WEEK 4: Spinal Anatomy and Spine Trauma Flashcards
smooth rounded intracanalicular surface
of the anterior arch
▪ Serves as a facet articulating with the facet below
Fovea Dentis
kyphotic apex?
T8
originates at the atlantoaxial arch and extends ventral to the spinal column to the sacrum
o Ligament is adherent and continuous to the periosteum of the vertebral bodies and ventral intervertebral annulus fibrosus
ALL
resist spinal flexion
o Courses along the vertebral bodies dorsally from the axis to the sacrum
PLL
where does PSA and ASA anastomose?
Lazorthe’s Basket
Originates from the union of the bilateral vertebral arteries and course inferiorly and is provided by an anterior segmental medullary artery from the aorta
ASA
originate from PICA or vertebral arteries; also supplied by radicular arteries
PSA
Territory supplied by the PSA is drained by the
middle posterior spinal vein and paired posterolateral spinal veins
Area supplied by the ASA is drained by the
MIDDLE ANTERIOR SPINAL VEIN
Microscopic- results from initial traumatic force on SC; DAI, petechial hemorrhage and shearing
primary or secondary?
Primary
signaling cascade that drives deleterious downstream events
▪ Begin to peak at day 3-6 and recede at day 9
primary or secondary
secondary
Cord injury is best assessed on__________view
T2 sagittal view
SCI sequelae that has the worse clinical outcome
Hemorrhage, edema, swelling or canal compromise-
Review the asia scale
A: Complete. no sensory and motor function is preserved in sacral segments S4-S5
B: incomplete. (+)sensory; (-) motor is preserved below the neurological level and extends through S4-S5
C: Incomplete. Sensory and motor functions are preserved below the level; most mm have a grade of less than 3
D; incomplete: sensory and motor fxn are preserved below the level. most mm have a grade of >/= 3
E: sensory and motor functions are normal.
High thoracic injury – FVC is at ?
30-50%
Cardiac tone is supplied by
t1 to t4
what to use in resuscitation ?
NSS or LR. do not use D5 because it will promote cerebral and spinal edema
▪ Hypotension and bradycardia due to the interruption of descending sympathetic tracts
▪ Preserved urine output and warm extremities
▪ Fluid administration is the first line treatmen
what kind of shock?
Neurogenic shock
▪ Loss of reflexes, bladder function and muscle tone below the level of the injury
▪ Duration is 4-12 days
Spinal shock
how do you test spinal shock?
By bulbocavernosus reflex, you do a rectal exam, and then you pull a catheter, if the sphincter hugs your tactating finger → (+) bulbocavernosus reflex → patient is not in a spinal shock
is a well-known somatic reflex that is useful for gaining information about the state of the sacral spinal cord segments. When present, it is indicative of intact spinal reflex arcs (S2–S4 spinal segments) with afferent and efferent nerves through the pudendal nerve.
bulbocavernosus reflex
Immediate problems related to administration of steroid are
hyperglycemia, decreased wound healing, hypertension.
MOA corticosteroids in SCI?
Decrease TNF9, decrease Ca2+ influx, protect neuronal membrane
Reduce excitotoxicity and apoptosis and mimic ENF
Nonsignificant trend was seen in toward improvement
GM1 Ganglioside
Most common neuroprotective agent:
Citicoline
▪ Synthetic tetracycline antibiotic with anti-inflammatory
• Phase 2 = motor improvement
Minocycline
Na channel blocker
▪ Mitigate neurotoxic effects improved
Riluzole
combination of fibriin sealant Tissel and Rho Inhibitor (improvement of 27%)
Cethrin
what does therapeutic hypothermia do?
decreased excitotoxicity, decreased PMN invasion and neuroinflammatory response
optimal temperature for therapeutic hypothermia?
24 to 26 degrees
TX for orthostatic hypotension
Treatment: Management of euvolemia, compression stockings and abdominal binders and gradual table tilt, midodrine
Caused by Related to loss of sympathetic output and loss of reflex vasoconstriction
ortho hypo
Unopposed sympathetic discharge and acute hypertension
o Seen in 48-90% and seen in the subacute period
o Provoked by strong noxious output below the level of the SCI (urinary retention or fecal impaction)
Autonomic Dysreflexia
autonomic dyreflexia happens if the SCI is above?
T6
most common respi complication?
Atelectasis
- Dorsal columns –
- Lateral spinothalamic tract (LST) –
- Ventral spinothalamic tract (VST) –
fine touch, vibration, proprioception
pain, temperature, gross sensation
light touch
- Most common incomplete cord injury
- Often in elderly with minor extension injury mechanisms
- Spinal cord compression, myelomalacia with selective lateral corticospinal tract white involvement
Central Cord Syndrome
• Complete cord hemi-transection due to penetrating trauma
Brown sequard syndrome
Ipsilateral and contralateral deficits in Brown sequard syndrome?
• Ipsilateral deficit: o Motor function o Proprioception o Vibratory sense • Contralateral deficit o Pain, temperature
what sci has Best prognosis for function motor activity
Brown sequard
Determine what SCI is this: Penetrating trauma
BS
Identify what SCI? Flexion injury
ACS
Identify what SCI? - Most have moderate but incomplete recovery
central
Identify what SCI? Hyper-extension mechanism
central cord
Identify what SCI?
- ipsilateral loss of motor function, vibratory sensation, and proprioception
- Contralateral loss of pain and temperature sensation
BS
Identify what SCI? - Bilateral loss of motor function, pain, and temperature sensation
- Spares proprioception and vibratory sensation
ACS
Identify what SCI?- Poor prognosis 10-20% chance of motor recovery
ACS
Identify what SCI? - Sensory and motor deficit in upper>lower extremities
CCS
Denis Three column model, what is anterior?
ALL, Ant Annulus, Ant wall of Vertebral Body
Denis Three column model, what is middle?
PLL
Post Annulus
Post wall of Vertebral body
Denis Three column model, what is posterior?
SSL/ISL
posterior arch
facet capsule
Ligamentum Flavum
Three independent predictors in TLICS (Thoracolumbar injury classification and severity score)
Morphology
Integrity of Posterior ligament complex
Neurological status
scoring for TLICS
0-3 non surgical
4 surgeon’s choice
>4 surgical
identify if this is neurogenic shock or spinal shock
sudden loss of descending sympathetic tracts after severe CNS damage
neurogenic shock
identify if this is neurogenic shock or spinal shock
hypotension and bradycardia
both
identify if this is neurogenic shock or spinal shock
flaccid
spinal shock
identify if this is neurogenic shock or spinal shock
lack of counteracting muscular effects of the lower extremities, which is due to peripheral nerve unresponsicveness to brain stimulation resulting in venous pooling
Spinal shock
identify if this is neurogenic shock or spinal shock
Excessive pooling of blood in the organs due to the loss of the descending sympathetic tracts and loss of the reflex vasoconstrictor effect of arterial baroreceptors
Neurogenic shock
