Spine Trauma Flashcards
Lumbosacral disk herniation
___ (most common site)
L5–S1
Features of ___:
–LMN signs in affected nerve root (unilateral)
–Paresthesia of the affected dermatome
–Muscle weakness
–Areflexia or hyporeflexia
radiculopathy
peripheral nerve lesion
Scapular winging
[nerve levels] radiculopathy
C3–C4
↓ Biceps reflex
__ radiculopathy
C5 (main nerve root)
C6
↓ Triceps reflex
__ radiculopathy
C7
and C8
↓ Biceps reflex
↓ Brachioradialis reflex
__ radiculopathy
C6
and C5
↓ Achilles reflex
__ radiculopathy
S1 (main nerve root)
S2
↓ Patellar reflex
__ radiculopathy
L3
L4 (main nerve root)
Damage to or compression of the nerve fibers
L3–S5 located below L2
Cauda equina syndrome
Gradual ⭐ usually unilateral Lower back pain
LATE onset of urinary retention
Saddle anesthesia (genitals/inner thighs) 😨
Asymmetric paresis of the legs
areflexia or hyporeflexia
Erectile dysfunction
Decreased rectal tone
Muscle atrophy
Diagnosis?
Cauda equina syndrome
(Gradual → Cauda has gotta build up)
(LMN signs)
Sudden ⭐ bilateral lower back pain EARLY onset of bladder and fecal incontinence Perianal numbness 😱 Symmetric paresis of legs hyperreflexia +/- fasciculations Erectile dysfunction
Sensory dissociation
+Babinski
Diagnosis?
Conus medullaris syndrome
(Acute → Conus is on us)
(LMN + UMN signs)
Damage to or compression of the spinal cord segments T12–L2, which are situated at approximately the level of the L1 vertebra
Conus medullaris syndrome
Presents with (+/-) – Localized neck or back pain
– Bilateral paralysis below affected level
– Sphincter dysfunction (urinary or bowel urgency, retention, or incontinence)
– loss of sensation
– Hyperreflexia
– +Babinski sign
Diagnosis?
Spinal cord compression
(It’s why during trauma we palpate the neck and along the back asking if it hurts and why we ask them to squeeze their butt cheeks otherwise we insert a finger in their butthole 😬)
*Tx may include decompressive surgery (ex: for disk herniation) or IV steroids and radiation therapy (for malignant compression).
Congenital malformation (dysplasia or hypoplasia) of the lumbosacral joints in L5–S1
Degenerative disease: most commonly in the elderly at L4–L5
(vertebra, slips out of position)
Spondylolisthesis
Spawn–deh–low–lis–thesis
Presents with:
CHRONIC lumbar pain
worsens with activity (spine extension)
Spine Step-off sign (+/-) 🚩
Gait problems
Diagnosis?
Spondylolisthesis
*Asymptomatic (in majority of pts)
Treatment options for Spondylolisthesis
(vertebra slips out of position)
– (conservative)
– (surgical)
Physical therapy (conservative)
Vertebral fusion (surgical)
Back pain (independent of positioning)
Morning stiffness 30+ min (improves w/ activity)
Tenderness over the sacroiliac joints
Reduced spinal mobility
Diagnosis
Ankylosing spondylitis
+/- anterior uveitis
Ankylosing spondylitis diagnostic criteria
Lower back pain for > __ months in patients < __ years of age + 1 following:
Sacroiliitis confirmed on x-ray or MRI & 1 +CRP/ESR test or 1 +HLA-B27 test & 2 +CRP/ESR test
3 months
45 years
Ankylosing spondylitis
- What is the next best step in management?
- First line treatment?
- Second line treatment?
X-Ray
First-line : NSAIDs
Second-line : TNF-α inhibitors
(etanercept/adalimumab/infliximab)
Ankylosing spondylitis Complications:
Complete fusion of the spine
Increased risk of ___ → pathological fractures
Restricted ___ expansion and spine mobility → breathing troubles
osteoporosis
chest wall
Most common type of vertebral fracture
Vertebral compression fracture
Pathologic 2/2 Osteoporosis (in elderly women)
Presents with:
ACUTE back pain
Point tenderness over spine 🚩
Weakness or numbness/tingling of BLE
Diagnosis?
Vertebral compression fracture
*Asymptomatic (in majority of pts)
(vs. Spondylolisthesis → CHRONIC back pain
+/-Spine Step-off sign 🚩)
Cx of Vertebral compression fracture
– [Vascular]
– [Neurologic]
Paravertebral hematoma (pinching cord) Neurogenic shock
Best initial imaging for vertebral fractures:
XR (AP/L)
CT
*MRI: most sensitive tool for detecting spinal cord lesions
Cauda equina syndrome:
(Compressive myelopathy)
\_\_\_ onset of urinary retention \_\_\_ anesthesia \_\_\_ paresis of the legs [Reflexes] _ Babinski sign
LATE Saddle (genitals/inner thighs) 😨 Asymmetric areflexia or hyporeflexia (–) Babinski
Conus medullaris syndrome:
(Compressive myelopathy)
\_\_\_ onset of urinary/fecal incontinence \_\_\_ anesthesia \_\_\_ paresis of the legs [Reflexes] _ Babinski sign
EARLY Perianal 😱 Symmetric hyperreflexia +/- fasciculations *Achilles reflex may be absent (+) Babinski
Spinal cord compression:
(Compressive myelopathy)
\_\_\_ onset sphincter dysfunction with urinary/fecal retention or incontinence \_\_\_ anesthesia below affected level \_\_\_ paresis of the legs \_\_\_ paralysis below the affected level [Reflexes] _ Babinski sign
Early All loss/reduction of sensation Symmetric Hyperreflexia (+) Babinski
