What group is most commonly affected by spinal injuries?
Adolescents and young adult males
What is the major cause of spinal injuries?
Road traffic accidents
What is the most frequent type of injury to the cervical spine?
Flexion and flexion-rotation injuries
Cervical spine: Flexion and flexion-rotation injuries are most common at what level? Stable or unstable?
Unstable 2/2 extensive posterior ligamentous damage
Cervical spine: Compression fractures are most common at what level? Stable or unstable?
STABLE b/c posterior bony elements and longitudinal ligaments are intact
Cervical spine: What is a 'tear drop' fracture?
Compression injury combined with rotation force leads to separation of small anteroinferior fragment from vertebral body = UNSTABLE
Cervical spine: Hyperextension injuries are most common in what population? Stable or unstable?
Older age groups and patients with degenerative spinal canal stenosis
STABLE but anterior longitudinal ligament is damaged
Cervical spine: What is the most common neurologic impairment following hyperextension injury?
Central cervical cord syndrome 2/2 cord compression b/w degenerated disc and osteophytes anteriorly and thickened ligamentum flavum posteriorly
Thoracolumbar spine: Flexion-rotation injuries are most common at what level? Stable or unstable?
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
Thoracolumbar spine: Flexion-rotation injuries usually result in what neurological deficits?
Complete deficit of either spinal cord, conus, or cauda equina
Thoracolumbar spine: Compression fractures are stable or unstable?
STABLE without neurological damage
Thoracolumbar spine: Hyperextension injuries cause damage to what structures? Stable or unstable?
Rupture of anterior longitudinal ligament, intervertebral disc, and fracture through vertebral body anteriorly
What are chance fractures?
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
What are open injuries?
Stab injuries or gunshot wounds causing cord damage from blast injury, vascular damage +/- cord penetration
What is 'spinal shock'? How long does it last?
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
What is complete transverse myelopathy?
All neurological function is absent below level of lesion, including autonomic function
Differentiate UMN vs. LMN signs
UMN - loss of voluntary function, increased muscle tone, hyperreflexia
LMN - reduced muscle tone, wasting, loss of reflexes
What autonomic deficits can be expected for patients with complete cervical or high thoracic lesions?
If lesion is above T5 may develop hypotension (sympathetic splanchnic vasomotor control outflow interrupted)
Thermal dysregulation develops without appropriate vasoconstriction/dilatation mechanisms
What is anterior cervical spinal cord syndrome?
Compression of anterior aspect of cord causes damage to corticospinal and spinothalamic tracts -> motor paralysis and loss of pain/temp below lesion
What is central spinal cord syndrome?
2/2 hyperextension injury causing cord compression b/w degenerated disc and osteophytes anteriorly and thickened ligamentum flavum posteriorly -> more UE than LE weakness
What is Brown-Sequard syndrome?
Hemisection of spinal cord - ipsilateral paralysis below level of lesion with loss of pain, temperature, and touch on contralateral side
What is spinal cord concussion?
Transient loss of function with recovery within 6 -48 hrs
What are the general principles of spinal injury management?
Prevent further injury, reduction and stabilization of bony injuries, prevent complications, rehab
Identify the fractures
A. Chance fracture through vertebral body and pedicle
B. Chance fracture through facet join and ligament
What imaging should you obtain in suspected cervical spine injury?
Plain c-spine radiographs or CT; if no abnormality, repeat x-rays in flexion and extension (to exclude instability 2/2 ligament damage)
What technique is used for restoration of normal spinal column alignment?
What are indications for surgical intervention in spinal cord injury patients?
1. Spine stabilization (most common)
2. Progression of neurologic deficit (absolute indication!)
3. Partial neurological injury with failure to improve
4. Open injuries
What GI complications can arise in acute spinal cord paralysis?
Paralytic ileus, acute gastric dilatation, peptic ulcer
What happens with bladder function during spinal shock?
Flaccid paralysis includes the bladder -> acute retention with overflow incontinence
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)