L9: Spinal Trauma Flashcards
(98 cards)
1
Q
A
2
Q
A
3
Q
Spinal nerve roots Exit through the intervertebral foramen …….
- C1- C7
A
Above
4
Q
Spinal nerve roots Exit through the intervertebral foramen …….
- C8 - S5
A
Below
5
Q
Spinal cord ends below lower border of …..
A
L1.
6
Q
What is cauda equina formed of?
A
- Formed by lumbosacral nerve root in the spinal canal before exiting.
- Cauda equina is below L1.
7
Q
Level of Cauda Equina
A
8
Q
if the vertebra level is ……, Then the cord Level is ……
A
9
Q
if the vertebra level is C2 - C7, Then the cord Level is ……
A
Add 1+
10
Q
if the vertebra level is T1 - T6 , Then the cord Level is ……
A
Add 2+
11
Q
if the vertebra level is T7 - T9, Then the cord Level is ……
A
Add 3+
12
Q
if the vertebra level is T 10, Then the cord Level is ……
A
L1, L2
13
Q
if the vertebra level is T11, Then the cord Level is ……
A
L3, L4
14
Q
if the vertebra level is T12, Then the cord Level is ……
A
L5
15
Q
if the vertebra level is L1, Then the cord Level is ……
A
Sacrococcygeal Segments
16
Q
Denis Column Model
A
17
Q
Denis Column Model
- Anterior Column
A
- Anterior longitudinal ligament.
- Anterior annular ligament.
- Anterior half of VB.
18
Q
Denis Column Model
- Middle Column
A
- Posterior long. Lig.
- Posterior annular ligament.
- Posterior half of VB.
19
Q
Denis Column Model
- Posterior Column
A
- Ligamentum flavum.
- Superior & Interspinous lig.
- Intertransverse capsular lig.
- Neural arch.
- Pedicle & spinous process.
20
Q
What is an Unstable Fracture?
A
Middle column
+
either anterior or Posterior column is damaged.
21
Q
Rupture of interspinous ligament
- Characters
A
- Associated with avulsion of spinous process.
- Unstable spin
- Further flexion → increase neurological injury
22
Q
Mechanisms (Causes) of Spinal Trauma
A
- Direct Injury
- Indirect Injury
23
Q
Mechanisms (Causes) of Spinal Trauma
- Direct Injury
A
- Penetrating injuries to the spine: e.g., firearms and knives.
24
Q
Mechanisms (Causes) of Spinal Trauma
- Indirect Injury
A
25
When to suspect Spinal Injury?
26
Injuries of the vertebral column tend to cluster in .......
27
**Sensory Assessment in Spinal Trauma**
- C5
28
**Sensory Assessment in Spinal Trauma**
- C6
29
**Sensory Assessment in Spinal Trauma**
- C7
30
**Sensory Assessment in Spinal Trauma**
- C8
31
**Sensory Assessment in Spinal Trauma**
- T1
32
**Sensory Assessment in Spinal Trauma**
- T3
33
**Sensory Assessment in Spinal Trauma**
- T4
34
**Sensory Assessment in Spinal Trauma**
- T8
35
**Sensory Assessment in Spinal Trauma**
- T10
36
**Sensory Assessment in Spinal Trauma**
- T12
37
**Sensory Assessment in Spinal Trauma**
- L2
38
**Sensory Assessment in Spinal Trauma**
- L3
39
**Sensory Assessment in Spinal Trauma**
- L4
40
**Sensory Assessment in Spinal Trauma**
- L5
41
**Sensory Assessment in Spinal Trauma**
- S1
42
**Sensory Assessment in Spinal Trauma**
- S2
43
**Sensory Assessment in Spinal Trauma**
- S3
44
**Sensory Assessment in Spinal Trauma**
- Grading
45
**Motor Assessment in Spinal Trauma**
46
**Motor Assessment in Spinal Trauma**
- C5
Deltoids / biceps
47
**Motor Assessment in Spinal Trauma**
- C6
Wrist extensors
48
**Motor Assessment in Spinal Trauma**
- C7
Elbow extensors
49
**Motor Assessment in Spinal Trauma**
- C8
Finger flexors
50
**Motor Assessment in Spinal Trauma**
- T1
Finger Abductors
51
**Motor Assessment in Spinal Trauma**
- L2
Hip flexors
52
**Motor Assessment in Spinal Trauma**
- L3
Knee extensors
53
**Motor Assessment in Spinal Trauma**
- L4
- Knee extensors
54
**Motor Assessment in Spinal Trauma**
- L5
- Ankle Dorsiflexion
- Long toe extensors
55
**Motor Assessment in Spinal Trauma**
- S1
- Ankle Plantar Reflex
- Long Toe Plantar Reflex
56
**Motor Assessment in Spinal Trauma**
- Grading
57
**Rectal Assessment in Spinal Trauma**
- Bulbocavernous Reflex
58
Stimulus for **Bulbocavernous Reflex**
- Squeezing the glans penis or clitoris.
- Tugging on an indwelling Foley catheter
59
Center of **Bulbocavernous Reflex**
S2 - S4
60
Response of **Bulbocavernous Reflex**
Anal Sphincter Contraction
61
Significance of Present **Bulbocavernous Reflex**
62
Significance of Absent **Bulbocavernous Reflex**
63
**Sacral Sparing** in complete Spinal Cord Injury
- Right or Wrong?
Wrong, Absence of sensory and motor functions in the lowest sacral segments.
64
CP of **Spinal Shock**
1. Loss anal tone, reflexes, autonomic control within 24-72 hr.
2. Flaccid paralysis bladder & bowel.
3. Priapism.
4. Lasts even days till reflex neural arcs below the level recovers.
65
Def of **Spinal Shock**
- Loss of sensation accompanied by motor paralysis with initial loss but gradual recovery of reflexes.
- Transient physiological reflex depression of cord function
'concussion of spinal cord'.
66
**Neurogenic Shock** Causes ......
Hemodynamic instability.
67
**Neurogenic Shock**
- Etiology
- Rostral cord injuries related to the loss of sympathetic tone to the peripheral vasculature and heart.
- Lesions above D6 → Disruption of sympathetic outflow from D1-L2 → Unopposed vagal tone → Peripheral vasodilatation.
68
**Neurogenic Shock**
- CP
- Bradycardia
- Hypotension
- Hypothermia
69
Degrees of **Spinal Trauma**
- Complete
- Incomplete
70
Degrees of **Spinal Trauma**
- Complete
- Flaccid paralysis
- total loss of sensory & motor functions.
71
Degrees of **Spinal Trauma**
- Incomplete
Incomplete - Mixed loss:
1. Anterior cord syndrome.
2. Posterior cord syndrome.
3. Central cord syndrome.
4. Brown Sequard's syndrome.
5. Cauda equina syndrome.
72
Etiology of **Anterior Cord Syndrome**
- Flexion rotational force to spine.
- Due to Compression fracture of vertebral body or anterior dislocation.
- Anterior spinal artery compression.
73
CP of **Anterior Cord Syndrome**
- Loss of power
- reduced pain and temperature below the lesion.
74
Etiology of **Posterior Cord Syndrome**
1. Hyperextension injuries.
2. Posterior vertebral body fracture.
75
CP of **Posterior Cord Syndrome**
1. Loss of proprioception and vibration sense.
2. Severe ataxia.
76
Etiology of **Central Cord Syndrome**
- Older age with cervical spondylosis.
- Hyperextension with minor trauma.
- Cord is compressed by osteophytes from vertebral body against thick ligamentum flavum.
- Damages the central cervical tract.
77
CP of **Central Cord Syndrome**
1. UMN lesion to legs (spastic).
2. LMN to arms (flaccid paralysis).
**(NB: It affects Upper limbs more than lower limbs)**
78
Etiology of **Brown Sequard Syndrome**
1. Hemisection of the cord
2. Stab injury and lateral mass fractures.
79
CP of **Brown Sequard Syndrome**
- Contralateral (Uninjured) side has good power but absent pinprick and temperature 2-3 segments below the lesion.
- Ipsilateral side has motor paralysis below the lesion.
80
Radiological Tool of Choice in **Spinal Trauma**
81
Radiological Tool of Choice in **Spinal Trauma**
- Suspectimg Level
Suspect the level from
- Examination
- Mode of trauma.
82
Radiological Tool of Choice in **Spinal Trauma**
- What to Start With?
X-Ray
83
Radiological Tool of Choice in **Spinal Trauma**
- If Suspicious
CT
84
Radiological Tool of Choice in **Spinal Trauma**
- Indications of MRI
1. Positive CT.
2. high suspicion even with negative CT.
3. Planning of surgery.
85
Def of **Whiplash Injury**
Sudden hyperextension and flexion.
86
CP of **Whiplash Injury**
- Increasing neck pain for the first 24 hours.
- Anterior longitudinal ligaments are torn causes dysphagia.
- Forward flexion against resistance is painful.
87
Recovery in **Whiplash Injury**
90% are asymptomatic after 2 years.
88
Types of **Vertebral Fractures**
- Compression Fractures
- Burst Fractures
- Seatbelt Type Fracture
- Dislocation Fracture
89
**Compression Fractures**
90
**Compression Fractures**
- Types
91
**Burst Fractures**
- Types
92
How to Suspect Spinal instability?
- SLICS
- TLICS
93
SLICS
94
**TLICS**
- Morphology (Immediate Stability)
95
Surgical Intervention in **Spinal Trauma**
- techniques
96
Surgical Intervention in **Spinal Trauma**
- Fusion
...
97
Surgical Intervention in **Spinal Trauma**
- Internal Fixation
(instrumentation).
* Internal fixation is not a substitute for fusion.
* Screws, hooks, cages.
98
Surgical Intervention in **Spinal Trauma**
- Decompression
of spinal canal
(Laminectomy)
