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CMED 311 > WEEK 4: Spinal Anatomy and Spine Trauma > Flashcards

WEEK 4: Spinal Anatomy and Spine Trauma Flashcards

1
Q

smooth rounded intracanalicular surface
of the anterior arch
▪ Serves as a facet articulating with the facet below

A

Fovea Dentis

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2
Q

kyphotic apex?

A

T8

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3
Q

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

A

ALL

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4
Q

resist spinal flexion

o Courses along the vertebral bodies dorsally from the axis to the sacrum

A

PLL

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5
Q

where does PSA and ASA anastomose?

A

Lazorthe’s Basket

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6
Q

Originates from the union of the bilateral vertebral arteries and course inferiorly and is provided by an anterior segmental medullary artery from the aorta

A

ASA

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7
Q

originate from PICA or vertebral arteries; also supplied by radicular arteries

A

PSA

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8
Q

Territory supplied by the PSA is drained by the

A

middle posterior spinal vein and paired posterolateral spinal veins

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9
Q

Area supplied by the ASA is drained by the

A

MIDDLE ANTERIOR SPINAL VEIN

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10
Q

Microscopic- results from initial traumatic force on SC; DAI, petechial hemorrhage and shearing

primary or secondary?

A

Primary

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11
Q

signaling cascade that drives deleterious downstream events
▪ Begin to peak at day 3-6 and recede at day 9

primary or secondary

A

secondary

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12
Q

Cord injury is best assessed on__________view

A

T2 sagittal view

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13
Q

SCI sequelae that has the worse clinical outcome

A

Hemorrhage, edema, swelling or canal compromise-

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14
Q

Review the asia scale

A

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.

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15
Q

High thoracic injury – FVC is at ?

A

30-50%

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16
Q

Cardiac tone is supplied by

A

t1 to t4

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17
Q

what to use in resuscitation ?

A

NSS or LR. do not use D5 because it will promote cerebral and spinal edema

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18
Q

▪ 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?

A

Neurogenic shock

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19
Q

▪ Loss of reflexes, bladder function and muscle tone below the level of the injury
▪ Duration is 4-12 days

A

Spinal shock

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20
Q

how do you test spinal shock?

A

 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

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21
Q

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.

A

bulbocavernosus reflex

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22
Q

Immediate problems related to administration of steroid are

A

hyperglycemia, decreased wound healing, hypertension.

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23
Q

MOA corticosteroids in SCI?

A

Decrease TNF9, decrease Ca2+ influx, protect neuronal membrane

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24
Q

Reduce excitotoxicity and apoptosis and mimic ENF

Nonsignificant trend was seen in toward improvement

A

GM1 Ganglioside

25
Q

Most common neuroprotective agent:

A

Citicoline

26
Q

▪ Synthetic tetracycline antibiotic with anti-inflammatory

• Phase 2 = motor improvement

A

Minocycline

27
Q

Na channel blocker

▪ Mitigate neurotoxic effects improved

A

Riluzole

28
Q

combination of fibriin sealant Tissel and Rho Inhibitor (improvement of 27%)

A

Cethrin

29
Q

what does therapeutic hypothermia do?

A

decreased excitotoxicity, decreased PMN invasion and neuroinflammatory response

30
Q

optimal temperature for therapeutic hypothermia?

A

24 to 26 degrees

31
Q

TX for orthostatic hypotension

A

Treatment: Management of euvolemia, compression stockings and abdominal binders and gradual table tilt, midodrine

32
Q

Caused by Related to loss of sympathetic output and loss of reflex vasoconstriction

A

ortho hypo

33
Q

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)

A

Autonomic Dysreflexia

34
Q

autonomic dyreflexia happens if the SCI is above?

A

T6

35
Q

most common respi complication?

A

Atelectasis

36
Q
  • Dorsal columns –
  • Lateral spinothalamic tract (LST) –
  • Ventral spinothalamic tract (VST) –
A

fine touch, vibration, proprioception

pain, temperature, gross sensation

light touch

37
Q
  • Most common incomplete cord injury
  • Often in elderly with minor extension injury mechanisms
  • Spinal cord compression, myelomalacia with selective lateral corticospinal tract white involvement
A

Central Cord Syndrome

38
Q

• Complete cord hemi-transection due to penetrating trauma

A

Brown sequard syndrome

39
Q

Ipsilateral and contralateral deficits in Brown sequard syndrome?

A 
• Ipsilateral deficit:
o Motor function
o Proprioception
o Vibratory sense
• Contralateral deficit
o Pain, temperature
40
Q

what sci has Best prognosis for function motor activity

A

Brown sequard

41
Q

Determine what SCI is this: Penetrating trauma

A

BS

42
Q

Identify what SCI? Flexion injury

A

ACS

43
Q

Identify what SCI? - Most have moderate but incomplete recovery

A

central

44
Q

Identify what SCI? Hyper-extension mechanism

A

central cord

45
Q

Identify what SCI?

  • ipsilateral loss of motor function, vibratory sensation, and proprioception
  • Contralateral loss of pain and temperature sensation
A

BS

46
Q

Identify what SCI? - Bilateral loss of motor function, pain, and temperature sensation
- Spares proprioception and vibratory sensation

A

ACS

47
Q

Identify what SCI?- Poor prognosis 10-20% chance of motor recovery

A

ACS

48
Q

Identify what SCI? - Sensory and motor deficit in upper>lower extremities

A

CCS

49
Q

Denis Three column model, what is anterior?

A

ALL, Ant Annulus, Ant wall of Vertebral Body

50
Q

Denis Three column model, what is middle?

A

PLL
Post Annulus
Post wall of Vertebral body

51
Q

Denis Three column model, what is posterior?

A

SSL/ISL
posterior arch
facet capsule
Ligamentum Flavum

52
Q

Three independent predictors in TLICS (Thoracolumbar injury classification and severity score)

A

Morphology
Integrity of Posterior ligament complex
Neurological status

53
Q

scoring for TLICS

A

0-3 non surgical
4 surgeon’s choice
>4 surgical

54
Q

identify if this is neurogenic shock or spinal shock

sudden loss of descending sympathetic tracts after severe CNS damage

A

neurogenic shock

55
Q

identify if this is neurogenic shock or spinal shock

hypotension and bradycardia

A

both

56
Q

identify if this is neurogenic shock or spinal shock

flaccid

A

spinal shock

57
Q

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

A

Spinal shock

58
Q

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

A

Neurogenic shock

CMED 311 (47 decks)

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