Braddom

Question 1

During the 1930s and 1940s, management of SCI finally

started to change when a few individuals, beginning with

Answer 1

Donald Monro in the United States and followed by Sir Ludwig Guttman in the United Kingdom, both neurosurgeons, began to comprehensively address the whole person with SCI. They not only began programs to teach people with SCI self-care and mobility with a goal of reintegrating into society but also addressed all the organ systems involved with SCI (e.g., neurologic, skeletal, urologic) to prevent complications.

Question 2

Incidence of SCI

Answer 2

United States is approximately 56 cases per million population (or approximately 17,500 per year)

Canada it is 53 cases per million

24 to 19 cases per million in Spain and France, respectively

between 12 and 14 cases per
million within The Netherlands, Qatar, Ireland, Finland,
and Australia

Question 3

The incidence of traumatic SCI is bimodal being highest

among?

Answer 3

Young adults and older individuals (>65 years). In the United States, the incidence of traumatic SCI in older adults (>65 years) approaches 90 cases per million.

Question 4

The most common causes of SCI worldwide in descending order of incidence are?

Answer 4

1. Transport crashes (50% of cases in Europe & 40% of cases in North America, South East Asia, & Mediterranean.
2. Falls (30% of cases in North America & Europe, but 40% in South East Asia & Mediterranean)
3. Violence
4. Sports

Question 5

Falls are the most common cause of SCI in those above the age of

Answer 5

60 years. High falls (from >1 m) are more common in younger people, whereas low falls (from <1 m) are more common for those older than 45 years.

SCI in older individuals is often related to cervical spinal stenosis and is caused by a relatively minor trauma, such as a fall at home or in the street, or a low velocity motor vehicle collision.

Question 6

leading cause of death both during the first postinjury year and during subsequent years

Answer 6

Diseases of the respiratory system, especially pneumonia

Question 7

The second most common cause of death

Answer 7

“other heart disease,” is thought to reflect deaths that are apparently caused by heart attacks in younger people without apparent underlying heart or vascular disease and cardiac dysrhythmia

Question 8

After SCI, older individuals (>65 years) have higher

rates of complications, including

Answer 8

Pneumonia

Respiratory

Insufficiency

Pulmonary embolism (PE)

Renal stones

Gastrointestinal bleeding.

Question 9

Spinal cord terminates at the level of the

Answer 9

L1-L2 intervertebral disk

Question 10

Gracilis tract, located in and contains fibers from?

Answer 10

medial posterior column,

T7-S5 dermatomes that relay touch, vibration, and position sense.

Question 11

The cuneatus tract, located in the and contains fibers from dermatomes?

Answer 11

located in the lateral posterior column rostral to T6

above T7 that relay touch, vibration, and position sense.

Question 12

Approximately 90% of the corticospinal fibers cross midline in the caudal medulla, forming the pyramidal decussations, and descend contralaterally in the lateral corticospinal tract to terminate on interneurons and alpha and gamma motor neurons in the spinal cord.

Answer 12

The remaining corticospinal fibers, located in the medial anterior column, do not cross midline in the medulla but descend ipsilaterally in the anterior corticospinal tract. These fibers ultimately cross midline segmentally near their terminations on interneurons and alpha and gamma motor neurons in the spinal cord.

Question 13

The cauda equina syndrome refers to an injury to the lumbosacral roots within the spinal canal , resulting in an

Answer 13

areflexic bladder, bowel, and lower limbs.

Question 14

During phase 1, occurring 0 to 24 hours postinjury, there is motor neuron hyperpolarization, manifesting clinically as hyporeflexia.

During phase 2, occurring on days 1 to 3 postinjury, there is denervation supersensitivity and receptor upregulation ,manifesting clinically with reflex return

Answer 14

During phase 3, occurring 1 to 4 weeks postinjury, there is interneuron synapse growth, manifesting clinically as early hyperreflexia.

And finally, during phase 4, occurring 1 to 12 months postinjury, there is long axon synapse growth, manifesting clinically as late hyperreflexia.

Question 15

Between T12 and L2, there is an anterior radicular artery that is more dominant than its neighbors, called the

Answer 15

Artery of Adamkiewicz

This artery, usually found on the left side of the body, is an important blood supply to the caudal two thirds of the spinal cord

Question 16

areas of spine particularly prone to ischemic damage

Answer 16

The regions between T1 and T4, and T12 and L2 because of the importance of individual radicular arteries. The ischemic damage often affects the anterior portion of the spinal cord more than the posterior portion because of the nature of the single anterior and dual posterior blood supplies

Question 17

The anterior column of the spine is composed of the

Answer 17

Anterior longitudinal ligament

Anterior portion of the vertebral body

Anterior portion of the annulus fibrosis or disk

Question 18

The middle column of the spine is composed of the posterior portion of

Answer 18

vertebral body

posterior portion of the annulus fibrosis

posterior longitudinal ligament.

Question 19

The posterior column of the spine is composed of the

Answer 19

Pedicles

Facet joints

Laminae

Supraspinous ligament

interspinous ligament

Facet joint capsule

Ligamentum flavum.

Question 20

Fractures or dislocations in the thoracic and lumbar spine most commonly involve the

Answer 20

T12 and the L1 vertebrae, respectively

Question 21

If there is translation more than 25% of the width of a vertebra, ligamentous structures in all three columns are probably disrupted

Answer 21

ligamentous structures in all three columns are probably disrupted

Question 22

Lap belt injuries in motor vehicle collisions occur most
often in children weighing less than 60 lb who are wearing a regular lap belt above the pelvic rim.

A clinical triad is often seen in these children of

Answer 22

abdominal wall bruising, intraabdominal injuries, and SCI at or close to the thoracolumbar junction

Question 23

A Jefferson fracture, originally described by Sir Geoffrey Jefferson, is a burst fracture of the

Answer 23

Atlas (C1 vertebra). This is caused by axial compression, which can occur, for example, when a football player spears another player with his helmet

Question 24

A hangman’s fracture is a traumatic spondylolisthesis of

the

Answer 24

Axis (C2 vertebra). It is caused by bilateral fractures
through the pars interarticularis of the axis that result from hyperextension and axial compression, as can occur in an abrupt deceleration when a person’s forehead strikes the windshield.

Question 25

A fracture of the odontoid process of the axis
can be caused by hyperflexion, hyperextension, or excessive lateral bending. The traditional classification of odontoid fractures includes three types.

Answer 25

Type 1 is a fracture through the tip of the odontoid

type 2 is a fracture through the base of the odontoid

type 3 is a fracture that extends from the base of the odontoid into the axis proper

Question 26

A flexion teardrop fracture is characterized by

Answer 26

retropulsion of the larger portion of a vertebral body into the spinal canal, detached from an anterior fragment (teardrop); it is associated with posterior facet and ligamentous disruption. Flexion teardrop fractures are often associated with an anterior cord syndrome, if not a complete SCI.

Question 27

A clay shoveler’s fracture is an avulsion fracture of the

Answer 27

spinous process of C6, C7, or T1. It is not typically associated with neurologic injury. Hyperflexion with rotation often causes a unilateral facet dislocation.

Question 28

People with nontraumatic SCI are significantly more likely to have paraplegia or tetraplegia ?

Answer 28

Paraplegia

Question 29

The most common presenting symptom of a spinal tumor

Answer 29

Pain

Pain associated with spinal tumors is often worse in the supine position, in contrast to the pain associated with degenerative spondylosis, which is usually worse in the upright position.

Question 30

If the tumor involves nerve roots, it occurs typically in a

If the tumor involves the spinal cord, the pain can present as

Answer 30

radicular distribution.

at-level or below-level spinal cord pain. Constitutional symptoms such as night sweats, fevers, unexplained weight loss, and anorexia can also suggest spinal tumor.

Question 31

People at increased risk for bacterial vertebral osteomyelitis include those

Answer 31

Who use intravenous drugs

immunosuppressed individuals

People with diabetes

People with renal disease who are receiving dialysis.

Question 32

The bacteria most commonly implicated in vertebral osteomyelitis

Answer 32

Staphylococcus Aureus

Question 33

Although infection can be seen in any portion

of the spine, which is the most common area.?

Answer 33

Lumbar spine

Question 34

Tuberculosis of the spine, also known as

Answer 34

Pott disease

Results from hematogenous spread of the bacterium Mycobacterium tuberculosis to the spine, typically from a pulmonary
focus.

Question 35

After traumatic cervical SCI, 20% to 30% of people classified as AIS A convert to AIS B or better by?

Answer 35

1 year

Question 36

The first step in the treatment of a person with a suspected spinal injury is ensuring an

Answer 36

adequate airway, breathing, and circulation.

Question 37

Neurogenic shock is a result of sympathetic denervation and is characterized by

Bradycardia results from

Neurogenic shock is treated

Answer 37

Hypotension and bradycardia in the setting of flaccid paralysis.

Unopposed parasympathetic input to the heart, but can also be stimulated by endotracheal suctioning

With restoration of intravascular volume and vasopressor agents. The ideal vasopressor agents have both alpha-adrenergic and beta-adrenergic actions to counter the loss of sympathetic tone and provide chronotropic support to the heart. Atropine is helpful to rapidly reverse the bradycardia. A temporary or permanent cardiac pacemaker insertion is rarely necessary.