Red Flags and Emergencies

Question 1

give 8 red flag symptoms

Answer 1

age <20 or >60
non mechanical, constant pain
systemic symptoms (weight loss etc)
saddle anaesthesia +/- bladder/bowel symptoms
history of cancer
history of steroids
structural deformity
severe pain > 6 weeks

Question 2

give 2 medical emergencies related to the spine

Answer 2

cauda equina syndrome

fracture with deteriorating neurology

Question 3

what are the most important aspects of the initial assessment of a spinal fracture?

Answer 3

immobilise
X ray
neurological examination
do not forget other injuries

Question 4

why must a neurological examination be performed quickly?

Answer 4

so that any change can be assessed which could drastically alter the management

Question 5

what is focused on in a neurological examination?

Answer 5

establish motor level
establish sensory level
pay attention to the saddle area
document any change

Question 6

how do you immobilise a cervical spine injury?

Answer 6

rigid collar

Question 7

what is important to remember in a cervical spine X ray and why?

Answer 7

make sure the X ray shows C7/T1

often left out giving a false positive where there can be a serious injury

Question 8

how is a thoracolumbar injury immobilised?

Answer 8

rigid spine board

Question 9

where do you visualise on X ray in a thoracolumbar injury?

Answer 9

whole spine

Question 10

what is the most common site of a thoracolumbar injury?

Answer 10

T12 or L1

Question 11

what can determine whether a spinal fracture causes spinal cord involvement?

Answer 11

size of spinal canal
location of injury
- can be severe even in absence of major bone injury in children and elderly particularly

Question 12

what can cause secondary spinal cord damage in a spinal fracture?

Answer 12

cord swelling
oedema
ischaemia
thrombosis of small vessels
venous obstruction
stretching
compression
undue movement
hypotension
inappropriate surgery
infection

Question 13

what are the 2 patterns of spinal cord injury?

Answer 13

complete
incomplete
- central cord
- brown-sequard
- anterior cord

Question 14

how are spinal cord injuries graded?

Answer 14

frankel/ASIA grading

• I/A = complete motor and sensory loss
• II/B = complete motor and incomplete sensory loss
• III/C = incomplete motor (no practical use)
• IV/D = useful motor and incomplete sensory
• V/E = normal motor and sensory function

Question 15

what feature can often determine whether complete or incomplete spinal cord injury?

Answer 15

saddle region sparing

Question 16

what are the common features of central cord injury?

Answer 16

arms worse then legs

Question 17

what commonly causes a central cord injury?

Answer 17

hyperextension injury

typically an elderly patient who falls with a hyperextension neck injury, can be little to no evidence of bone damage

Question 18

what are the typical features of a brown - sequard cord injury?

Answer 18

paralysis on ipsilateral side

hypaesthesia on contralateral side

Question 19

how does a brown-sequard fracture typically occur?

Answer 19

usually associated with a fracture

Question 20

which spinal cord injury has the best prognosis?

Answer 20

brown-sequard

Question 21

what are the features usually associated with an anterior spinal cord injury?

Answer 21

motor loss
loss of pain, temperature sensation
preservation of deep touch, position and vibration sensation
poor prognosis

Question 22

what can cause an anterior cord injury?

Answer 22

traumatic or vascular injury

- often a result of abdominal aneurysm repair