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NS by Dorka > Ch. 16 - Spinal injuries > Flashcards

Ch. 16 - Spinal injuries Flashcards

1
Q

What group is most commonly affected by spinal injuries?

A

Adolescents and young adult males

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2
Q

What is the major cause of spinal injuries?

A

Road traffic accidents

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3
Q

What is the most frequent type of injury to the cervical spine?

A

Flexion and flexion-rotation injuries

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4
Q

Cervical spine: Flexion and flexion-rotation injuries are most common at what level? Stable or unstable?

A

C5/6

Unstable 2/2 extensive posterior ligamentous damage

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5
Q

Cervical spine: Compression fractures are most common at what level? Stable or unstable?

A

C5/6

STABLE b/c posterior bony elements and longitudinal ligaments are intact

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6
Q

Cervical spine: What is a ‘tear drop’ fracture?

A

Compression injury combined with rotation force leads to separation of small anteroinferior fragment from vertebral body = UNSTABLE

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7
Q

Cervical spine: Hyperextension injuries are most common in what population? Stable or unstable?

A

Older age groups and patients with degenerative spinal canal stenosis

STABLE but anterior longitudinal ligament is damaged

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8
Q

Cervical spine: What is the most common neurologic impairment following hyperextension injury?

A

Central cervical cord syndrome 2/2 cord compression b/w degenerated disc and osteophytes anteriorly and thickened ligamentum flavum posteriorly

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9
Q

Thoracolumbar spine: Flexion-rotation injuries are most common at what level? Stable or unstable?

A

T12/L1 resulting in anterior dislocation of T12 on the L1 vertebral body (which usually sustains a wedge compression fracture)

UNSTABLE 2/2 posterior longitudinal ligament and posterior bony element disruption

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10
Q

Thoracolumbar spine: Flexion-rotation injuries usually result in what neurological deficits?

A

Complete deficit of either spinal cord, conus, or cauda equina

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11
Q

Thoracolumbar spine: Compression fractures are stable or unstable?

A

STABLE without neurological damage

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12
Q

Thoracolumbar spine: Hyperextension injuries cause damage to what structures? Stable or unstable?

A

Very uncommon

Rupture of anterior longitudinal ligament, intervertebral disc, and fracture through vertebral body anteriorly

UNSTABLE

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13
Q

What are chance fractures?

A

High-speed accident while wearing lap belts w/o shoulder harness leads to HYPERFLEXION injury to thoracolumbar spine causing:

fracture through spinous process pedicle and vertebral body OR
fracture through end-plate with disruption of facet join and ligaments

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14
Q

What are open injuries?

A

Stab injuries or gunshot wounds causing cord damage from blast injury, vascular damage +/- cord penetration

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15
Q

What is ‘spinal shock’? How long does it last?

A

Transient depression in segments caudal to cord lesion immediately after severe injury 2/2 sudden withdrawal of excitatory influence from supraspinal centers -> AREFLEXIC FLACCID PARALYSIS

Duration varies: 3-4 days or up to 6-8 wks

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16
Q

What is complete transverse myelopathy?

A

All neurological function is absent below level of lesion, including autonomic function

17
Q

Differentiate UMN vs. LMN signs

A

UMN - loss of voluntary function, increased muscle tone, hyperreflexia

LMN - reduced muscle tone, wasting, loss of reflexes

18
Q

What autonomic deficits can be expected for patients with complete cervical or high thoracic lesions?

A

If lesion is above T5 may develop hypotension (sympathetic splanchnic vasomotor control outflow interrupted)

Thermal dysregulation develops without appropriate vasoconstriction/dilatation mechanisms

19
Q

What is anterior cervical spinal cord syndrome?

A

Compression of anterior aspect of cord causes damage to corticospinal and spinothalamic tracts -> motor paralysis and loss of pain/temp below lesion

20
Q

What is central spinal cord syndrome?

A

2/2 hyperextension injury causing cord compression b/w degenerated disc and osteophytes anteriorly and thickened ligamentum flavum posteriorly -> more UE than LE weakness

21
Q

What is Brown-Sequard syndrome?

A

Hemisection of spinal cord - ipsilateral paralysis below level of lesion with loss of pain, temperature, and touch on contralateral side

22
Q

What is spinal cord concussion?

A

Transient loss of function with recovery within 6 -48 hrs

23
Q

What are the general principles of spinal injury management?

A

Prevent further injury, reduction and stabilization of bony injuries, prevent complications, rehab

24
Q

Identify the fractures

A

A. Chance fracture through vertebral body and pedicle

B. Chance fracture through facet join and ligament

25
Q

What imaging should you obtain in suspected cervical spine injury?

A

Plain c-spine radiographs or CT; if no abnormality, repeat x-rays in flexion and extension (to exclude instability 2/2 ligament damage)

26
Q

What technique is used for restoration of normal spinal column alignment?

A

Traction

27
Q

What are indications for surgical intervention in spinal cord injury patients?

A
  1. Spine stabilization (most common)
  2. Progression of neurologic deficit (absolute indication!)
  3. Partial neurological injury with failure to improve
  4. Open injuries
28
Q

What GI complications can arise in acute spinal cord paralysis?

A

Paralytic ileus, acute gastric dilatation, peptic ulcer

29
Q

What happens with bladder function during spinal shock?

A

Flaccid paralysis includes the bladder -> acute retention with overflow incontinence

30
Q

Jefferson’s fracture

A

Bilateral fractures of posterior arch of atlas from direct vertical blow to head (head presses down on spinal colum and atlas is squeezed b/w occipital condyles above and axis below)

31
Q

Identify the fracture

A

Jefferson’s fracture

32
Q

Odontoid fractures

A

Type 1 - tip of dens

Type 2 - base of dens (most common, can disrupt blood supply to dens with subsequent non-union of fracture)

Type 3 - base with extension into adjacent C2 vertebral body

33
Q

Hangman’s fracture

A

Avulsion of laminar arches of C2 w/ dislocation of C2 vertebral body from C3

34
Q

Identify the fracture

A

Hangman’s fracture

35
Q

Identify the fracture

A

‘Tear drop’ fracture

NS by Dorka (21 decks)

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