Spinal Trauma

Question 1

Neurogenic shock is associated with spinal cord injury above what level and why

Answer 1

T6
Descending sympathetic fibres in thoracic cord vasomotor

Question 2

What is spinal shock

Answer 2

Loss of muscle tone and reflexes immediately after injury

Later develops spasticity

Question 3

Disproportionately greater loss of motor strength in UL > LL, varying sensory loss = which SCI syndrome

Answer 3

Central cord

Question 4

Symptoms of anterior cord syndrome

Answer 4

Paraplegia, loss of pain and temperature sensation

Proprioception is preserved bc dorsal column in posterior aspect of cord is not injured

Question 5

Brown Sequard syndrome

Answer 5

1-2 level below injury:

1. Ipsilateral motor loss, due to damage to corticospinal tract,
2. Contralateral pain and temperature sensation loss due to damage to spinothalamic tract

Question 6

Who is central cord likely in?

Answer 6

Elderly with spinal stenosis who sustained a fall - hyperextension injury

Question 7

Main C spine injuries

Answer 7

Atlanto-occipital dislocation - brainstem destruction and apnoea

Atlas C1 # - axial loading burst # Jefferson, disruption of anterior and posterior rings

Atlas C1 # rotary subluxation - presents w torticollis

Axis C2 # - odontoid, hangman’s - pars interarticularis

Question 8

Symptoms, MOI and precaution of TL junction #

Answer 8

Bladder and bowel dysfunction
Loss of power and sensation in LL

MOI hyperflexion + rotation, severe kinetic energy transfer fall or seat belt

Extra caution when logrolling, susceptible to rotation

Question 9

Spinal indications for screening for blunt carotid and veterbral artery injuries

Answer 9

C1-3#
Fracture with subluxation
Fractures involving foramen transversarium

Question 10

Why are lumbar fractures less likely to result in complete neurological deficit

Answer 10

1. Spinal cord ends at L1, from theron it is the Cauda equina which is less tightly packed and thus less susceptible to compression
2. Lumbar vertebrae have a wider spinal canal

Question 11

neck pain + normal radiograph - next step

Answer 11

MRI or flexion-extension XR which will detect occult instability

Question 12

What to assess C spine XR for

Answer 12

Bony deformity or fracture of vertebral body process
Loss of alignment of posterior aspect of vertebral bodies
Narrowing of vertebral canal
Increased distance between spinous processess
Increased prevertbral soft tissue space

Question 13

Mx of nonresponder to IVI

Answer 13

eFAST to review occult haemorrhage

Vasopressor, Dopamine, NA
Catheterise to prevent bladder distension

Cautious IVI to avoid pulmonary oedema in neurogenic shock