Flashcards in Spinal injuries Deck (13):
When would you get a central cord injury?
Which limbs are affected most?
Typically hyperextension injury
Arms worse than legs
Prognosis variable but generally good
Paralysis on ipsilateral side
Hypaesthesia on contralateral side
Anterior cord injury:
Loss of pain and temperature sense
Deep touch, position and vibration preserved
May have traumatic or vascular cause
Treatment for children with unstable spine and ligament reduction?
Ankylosing spondylitis, how would you NOT treat?
DO NOT GIVE COLLAR!! Immobilise in natural postition
If you are suspicious of injury --> CT is MANDATORY
Injury classically lifting heavy object
Pain worse on coughing
Treatment for acute disc tear
is characteristically worse on coughing (which increases disc pressure).
Symptoms usually resolve but can take 2‐3 months to settle.
Analgesia and physiotherapy are the mainstay of treatment.
L4, L5 and S1 form what?
Treatment for sciatica/lumar radiculopathy
First line treatment is with analgesia, maintaining mobility and physiotherapy.
Occasionally drugs for neuropathic pain (eg Gabapentin) can be used if leg pain is particularly severe. The majority of cases are dealt with in primary care with around 80‐90% of disc prolapses recovering spontaneously by 3 months.
Very occasionally surgery (discectomy) is indicated when pain is not resolving despite physiotherapy and there are localising signs suggesting a specific nerve root involvement and positive MRI evidence of nerve root compression. Again evidence of secondary gain (compensation claim, disability benefit) or psychological dysfunction is usually a predictor of poor outcome of surgery and a contra‐indication. Discectomy has a small risk of permanent neurologic injury (less than 1%)
Treatment for bony nerve root entrapment?
Surgical decompression, with trimming of the impinging osteophytes, may be performed in suitable candidates.
Defect in the pars interarticularis (like where one vertebrae articulates with the other)
The forward slipping of one vertebrae over another
May co-exist with spondylolysis