Spine Red Flags Flashcards
MSK based spinal flags
fracture
cervical instability
malignancy
neurological related spine red flags
cervical myelopathy
cauda equina
cardiovascular related spine flags
vertebral basilar insufficiency
abdominal aortic aneurysm
myocardial infarction
pneumothorax
infections of the spine
osteomyelitis
sacroiliitis
what causes spinal fractures
axial loading and trauma
what % of calcaneal fractures are associated with _________
10%
low thoracic or lumbar fx
risk factors to consider in spinal fx
trauma
osteoporosis
hx of spinal fracture
hx of cancer
ages related to spinal fracture risk factors
females >65
males >75
what in a patient’s history would make you suspicious of osteoprosis
history of osteoporosis
late onset menarche (>16 y/o)
early menopause (<45)
corticosteroid use >3 mo
if a superficial bone is tender to palpation after trauma, think
fracture
presentation of cervical fx
neck pain that worsens with motion
instability s/s
possible cord and/or vertebral artery s/s
during flexion, explain the motion of the dens
will push into the spinal cord during flexion
high risk factors in the Canadian C-Spine Rule that indicate a CT scan
65 or older
dangerous mechanism
paresthesia in extremities
dangerous mechanisms can be described as
fall from > 3 feet or 5 stairs
axial load to head
MVC
In the Canadian C-Spine rules, what are factors that would not allow for safe ROM assessment
not a simple MVC
unable to sit up in ER
inability to ambulate
midline c-spine tenderness
immediate onset of neck pain
if cervical AROM is less than ____,
CT scans are indicated
45°
when is the Canadian C-spine rule not applicable
non-trauma cases
glasglow coma scale <15
unstable vitals
age <16
acute paralysis
known vertebral disease
previous C-Spine surgery
pregnancy
what is the sensitivity of the canadian c-spine rule
90-100%
what is the NEXUS criteria?
criteria in which all must be negative for CT scan to not be indicated
what are the criteria in the NEXUS criteria
no posterior midline cervical spine tenderness
no evidence of intoxication
normal level of consciousness
no focal neurological deficit
no painful distraction injury
sensitivity of the NEXUS criteria
83-100%
which criteria has been very successful in identifying odontoid fx
NEXUS
what portion of the body are there more distracting injuries? what are examples
UE>LE
fx, degloving, crush, burns or large visceral injuries
red flags for a vertebral fx in patients presenting with LBP
> 70 y/o
corticosteroid use
trauma
contusion/abrasion
what warrants lumbar radiography? which directions?
lumbar compression
minor traumatic fx
A-P and lateral views
what on an MRI will indicate a pathologic lumbar fracture
abnormal bone marrow signal
what types of scans can be done on a lumbar fx
lumbar radiography
CT w/o contrast
MRI w/o contrast
IFOMPT upper c-spine instability risk factors
history of trauma
infection
congenital collagenous compromise
inflammatory arthritides
recent head/neck/dental surgery