spinal cord injury
● C. Sacral sparing which is preserved sensation around the anus, voluntary rectal sphincter contraction, or voluntary toe flexion
● D. An injury does not qualify as incomplete with preserved sacral reflexes alone (bulbocavernous)
● E. All of the above
E. All of the above
Complete spinal cord injury is lack of preservation of any motor and/or sensory function more than three segments below the level of the injury in the absence of spinal shock. Spinal shock is often used in two completely different senses. Which of the following statements is true regarding the second sense of spinal shock?
● A. It is the hypotension due to interruption of sympathetics (which implies spinal cord injury above T1)
● B. It is the hypotension due to unopposed parasympathetics, loss of muscle tone due to skeletal muscle paralysis below the level of injury, and loss of blood from associated wounds
● C. It is the transient loss of all neurologic functions (including segmental and polysynaptic reflex activity and autonomic function) below the level of spinal cord injury which leads to flaccid paralysis and areflexia but may abate in as little as 72 hours but typically persists for 1 to 2 weeks, occasionally several months
● D. This is not accompanied by loss of bulbocavernosus reflex
● E. Spinal cord reflexes immediately above the level of injury are never depressed
D. This is not accompanied by loss of bulbocavernosus reflex
Whiplash-associated disorder (WAD) is defined as a traumatic injury to the soft tissue structures in the region of the cervical spine due to hyperflexion, hyperextension, or rotational injury in the absence of fractures, dislocations, or intervertebral disk herniations. Which of the following is true regarding grading of whiplash-associated injury?
● A. Grade 1 (neck pain or stiffness or tenderness with no signs) is managed with range of motion exercises and these should be started immediately with early return to daily activities encouraged immediately
● B. Grade 2 (neck pain or stiffness or tenderness with reduced range of motion or point tenderness) is treated with range of motion exercises started immediately, return to regular activities ASAP, cervical collar and rest for no more than 72 hours, passive modality therapies like heat, ice, TENS, ultrasound, relaxation, etc., are optional if symptoms last for more than 3 weeks and with NSAIDs and non-narcotic analgesics
● C. Grade 3 (pain, tenderness, stiffness, reduced range of motion, point tenderness and symptoms with increased weakness, sensory deficit with absent deep tendon reflex) is treated with all of the above except that the cervical collar is used for no more than 96 hours; occasional narcotics may also be given or surgery only for progressive neurologic deficit and persisting neck pain
● D. Surgery is needed for all other grades of WAD
D. Surgery is needed for all other grades of WAD
Which of the following statements is correct regarding pediatric spine injuries?
● A. A retroclival hematoma should raise the index of suspicion for AOD
● B. When AOD is a consideration, cervical CT is the imaging modality of choice to measure the condyle C1 interval
● C. Most stable fractures and ligamentous injuries may be treated nonsurgically, and C2 synchondrosis fractures are usually managed with halo traction
● D. SCIWORA, synchondrosis fractures (os odontoideum, C2 synchondrosis) and atlanto-axial rotatory fixation/subluxation are somewhat unique to pediatric population
● E. All of the above
E. All of the above
Pseudospread of atlas is defined as more than 2 mm total overlap of the two C1 lateral masses on C2 on AP open mouth view (which may be diagnosed as Jefferson fracture), while pseudosubluxation is anterior displacement or significant angulation usually of c3 and c4. True subluxation in children may occur because of which of the following?
● A. Fractures like hangman’s fracture
● B. Injury to the c2–c3 disk and posterior elements
● C. Jefferson fracture
● D. Odontoid tip fracture
● E. None of the above
A. Fractures like hangman’s fracture
Which of the following is correct regarding pediatric c spine injuries?
● A. Children less than 8 months of age when restrained, immobilization with thoracic elevation or an occipital recess allows more neutral alignment due to the relatively large head
● B. In children less than 7 years old, c2 synchondrosis is treated with closed reduction and halo immediately
● C. Acute atlanto-axial rotatory subluxation does not reduce spontaneously and require closed reduction and halo immobilization
● D. All of the above
D. All of the above
Which of the following statements regarding sports-related spinal spine injury is correct?
● A. Type one is permanent spinal cord injury
● B. Type two is transient SCI without radiologic abnormality
● C. Type three is radiologic abnormality without neurologic deficit
● D. All of the above
D. All of the above
Which of the following are the characteristics of spear tackler’s spine?
● A. Cervical spinal stenosis
● B. Loss of normal cervical lordosis
● C. Evidence of pre-existing cervical abnormality
● D. Documented spear tackler’s technique
● E. All of the above
E. All of the above
After injury to the spinal cord, disproportionately greater motor deficit in the upper extremity than the lower ones usually results from hyperextension injuries in the presence of osteophytic spur. What is the most probable diagnosis?
● A. Central cord syndrome
● B. Brown Sequard syndrome
● C. Left right dissociative loss
● D. Gerstmann syndrome
● E. None of the above
A. Central cord syndrome
A patient presents with pain, and paresthesias in the neck, upper arms, and torso. Long tract findings are minimal with mild paresis of the upper extremity. What is this condition called?
● A. Central cord syndrome
● B. Posterior cord syndrome
● C. Gerstmann syndrome
● D. None of the above
B. Posterior cord syndrome
A patient presented to the emergency after roadside accident. He was conscious, oriented, and mobile. He complained of neck pain and on examination, there were only reduced range of motion and point tenderness. What is the whiplash-associated disorder grade?
● A. 0
● B. 1
● C. 2
● D. 3
● E. 4
C. 2
About 70% of patients with whiplash-associated disorder (WAD) recover within how long?
● A. 1 month
● B. 3 months
● C. 6 month
● D. 12 months
● E. 24 months
C. 6 month
Odontoid epiphysiolysis is a fracture through the neurocentral synchondrosis. It might mimic which of the following?
● A. Hangman type I
● B. Hangman type II
● C. Jefferson type
● D. Odontoid type I
● E. Odontoid type II
E. Odontoid type II
According to NEXUS criteria, X-ray of the cervical spine is recommended in which of the following?
● A. GCS 15
● B. Neurologically intact
● C. Posterior midline cervical tenderness and distracting pain
● D. Not hypotensive without explanation
● E. Not intoxicated
C. Posterior midline cervical tenderness and distracting pain
Pseudospread of the atlas is defined as > 2 mm total overlap of the two C1 lateral masses on C2 on AP open-mouth view. It might mimic which of the following?
● A. Hangman type I
● B. Hangman type II
● C. Jefferson type
● D. Odontoid type I
● E. Odontoid type II
C. Jefferson type
