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SA Optho/Neuro > Vertebral Trauma > Flashcards

Vertebral Trauma Flashcards

1
Q

What are the common etiologies resulting in vertebral trauma?

A

Motor vehicle accidents, falls, animal-animal encounters, malicious abuse, penetrating missiles

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2
Q

What are the different types of vertebral column injuries?

A

Fracture/luxation, acute disc herniation, soft tissue injury, contusion/laceration, nerve root injury/entrapment

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3
Q

What are the normal forces acting on the axial skeleton?

A

Bending (dorsoventral and lateral), torsional, shear, axial loading (compression, tension)

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4
Q

What forces do the vertebral body, articular facets, and intervertebral discs resist the most?

A

Vertebral body-bending and axial loading
Articular facets-all forces
intervertebral disc- most important stabilizer against lateral bending and torsion

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5
Q

What causes fractures of the vertebral columns?

A

Excessive biomechanical forces applied

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6
Q

What are the stress riser regions of the spine where injuries are more common?

A

Areas where there is a sharp change in the structure of the vertebrae
-cranio-cervical junction
-cervical-thoracic junction
-T-L junction
-L-S junction

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7
Q

What should be your primary goal when performing an exam of a patient with a potential back injury?

A

Do not make things worse! Establish the severity of neurologic signs and determine what other injuries are present or need further investigation

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8
Q

What should be the first thing done for treatment in back injury cases?

A

Emergency ABCs!

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9
Q

What concurrent injuries are common in vertebral trauma cases?

A

Cardiothoracic injury, appendicular fractures, soft-tissue trauma, head injury, UTIs

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10
Q

How should you perform a neuro exam in back patients?

A

Perform with animal immobilized in lateral recumbency
-assess mentation, body posture, cranial nerves
-look for voluntary motor movement (hard to do when in lateral)
-test all reflexes and dont forget the tail!
-ASSESS FOR DEEP PAIN!! (head movement during withdrawal)

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11
Q

T/F: until proven otherwise, assume all injuries are stable

A

FALSE- should assume all are unstable

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11
Q

Would a patient with a modified frankel score of 4 have deep pain intact?

A

Yes- only 5 has deep pain absent

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12
Q

What would a MFS of 1 indicate?

A

The animal is in pain

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13
Q

Why might spinal shock lead you to an incorrect localization during your neurologic exam of a patient?

A

It causes you to see decreased reflexes to the pelvic limbs, even while the lesion may be cervical

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14
Q

What is the prognosis in a cervical injury case if they survive the acute injury?

A

60-70%

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15
Q

What is the prognosis for a cervical or thoracolumbar injury where deep pain is no longer present?

A

Grave to hopeless
-generally recommend euthanasia

16
Q

What is the prognosis for T3-L3 and L4-S2 injuries with intact pain perception?

A

75-80% have a good prognosis with surgery

17
Q

What is the best way to immobilize a back dog for treatment?

A

Use whatever you have! Plywood, cardboard, stretcher, gurney, cage door, tape, cloth
- be sure to check that what you use does not interfere with the animals ventilation

18
Q

What supportive care is indicated with back animals?

A

Maintaining perfusion to injured tissues (oxygen therapy, fluids), analgesics

19
Q

What analgesics should you use for back animals?

A

Treat pain as soon as patient is stable
-full mu-opioids are usually indicated, and you can combine with NSAIDs and sedatives/anxiolytics

20
Q

What should you avoid when imaging back patients?

A

Putting them in sternal or dorsal if at all possible- dont want to worsen injury

21
Q

When is a vertebral fracture considered unstable?

A

When 2/3 compartments are affected

22
Q

When should CT/MRI be persued?

A

When there is no obvious radiographic lesions, the lesions are discordant with localization, when surgery is indicated or when you are trying to evaluate the integrity of the spinal cord

23
Q

What is the common treatment protocol for a stable injury?

A

6 weeks of cage rest + analgesics

24
Q

What is the common treatment protocol for an unstable injury?

A

Surgery in most cases
-can consider conservative on a case by case basis

25
Q

What are the indications for conservative management with an unstable injury?

A

If it is a cervical fracture (cervical surgery has high morbidity/mortality), if it is a caudal lumbar or lumbosacral fracture with minimal neurologic deficit, if there is no significant concurrent injuries, if deep pain is intact
-external coaptation is required in these cases

26
Q

Describe external coaptation for fracture stabalization

A

You should make no attempt to reduce the fracture or luxation before or after putting on the brace- it is difficult to achieve anatomic reduction and rigid fixation

27
Q

For conservative treatment, what should the followup look like?

A

First hospitalize for 2-5 days to assess pain control, neuro status, bladder/bowel function and its affect on the brace, and coaptation tolerance. Then recheck weekly for the next 3 weeks (if need for analgesia continues past 2 weeks consider stronger meds), repeat rads at 4 weeks and remove coaptation when there is evidence of healing

28
Q

What are the indications and goals of surgical treatment for back cases?

A

Indicated when unstable injury with moderate to severe neurologic signs. Goals are to reduce the malalignment, achieve rigid fixation, +/- decompress the spinal cord

29
Q

When is decompression of the spinal cord indicated?

A

If imaging confirms cord compression due to displaced fracture fragment, disc rupture, compressive hematoma, or penetrating missile

30
Q

What are the advantages and disadvantages to pins/screws and bone cement for repairing back injuries?

A

Advantages: excellent strength against lateral bending, easily adaptable configurations applicable in all anatomic areas, no need to remove implants

Disadvantages: low resistance to dorsoventral bending, chance of implant failure

31
Q

What are the main considerations when deciding on surgery in cervical vertebral trauma cases?

A

Severe injury may result in death, the canal cord diameter is favorable which encourages healing, there is a low incidence of body fractures, a high surgical mortality, good success with conservative treatment, and prognosis greatly is improved with early referral

32
Q

What are the main considerations for thoracolumbar injuries?

A

Surgery is indicated if unstable. It is difficult to rigidly immobilize, there are severe consequences if decompensation occurs, and residual deficits are common with conservative therapy

33
Q

What are the main considerations for lumbosacral injuries?

A

The lumbar spine is mobile and sacrum is immobile (stress riser region)
-the nerve roots of the cauda equina are more injury tolerant than the spinal cord
-most morbidity is associated with incontinence

34
Q

What species are sacrocaudal luxations most common in?

A

Tail pull injuries are common in cats, occurs when there is traction/avulsion trauma to the S1-S3 segments

35
Q

What are the clinical signs associated with sacrocaudal luxations?

A

plantigrade stance with paraparesis-usualy transient
-a week/paralyzed, flaccid tail
-diminished/absent perineal reflex, anal tone, and tail pain perception
-urinary/fecal incontinence
-concurrent injuries are common in 80% of cases (especially with vehicular trauma, pelvic, pelvic limb fractures)

36
Q

What is the treatment for sacrocaudal luxation?

A

Cage rest, analgesics, bladder management
-tail amputation may be indicated but there is also a variety of internal fixation methods

37
Q

What is the prognosis for sacrocaudal luxation?

A

Most cats will show clinical improvement within 2 weeks of the injury. 75-100% of cats with intact pain sensation will have urinary function return, and 90% will have tail function improve/return
-if there is absent sensation, many will still have urinary function return
-absent of perineal or tail sensation >30 days poor prognostic indicator

38
Q

What is the most important indicator for prognosis in sacrocaudal luxation cases?

A

Tail and perineal sensation

SA Optho/Neuro (8 decks)

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