WEEK 4: Spinal Anatomy and Spine Trauma

Question 1

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

Answer 1

Fovea Dentis

Question 2

kyphotic apex?

Answer 2

T8

Question 3

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

Answer 3

ALL

Question 4

resist spinal flexion

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

Answer 4

PLL

Question 5

where does PSA and ASA anastomose?

Answer 5

Lazorthe’s Basket

Question 6

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

Answer 6

ASA

Question 7

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

Answer 7

PSA

Question 8

Territory supplied by the PSA is drained by the

Answer 8

middle posterior spinal vein and paired posterolateral spinal veins

Question 9

Area supplied by the ASA is drained by the

Answer 9

MIDDLE ANTERIOR SPINAL VEIN

Question 10

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

primary or secondary?

Answer 10

Primary

Question 11

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

primary or secondary

Answer 11

secondary

Question 12

Cord injury is best assessed on__________view

Answer 12

T2 sagittal view

Question 13

SCI sequelae that has the worse clinical outcome

Answer 13

Hemorrhage, edema, swelling or canal compromise-

Question 14

Review the asia scale

Answer 14

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.

Question 15

High thoracic injury – FVC is at ?

Answer 15

30-50%

Question 16

Cardiac tone is supplied by

Answer 16

t1 to t4

Question 17

what to use in resuscitation ?

Answer 17

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

Question 18

▪ 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?

Answer 18

Neurogenic shock

Question 19

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

Answer 19

Spinal shock

Question 20

how do you test spinal shock?

Answer 20

 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

Question 21

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.

Answer 21

bulbocavernosus reflex

Question 22

Immediate problems related to administration of steroid are

Answer 22

hyperglycemia, decreased wound healing, hypertension.

Question 23

MOA corticosteroids in SCI?

Answer 23

Decrease TNF9, decrease Ca2+ influx, protect neuronal membrane

Question 24

Reduce excitotoxicity and apoptosis and mimic ENF

Nonsignificant trend was seen in toward improvement

Answer 24

GM1 Ganglioside

Question 25

Most common neuroprotective agent:

Answer 25

Citicoline

Question 26

▪ Synthetic tetracycline antibiotic with anti-inflammatory | • Phase 2 = motor improvement

Answer 26

Minocycline

Question 27

Na channel blocker | ▪ Mitigate neurotoxic effects improved

Answer 27

Riluzole

Question 28

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

Answer 28

Cethrin

Question 29

what does therapeutic hypothermia do?

Answer 29

decreased excitotoxicity, decreased PMN invasion and neuroinflammatory response

Question 30

optimal temperature for therapeutic hypothermia?

Answer 30

24 to 26 degrees

Question 31

TX for orthostatic hypotension

Answer 31

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

Question 32

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

Answer 32

ortho hypo

Question 33

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)

Answer 33

Autonomic Dysreflexia

Question 34

autonomic dyreflexia happens if the SCI is above?

Answer 34

T6

Question 35

most common respi complication?

Answer 35

Atelectasis

Question 36

* Dorsal columns – * Lateral spinothalamic tract (LST) – * Ventral spinothalamic tract (VST) –

Answer 36

fine touch, vibration, proprioception pain, temperature, gross sensation light touch

Question 37

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

Answer 37

Central Cord Syndrome

Question 38

• Complete cord hemi-transection due to penetrating trauma

Answer 38

Brown sequard syndrome

Question 39

Ipsilateral and contralateral deficits in Brown sequard syndrome?

Answer 39

``` • Ipsilateral deficit: o Motor function o Proprioception o Vibratory sense • Contralateral deficit o Pain, temperature ```

Question 40

what sci has Best prognosis for function motor activity

Answer 40

Brown sequard

Question 41

Determine what SCI is this: Penetrating trauma

Answer 41

BS

Question 42

Identify what SCI? Flexion injury

Answer 42

ACS

Question 43

Identify what SCI? - Most have moderate but incomplete recovery

Answer 43

central

Question 44

Identify what SCI? Hyper-extension mechanism

Answer 44

central cord

Question 45

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

Answer 45

BS

Question 46

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

Answer 46

ACS

Question 47

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

Answer 47

ACS

Question 48

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

Answer 48

CCS

Question 49

Denis Three column model, what is anterior?

Answer 49

ALL, Ant Annulus, Ant wall of Vertebral Body

Question 50

Denis Three column model, what is middle?

Answer 50

PLL Post Annulus Post wall of Vertebral body

Question 51

Denis Three column model, what is posterior?

Answer 51

SSL/ISL posterior arch facet capsule Ligamentum Flavum

Question 52

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

Answer 52

Morphology Integrity of Posterior ligament complex Neurological status

Question 53

scoring for TLICS

Answer 53

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

Question 54

identify if this is neurogenic shock or spinal shock | sudden loss of descending sympathetic tracts after severe CNS damage

Answer 54

neurogenic shock

Question 55

identify if this is neurogenic shock or spinal shock | hypotension and bradycardia

Answer 55

both

Question 56

identify if this is neurogenic shock or spinal shock flaccid

Answer 56

spinal shock

Question 57

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

Answer 57

Spinal shock

Question 58

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

Answer 58

Neurogenic shock