Spine Trauma

Question 1

The halo vest is most effective at controlling which of the following spinal motions?

Answer 1

ideal for controlling motion at upper cervical spine and atlantoaxial joint.

Question 2

With halo immobilization the anterior pin should be placed?

Answer 2

approximately 1-cm region just above the lateral one third of the orbit (eyebrow) at or below the equator of the skull.

Question 3

What is the most common neurologic complication with halo traction?

Answer 3

Cranial nerve VI palsy is the most common nerve palsy associated with halo cervical traction. A cranial nerve VI palsy would result in paralysis of the lateral rectus, causing a deficit in lateral eye movement.

Question 4

What is tetraplegia?

Answer 4

injury to the cervical spinal cord leading to impairment if function in the arms, trunk, legs, and pelvic organs

Question 5

What is paraplegia?

Answer 5

injury to the thoracic, lumbar or sacral segments leading to impairment if function in the trunk, legs, and pelvic organs depending on the level of injury. Arm function is preserved

Question 6

What is a complete cord injury?

Answer 6

no spared motor or sensory function below the affected level.
must have recovered from spinal shock (bulbocavernosus reflex is intact) before an injury can be determined as complete.
ASIA-A

Question 7

contraindications to steriod administration

Answer 7

GSW (gun shot wounds)
pregnancy
under 13 years
> 8 hours after injury 
brachial plexus injuries

Question 8

High dose methylprednisone what is dose and timing?

Answer 8

must be initiated in first 8 hours to be effective
load 30 mg/kg over 1st hour (2 grams for 70kg man)
drip 5.4 mg/kg/hr drip
for 23 hours if started < 3 hrs after injury
for 48 hours if started 3-8 hours after injury

Question 9

what is spinal shock?

Answer 9

defined as temporary loss of spinal cord function and reflex activity below the level of a spinal cord injury.

Question 10

characteristics of spinal shock are?

Answer 10

1. flaccid areflexic paralysis
2. bradycardia & hypotension (due to loss of sympathetic tone)
3. absent bulbocavernosus reflex

Question 11

Neurogenic Shock

Answer 11

characterized by hypotension & relative bradycardia in patient with an acute spinal cord injury

Question 12

Treatment of Neurogenic Shock

Answer 12

Swan-Ganz monitoring for careful fluid management
pressors to treat hypotension
usually, low doses of dopamine in the 2- to 5-mcg/kg/min range are sufficient

Question 13

function of C1-3 tetraplegic

Answer 13

Ventilator dependent with limited talking.

- Electric wheelchair with head or chin control

Question 14

function of C3-4 tetraplegic

Answer 14

Initially ventilator dependent, but can become independent

- Electric wheelchair with head or chin control

Question 15

level of function of C5 tetraplegic

Answer 15

Ventilator independent

• Has biceps, deltoid, and can flex elbow, but lacks wrist extension and supination needed to feed oneself
• Independent ADL’s; electric wheelchair with hand control, minimal manual wheelchair function

Question 16

Level of function of C6 tetraplegic

Answer 16

C6 has much better function than C5 due to ability to bring and to mouth and feed oneself (wrist extension and supination intact)
- Independent living; manual wheelchair with sliding board transfers, can drive a car with manual controls

Question 17

Level of function of C7 tetraplegic

Answer 17

Improved triceps strength

- Daily use of a manual wheelchair with independent transfers

Question 18

Level of function of C8-T1

Answer 18

Improved hand and finger strength and dexterity

- Fully independent transfers

Question 19

level of function SCI T2-T6

Answer 19

• Normal UE function
• Improved trunk control
• Wheelchair-dependent

Question 20

Level of function T7-T12 SCI

Answer 20

Increased abdominal muscle control

- Able to perform unsupported seated activities; with extensive bracing walking may be possible

Question 21

ASIA -AIS - A

Answer 21

complete SCI No motor or sensory

Question 22

ASIA - AIS - B

Answer 22

Incomplete. No motor function but some remaining sensory

Question 23

ASIA - AIS- C

Answer 23

Incomplete. 50% or more of muscles below injury are less than Grade 3.

Question 24

ASIA- AIS - D

Answer 24

Incomplete. 50% or more of muscles below injury are greater than or equal to than Grade 3.

Question 25

ASIA - AIS - E

Answer 25

Normal

Question 26

what is the rate of Depression with SCI?

Answer 26

Approximately 11% of patients with spinal cord injuries meet the criteria for Major Depressive Disorder (MDD).