Subaxial Spine Trauma Flashcards
Allen and Ferguson Classification System
most widely used early on (1980s) plain radiographic evaluation inferred or known injury mechanisms made 6 phylogenies of injury: 1) flexion-compression 2) vertical compression 3) flexion-distraction 4) extension compression 5) extension distraction 6) lateral flexion
NEXUS criteria
for awake alert patients lets you remove the C collar without obtaining imaging patient must lack: - midline tenderness - intoxication - a distracting injury - a neurologic deficit - an altered level of consciousness
*if >65 years old just get advanced imaging as the reliability of nexus has been questioned
Incidence of non-contiguous spinal column injuries in patients with C-spine injuries:
10-20%
What is the formerly recommended dose of methylprednisolone:
30mg/kg + 5.4mg/kg/hr
- based upn the results of NASCIS II and III trials
- initiate treatment within 8 hours
- for non-penetrating injuries
Closed reduction of facet dislocations:
- supine, gardner wells tongs
- live fluoro
- +/- pre-reduction MRI?
- start with 10-15lb (weight of the head), and go up by 5-10lb per level of injury
- safe closed reduction has been performed with 140lb of weight
Incidence of Vertebral artery injury in subaxial cervical spine injuries:
11%
AO Spine Classification Types
A: Compression
B: Tension band injuries (alignment is maintained)
C: Translation injuries
D: facet injuries
AO Spine Neurologic Modifier
N0: intact N1: transient deficit, resolved N2: radiculopathy N3: Incomplete spinal cord injury N4: Complete spinal cord injury
STASCIS Study showed:
early surgery (<24 hours) is safe and may improve neurologic outcome at 6 months follow up (at least a 2 grae AIS improvement score)
Pediatric modifications to standard backboard:
occipital recess or a mattress should be added
- prevents anterior translation of the skull and spine in children
Importance of ruling out cervical injuries quickly and removing the collar?
collar can:
- increase venous congestion
- increase CSF pressure
- predispose to aspiration
this level of neurologic injury presents with acute respiratory arrest:
spinal cord at C3 and above
- requires emergent intubation
lower cervical cord injuries can manifest with pulmonary issues by:
causing rapid fatigue and respiratory failure due to impaired function of diaphragm and intercostals
- may require pre-emptive intubation
injury at this spinal cord level is associated with neurogenic shock
rostral to T4
Treatment of neurogenic shock:
remember, this is loss of sympathetic tone
- fluid resuscitation
- invasive pressure monitoring (A line or central line)
- pressors (dopamine, norepi –> both alpha agonists which increase SVR)
- temporary pacing may be required for bradycardia, OR atropine
