Spinal Injury

Question 1

Give 4 functions of the spine

Answer 1

Support the axial skeleton

Movement of the trunk

Protect the spinal cord

Haematopoeisis

Question 2

What spinal fractures are most common and why?

Answer 2

Thoracolumbar fractures most common

Majority L1 and T12

• Transition between fixed thoracic spine and free lumbar spine
• Fewer further from junction

Question 3

When assessing a spinal fracture where else should you check?

Answer 3

THE WHOLE SPINE

10% of spinal fractures will have another spinal injury
-Remember distracting injuries

Question 4

Give signs and symptoms of spinal injury

Answer 4

Pain

Flaccidity, paralysis, numbness

Paraesthesia, paresis, weakness

Priapism, incontinence etc

Need to rule out abdominal trauma

Spinal shock versus neurogenic shock

Hypotension, bradycardia, vasodilation

Question 5

What is the difference between spinal and neurogenic shock?

Answer 5

Spinal shock is transient
-Flacid areflexic paralysis

Neurogenic shock effects autonomic NS
-Vascularities dilate

Question 6

What are the 5 ASIA assessment groups for spinal injury

Answer 6

A
B
C
D
E

Question 7

What is ASIA A

Answer 7

A = “complete” spinal cord injury

-No motor or sensory function

Question 8

What is AISA B

Answer 8

B = “incomplete” spinal cord injury

-Sensory but not motor function preserved bewlow neurological level
iIncludes the sacral segments S4-S5

-Transient phase and if recovers motor incomplete i.e. ASIA C or D

Question 9

What is ASIA C

Answer 9

C = “incomplete” spinal cord injury

• Motor function preserved below the neurological level
• More than half of key muscles below the neurological level have a muscle grade of less than 3

Question 10

What is ASIA D

Answer 10

D = “incomplete” spinal cord injury

-Motor function is preserved below the neurological level and at least half of key muscles below the neurological level have a muscle grade of 3 or more

Question 11

What is ASIA E

Answer 11

E = “normal” where motor and sensory scores are normal.

Can have spinal cord injury and neurological deficits with completely normal motor and sensory scores

Question 12

What segmental spinal cord levels control neck flexors and extensors?

Answer 12

C1-C6 = Neck flexors

C1-T1 = neck extensors

Question 13

What segmental spinal cord levels control diaphragm?

Answer 13

C3,C4 and C5

mostly C4

Question 14

What segmental spinal cord levels control shoulder movement and flexion of elbow joint?

Answer 14

C5 and C6

Shoulder movement, raise arm (deltoid); flexion of elbow (biceps)

Question 15

What segmental spinal cord levels externally rotate the arm (supinate)?

Answer 15

C6

Question 16

What segmental spinal cord levels extend elbow and wrist (triceps and wrist extensors); pronates wrist

Answer 16

C6 and C7

Question 17

What segmental spinal cord levels flex wrist and supply the small muscles of the hand?

Answer 17

C7 and T1

Question 18

What segmental spinal cord levels supply intercostals and trunk above the waist?

Answer 18

T1-T6

Question 19

What segmental spinal cord levels supply abdominal muscles?

Answer 19

T7-L1

Question 20

What segmental spinal cord levels control thigh flexion?

Answer 20

L1-L4

Question 21

What segmental spinal cord levels control thigh abduction and adduction?

Answer 21

Abduction = L4, L5 and S1

Adduction = L2, L3 and L4

Question 22

What segmental spinal cord levels control extension of the leg at the hip (Gluteus maximus)?

Answer 22

L5, S1, S2

Question 23

What segmental spinal cord levels control extension of the leg at the knee (quadriceps femoris)?

Answer 23

L2, L3 and L4

Question 24

What segmental spinal cord levels control flexion of the leg at the knee (hamstrings)?

Answer 24

L4, L5, S1 and S2

Question 25

What segmental spinal cord levels control dorsiflextion of the foot (tibialis anterior)? What about plantar flexion of foot?

Answer 25

L4, L5, S1 Plantarflexion = L5, S1 and S2

Question 26

What segmental spinal cord level controls extension of the toes? What about flexion of the toes

Answer 26

L4, L5 and S1 Flexion = L5, S1 and S2

Question 27

What are the features of anterior cord syndrome?

Answer 27

Both motor and sensory pathways Crude sensation, movement and fine sensation lost

Question 28

What are the features of central cord syndrome?

Answer 28

Weakness and paralysis of both arms and some sensory loss Legs less effected

Question 29

What are the features of Brown-Sequard syndrome?

Answer 29

Injury to half of cord Movement and some sensory loss below injury Pain and temperature on opposite side

Question 30

How do you initially manage someone who may have attained a spinal injury?

Answer 30

Mechanism of injury Other associated injuries Prevent secondary injury Immobilise the spine Spinal injury only part of the picture Immediate life threatening injuries Haemorrhage

Question 31

What is a chance fracture?

Answer 31

It consists of a compression injury to the anterior portion of the vertebral body and a transverse fracture through the posterior elements of the vertebra and the posterior portion of the vertebral body. It is caused by violent forward flexion, causing distraction injury to the posterior elements.

Question 32

What are burst fractures?

Answer 32

A vertebra breaks from a high-energy axial load (e.g., traffic collisions or falls from a great height or high speed, and some kinds of seizures), with sharps of vertebra penetrating surrounding tissues and sometimes the spinal canal. Burst fractures are considered more severe than compression fractures because long-term neurological damage can follow. The neurologic deficits can reach their full extent immediately, or can progress for a prolonged time.

Question 33

What is a wedge compression fracture?

Answer 33

A compression fracture is a common fracture of the spine. It implies that the vertebral body has suffered a crush or wedging injury. This may cause the front part of the vertebral body to crush forming a wedge shape. This is known as a compression fracture. If the entire vertebral body breaks, this is considered a burst fracture.

Question 34

What does SCIWORA stand for?

Answer 34

Spinal Cord Injury Without Radiographic Abnormality

Question 35

What is a Clay Shoveler's fracture?

Answer 35

Clay-shoveler's fracture is a stable fracture through the spinous process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae, classically at C6 or C7

Question 36

What is a Jefferson fracture?

Answer 36

A Jefferson fracture is a bone fracture of the anterior and posterior arches of the C1 vertebra, though it may also appear as a three- or two-part fracture. The fracture may result from an axial load on the back of the head or hyperextension of the neck (e.g. caused by diving), causing a posterior break, and may be accompanied by a break in other parts of the cervical spine.

Question 37

What is a hangman's fracture?

Answer 37

A hangman's fracture is the colloquial name given to a fracture of both pedicles or pars interarticularis of the axis vertebra (C2) (or epistropheus).