Spine Trauma Flashcards
Why should a thoracic vertebral injury prompt you to look more closely at other possible injuries? (2)
Strongest part of the spine
It is the nearest to the cord
Why are lumbar vertebral injuries less often associated with neurologic deficits after trauma than are thoracic injuries?
Much more space in the vertebral column
Sacral fractures that involve the central sacral canal can produce what s/sx?
Bowel or bladder dysfunction
Who determines spinal stability?
Surgeon in conjunction with radiology
What is the secondary injury the occurs with spinal cord injuries?
Bleeding and edema that occurs, resulting in ischemia
What is the definition of a complete vs incomplete neurologic lesion in the context of spinal trauma?
- Complete = total absence of sensory and motor function below the level of the injury
- Incomplete = some function still exists
What is spinal shock?
The temporary loss or depression of spinal reflex activity that occurs below a complete or incomplete spinal cord injury
Where does the spinothalamic tract cross the midline?
At the spinal level of innervation
What is the role of spinal immobilization for neurologically intact patients with isolated penetrating neck injuries?
No longer recommended
Any patient with an injury at what spinal level should have their airway secured? Why?
C5 or higher
Phrenic nerve disruption
Hypotension in a spinal injury is presumed to be what until proven otherwise?
Volume loss (not neurogenic shock)
If a spinal trauma patient presents with problems breathing or palpitations, what should you consider?
Intubation
Why is the anal wink reflex important to perform in the setting of spinal trauma?
“sacral sparing” with preservation of the anogenital reflexes means the spinal cord level lesion is incomplete
What are the s/sx of anterior cord syndrome?
- Complete paralysis below the lesion with loss of pain and temperature sensation
- Maintained proprioception and vibratory function
What are the s/sx of central cord syndrome?
Quadriparesis-great in the upper extremities than in the lower extremities.
What are the s/sx of brown sequard syndrome?
- Loss of pain and temp contralateral to the lesion
- Loss of proprioception and movement ipsilateral to the lesion
What causes anterior cord syndrome? (3)
- Trauma
- Thrombosis of the anterior spinal artery
- Mass effect
Why are s/sx of central cord syndrome more pronounced in the upper as opposed to the lower extremities?
The upper extremities are deeper in the spinal cord
What s/sx, besides bowel/bladder incontinence, are associated with cauda equina syndrome?
Decreased motor/sensory function in the lower extremities.
What are the classic s/sx of neurogenic shock?
Hypotension
Bradycardia
Warm extremities
True or false: neurogenic shock is a diagnosis of exclusion
True–assume volume loss until proven otherwise
How far down should you be sure to image in cases of traumatic neck pain?
C1-T1
Will plain radiographs or CT detect ligamentous injuries to the neck?
No
How sensitive and specific (generally) are flexion and extension radiographs in assess ligamentous instability in traumatic neck pain?
Not very–don’t order
