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24 Cards in this Set
- Front
- Back
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When viewed cross-sectionally, how is the anatomy of the spine divided?
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Cross-sectional anatomy of the spine divided into three columns:
Anterior column Middle column Posterior column |
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What constitutes the anterior column in the three-column concept of spinal stability?
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Anterior aspect of vertebral body
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What constitutes the middle column in the three-column concept of spinal stability?
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Posterior aspect of vertebral body
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What constitutes the posterior column in the three-column concept of spinal stability?
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Vertebral arch (pedicles, laminae, processes)
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What are the 4 main types of spinal fracture?
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Compression fracture
Burst fracture Flexion-distraction Fracture-dislocation |
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What is a Chance fracture?
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Flexion-distraction fracture of the spine
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What is radiculopathy?
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Impingement of nerve root
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What is myelopathy?
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Impingement of spinal cord
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In which 4 patients should you assume a cervical spine injury?
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1) A patient with head trauma
2) A patient with a history of high-energy trauma 3) A patient with neck pain 4) A patient with a neurological deficit |
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What associated symptoms should you ask the patient with suspected spinal injury on history?
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Neurologic symptoms: weakness, numbness, paraesthesias
Neck pain Orientation to time, person, and place |
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Describe the physical examination of the spine in a patient with suspected C-spine injury.
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Maintain the neck in a neutral position
Palpate the C-spine for tenderness and bony abnormalities Log-roll, palpate thoracic and lumbar spines for tenderness and bony abnormalities |
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In addition to direct examination of the spine itself, name two things you MUST do on physical examination in a patient with suspected C-spine injury.
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Full neurological assessment, including mental status
Digital rectal examination to assess for sphincter tone |
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What imaging study should you initially order to investigate a possible cervical spine injury?
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1) Cross-table lateral should be initial test (will reveal 70-79% of all cervical spine injuries)
Must include up to C7 and T1 Also known as the “Swimmer’s view” 2) AP 3) Open mouth view The latter two views improve yield |
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If the patient’s C-spine cannot be adequately viewed with X-ray, what imaging modality would you order?
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CT scan
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Which radiographic view is best to visualize the odontoid?
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Open mouth view
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What should you look for on the lateral/swimmer’s view?
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Anterior spinal line
Posterior spinal line Spinolaminar line Spinous process line |
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What should you look at on the open mouth/odontoid view?
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Lateral masses of C1 should align over facet joints of C2
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What are the indications for MRI in evaluation of the patient with suspected spinal injury?
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Patient with complete or incomplete neurologic deficits (to search for and quantify cord compression)
Patients whose neurologic status deteriorates |
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If a patient has a suspected C-spine injury, when should you order X-rays of the thoracic, lumbar, and sacral spine?
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If you find any fracture anywhere, the complete spine should be X-rayed to look for more
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What is the initial treatment for a patient with an unstable cervical spine injury?
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Immobilization
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What is the principle method of immobilization of the cervical spine?
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o Rigid collar
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What does SCIWARA mean?
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Spinal cord injury without radiologic abnormality
Note that the spine may be unstable despite normal C-spine X-ray |
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When is surgical decompression of the spinal cord indicated?
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All cases of radiographically demonstrable neurologic compression after realignment of the spine
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How do you clear a C-spine?
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Clinically:
History: no neck pain, not intoxicated, oriented, no neurologic symptoms (weakness, numbness, tingling) Physical: non-tender to palpation, no bony abnormalities Radiographically well-visualized and cleared |
