Spine: Emergencies

Question 1

What are the red flags of back pain?

Answer 1

50 first back pain
Non-mechanical (constant)
Hx cancer***
Hx steroids
general malaise, fever, unexplained weight loss
structural deformity
saddle anaesthesia/paraesthesia +/- loss of bladder control
severe pain longer then 6 weeks

Question 2

What is the back emergency?

Answer 2

Cauda equina

fracture with deteriorating neurology

Question 3

What are the symptoms of cauda equina?

Answer 3

urinary upset
painless retention + overflow
saddle anaesthesia/para
loss bowel control

Question 4

How do you assess a spinal fracture?

Answer 4

immobilise
xray(make sure C7/T1 for C, whole spine for TL)
rigid collar for C spine
Rigid spine board for Thoracolumbar spine
neuro exam
Nb, other injuries

Question 5

Why is it important to xray C7/T1?

Answer 5

mobile/immobile= risk of dislocation

Question 6

What is the most common thoracolumbar injury?

Answer 6

T12/L1`

Question 7

How can you assess spinal cord injury?

Answer 7

size of spinal canal
location of injury
bone pinching
contact pressure

Question 8

What is the most common cause of spinal cord damage in a spinal patient?

Answer 8

hypoxia
hypoxaemia
poorperfusion

Question 9

What are the signs of secondary cord damage?

Answer 9

cord swelling
oedema
ischaemia
thrombosis of small veins
venous obstruction

Question 10

What are the patterns of spinal cord damage?

Answer 10

Complete

Incomplete

Question 11

What are the incomplete causes of spinal cord damage?

Answer 11

central cord
brown sequard
anterior cord

Question 12

What is the level of cord damage in Frankel
1)
2)
3)
4)
5)

Answer 12

1) complete motor and sensory loss
2) complete motor, incomplete sensory loss
3) incomplete motor loss (no practical use
4) useful motor, incomple sensory
5) normal motor and sensory