Ch 043 Spinal Injuries

Front 1

List the 3 spinal tracts and symptoms the are responsible for and at which side?

Spinal cord extend to ?

Back 1

(1) corticospinal tract (posterolateral cord) – voluntary motor power , ipsilat

(2) spinothalamic tract (anterolateral cord) –pain and temperature from contralat

(3) posterior column – proprioception,vibration, & some light touch, from ipsilat

Spinal cord extends to L2

Front 2

List the spine inures stable (5) vs unstable (13) and the MOI?

Back 2

“Jefferson Can Bit Off A Hangman’s Thumb” : all flex except the noted

Jefferson (C)

Chance #

Bilateral facet dislocation

Odontoid (types II, III)

Atlantoaxial (ant/post/rotary) or atlanto-occipital dislocations

Hangman’s fracture (E)

Teardrop fracture (F for ****** , E for excellent)

Stable:

V body: C

Wedge :E

SP: direct/ avulsion against flex

TP: F

Uni facet dislocation: Rot

Tear Drop Extension: E

Front 3

What type of #?

When does it become unstable?

Back 3

Compresion Wedgefracture

unstable if vertebrae ≥ 50%compressed or multiple

Front 4

Identify?

What is MOI/# involved?

Back 4

Clayshoveler’s

Flexion against supraspinous ligament → avulsion of SP

Stable

Front 5

Subluxation, define/ radiology?

Back 5

No bony injury

Radiographs may be normal, but may show widening of interspinous or intervertebral spacesposteriorly or at facets

Front 6

How to Dx Atlanto-occipital dislocation?

Back 6

Front 7

Describe and Dx?

Back 7

Flexion teardrop

Anteriordisplacement of teardrop-shaped fragment from anteroinferior vertebrae

Front 8

Identify?

Which vertebra is #?

What are you going to see on AP x ray?

What do you call this finding on Lateral x ray?

Back 8

Unilateralfacet dislocation.

Antdisplacement < 50% of vertebral body on lateral XR (the # is in the one above)

APXray shows SP off midline,

Lateral Xray “Bowtie”

Front 9

Bilateral facet dislocation

How does it look like?

describe it?

Back 9

Ant displacement > 50%of vertebral body

Front 10

Rotary atlantoaxial dislocation

Stability?

Best view to assess?

Back 10

Unstable.

Seen best with open mouthview

Front 11

Extensionteardrop

Appearance?

Ass w?

Back 11

Appearancesimilar to flexion (deferent michanism)

Assd with central cordsynd

Front 12

Identify and describe?

Stability?

Back 12

Posteriorneural arch # (C1)

Posterior arch compressed between cranium and C2 SP

Unstable.

Front 13

Hangman’s #

Describe?

Stable?

MOE?

Back 13

(C2)Bilateralpedicle #’s +/- dislocation

Unstable

Extention

Front 14

Vertebralburst

MOI

How to differentiate from wedge compression & flexion teardrop

Back 14

MOI: Vertical compression

Differentiating: Frontalplane (AP) shows vertical # unlike wedge compression & flexionteardrop

Front 15

Dx?

Describe?

MOI?

How to make Dx?

Back 15

Jefferson# (C1)

MOI:Vertical compression

Fracturesof:

1. ant and post arches 2. disruption of TV ligament

Dx: Sum of displacement of left and right sides>7mm = #

Front 16

What nerves are responsible for the following:

Diaphragm

Horner’s syndrome

Priapism

Back 16

Diaphragm innervated by C3-5

Horner’s syndrome (ptosis, miosis, anhidrosis) possible with injury to sympathetic trunk C7-T2

Priapism with severe SCI

Front 17

What type of motor neuron lesion with:

Paralysis with intact reflexes

Paralysis w/o DTRs

Back 17

Paralysis with intact reflexes → UMN (spinal cord lesion);

Paralysis w/o DTRs → LMN (nerve root, cauda equina)

Front 18

MotorFindings in spinal inj

Back 18

Front 19

SensoryFindings in spinal inj

Back 19

Front 20

Reflex?

Back 20

Front 21

What is the Frankel classification of SCI:

Back 21

A (complete – no sensory, no motor), B, C, D, E (normal)

A = Complete

B = Sensation, no motor

C = Preserved motor but major muscle groups have strength :heart:

D = Preserved motor with most major at least 3

E = Normal

Front 22

What improves prognosis in Complete cord lesions

Back 22

Search for sacral sparring(perianal sensation, normal rectal tone, flexor toe movement NOT anal wink orbulbocavernosus reflex)

Front 23

Central cord syndrome

S/S?

Prognosis?

Brown-Sequard syndrome

S/S?

MOI?

Anterior cord syndrome:

S/S?

MOI?

Back 23

Central cord syndrome

S/S: Proximal > distal, upper > lower extremity motor loss, patchy sensory loss

MOI: Buckling of ligamentumflavum into cord with extension

Prognosis >50% ambulatory and regain bowel and bladderfunction

Brown-Sequard syndrome

S/S:- ipsilateral motor and vib/sensation loss,

-contralateral loss of pain/temperature

MOI: penetrating trauma

Anterior cord syndrome

S/S: legs>arms motor/pain/temp with preservation of (touch, vibration)

MOI: flexion injuries orvascular mechanism

Front 24

Posteroinferior cerebellar artery syndrome

S/S

MOI

Back 24

Posteroinferior cerebellar artery syndrome

S/S: dysphagia, dysphonia, hiccups, N/V, dizziness/vertigo, and cerebellar ataxia

MOI: severe hyperextension and resulting compression of vertebral arteries

Front 25

Conus medullaris vs caudaequina?

Back 25

Cauda equina : diminished sensation, reflexes, including Babinski, and power (LMN lesion)

Conus medullaris : bilateral,can have intact bulbocavernosus reflex, normal/↑ rectal tone, may have ↑reflexes (UMN lesion), possibly ↑muscle tone (spasticity)

Front 26

CanadianC-Spine Rule

Inclusion/exclusion?

Define dangerous mechanism?

Simple rear-end MVCexcludes?

Back 26

Included:alert (GCS 15) and stable trauma patients with neck pain or no neck pain butinjury above the clavicles, not ambulatory, AND dangerous mechanism

Excluded:

-<16yo,

-minor injuries (laceration),

-GCS<15,

-injury >48h,

-grossly abnormal VS

- penetrating trauma (open),

-paralysis

-vertebral disease (RA, AK, previous sx, stenosis)

-Pregnancy

Front 27

NEXUS?

Back 27

– “NSAID” –

1. Neurologic deficit

2. Spine tenderness (midline)

3. ALOC

4. Intoxication

5. Distracting injury

Front 28

NEXUS vs CCSR

Derivation Cohort

Derivation Setting

Derivation Sensitivity

Derivation Specificity

Derivation Xray Order Rate

Validation Cohort

Validation Setting

Validation Sensitivity

Validation Specificity

Validation NPV

Validation Xray Order Rate

Back 28

Front 29

In lateral C spine x ray:

How to know its adequate?

Lines?

Back 29

Adequacy (T1)

Lines:

1. Anterior vertebral

2. Posterior vertebral

3. Spinolaminal line,

4. SP line

Soft tissues, retropharyngeal space:

Generalrule – above C4 < ½ vertebral body; below C4 1 vertebral body

7 @C2 , 2 @C7

Front 30

How to do Atlanto-occipital assessment?

Back 30

Power’s ratio and Wackenheim’s line (linedrawn from clivus passes tangentially to the posterior tip of odontoid)

Front 31

What is posterior cervical line in peds (swischeck)?

Pseudosubluxation?

normal Predental space in peds and adults?

Back 31

Connectsthe points bisecting the bases of the spinous processes of C1 and C3

Pseudosubluxationallowed in children at C2/C3 ≤ 2 mm

Predentalspace: 3mm in adults, 5 mm in children

Front 32

Indications for C-spine CT

Back 32

Front 33

MRI spine in trauma good for the Dx of?

Back 33

Gold standard for acute

1. Disk herniation,

2. Ligamentous injury,

3. Epidural and subdural hemorrhage,

4. Vertebral artery occlusion

Front 34

Differential Diagnosis for Bradycardia + Hypotension in Trauma

Back 34

1. Spinal shock (diagnosis of exclusion)

2. Cushing’s Response

3. Cardiac contusion

4. Retroperitoneal hemorrhage (b/c ↑ vagal tone)

5. Hemorrhage in person who is β-Blocked