Spine Trauma

Question 1

Lumbosacral disk herniation

___ (most common site)

Answer 1

L5–S1

Question 2

Features of ___:

–LMN signs in affected nerve root (unilateral)
–Paresthesia of the affected dermatome
–Muscle weakness
–Areflexia or hyporeflexia

Answer 2

radiculopathy

peripheral nerve lesion

Question 3

Scapular winging

[nerve levels] radiculopathy

Answer 3

C3–C4

Question 4

↓ Biceps reflex

__ radiculopathy

Answer 4

C5 (main nerve root)

C6

Question 5

↓ Triceps reflex

__ radiculopathy

Answer 5

C7

and C8

Question 6

↓ Biceps reflex
↓ Brachioradialis reflex
__ radiculopathy

Answer 6

C6

and C5

Question 7

↓ Achilles reflex

__ radiculopathy

Answer 7

S1 (main nerve root)

S2

Question 8

↓ Patellar reflex

__ radiculopathy

Answer 8

L3

L4 (main nerve root)

Question 9

Damage to or compression of the nerve fibers

L3–S5 located below L2

Answer 9

Cauda equina syndrome

Question 10

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?

Answer 10

Cauda equina syndrome

(Gradual → Cauda has gotta build up)

(LMN signs)

Question 11

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?

Answer 11

Conus medullaris syndrome

(Acute → Conus is on us)

(LMN + UMN signs)

Question 12

Damage to or compression of the spinal cord segments T12–L2, which are situated at approximately the level of the L1 vertebra

Answer 12

Conus medullaris syndrome

Question 13

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?

Answer 13

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).

Question 14

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)

Answer 14

Spondylolisthesis

Spawn–deh–low–lis–thesis

Question 15

Presents with:

CHRONIC lumbar pain
worsens with activity (spine extension)
Spine Step-off sign (+/-) 🚩
Gait problems

Diagnosis?

Answer 15

Spondylolisthesis

*Asymptomatic (in majority of pts)

Question 16

Treatment options for Spondylolisthesis
(vertebra slips out of position)

– (conservative)
– (surgical)

Answer 16

Physical therapy (conservative)

Vertebral fusion (surgical)

Question 17

Back pain (independent of positioning)
Morning stiffness 30+ min (improves w/ activity)
Tenderness over the sacroiliac joints
Reduced spinal mobility

Diagnosis

Answer 17

Ankylosing spondylitis

+/- anterior uveitis

Question 18

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

Answer 18

3 months

45 years

Question 19

Ankylosing spondylitis

1. What is the next best step in management?
2. First line treatment?
3. Second line treatment?

Answer 19

X-Ray

First-line : NSAIDs

Second-line : TNF-α inhibitors

(etanercept/adalimumab/infliximab)

Question 20

Ankylosing spondylitis Complications:

Complete fusion of the spine

Increased risk of ___ → pathological fractures

Restricted ___ expansion and spine mobility → breathing troubles

Answer 20

osteoporosis

chest wall

Question 21

Most common type of vertebral fracture

Answer 21

Vertebral compression fracture

Pathologic 2/2 Osteoporosis (in elderly women)

Question 22

Presents with:

ACUTE back pain
Point tenderness over spine 🚩
Weakness or numbness/tingling of BLE

Diagnosis?

Answer 22

Vertebral compression fracture

*Asymptomatic (in majority of pts)

(vs. Spondylolisthesis → CHRONIC back pain
+/-Spine Step-off sign 🚩)

Question 23

Cx of Vertebral compression fracture
– [Vascular]
– [Neurologic]

Answer 23

Paravertebral hematoma (pinching cord)
Neurogenic shock

Question 24

Best initial imaging for vertebral fractures:

Answer 24

XR (AP/L)
CT

*MRI: most sensitive tool for detecting spinal cord lesions

Question 25

Cauda equina syndrome: (Compressive myelopathy) ``` ___ onset of urinary retention ___ anesthesia ___ paresis of the legs [Reflexes] _ Babinski sign ```

Answer 25

``` LATE Saddle (genitals/inner thighs) 😨 Asymmetric areflexia or hyporeflexia (–) Babinski ```

Question 26

Conus medullaris syndrome: (Compressive myelopathy) ``` ___ onset of urinary/fecal incontinence ___ anesthesia ___ paresis of the legs [Reflexes] _ Babinski sign ```

Answer 26

``` EARLY Perianal 😱 Symmetric hyperreflexia +/- fasciculations *Achilles reflex may be absent (+) Babinski ```

Question 27

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 ```

Answer 27

``` Early All loss/reduction of sensation Symmetric Hyperreflexia (+) Babinski ```