Spinal Cord Injuries

Front 1

Define radiculopathy

Back 1

disorder of the spinal nerve roots

Front 2

Define myelopathy

Back 2

disorder of the spinal cord

Front 3

Define pathologic fracture

Back 3

fx occurring at a site of weakened preexisting disease; especially neoplasm or necrosis of the bone

Front 4

Discuss the epidemiology of spinal cord injury in terms of age, sex, when it is most likely to occur and the etiology of over 90% of all cases

Back 4

90% due to blunt trauma (MVC, assaults, GSW, falls, sport accidents). C-spine most common 61%, thoracolumbar jct 19%, thoracic spine 16%, lubosacral 4%

Front 5

Describe the 4 categories of major spinal injuries

Back 5

Compression (wedge), burst, flexion-distraction (seatbelt type injuries), fracture/dislocations

Front 6

Define compression (wedge) fractures

Back 6

result from axial loading and flexion. Failure of anterior column, middle column remains intact. Usually stable

Front 7

Define burst fractures

Back 7

follow failure of vertebral body under axial load both anterior and middle columns fail. Retropulsion of bone and disk fragments into canal and may cause spinal cord compression

Front 8

Define felxion-distraction fractures (seatbelt type injuries)

Back 8

seatbelt serves as axis of rotation during distraction, failure of posterior and middle columns, intact anteror column prevents subluxation

Front 9

Define fracture / dislocations

Back 9

most damaging of injuries; compression, flexion and distraction, rotation or shearing forces lead to failure of all 3 columns

Front 10

Identify the area of the spine most likely to be affected in motor vehicle injuries and in falls from a height

Back 10

cervical spine

Front 11

Describe the corticospinal tract and what happens when it is damaged in a SCI

Back 11

Damage results in ipsilateral clinical findings such as muscle weakness, spasticity, increased deep tendon relfexes and babinski sign.

Front 12

What pathway is the corticospinal tract

Back 12

descending motor pathway

Front 13

Briefly discuss etiology, symptoms and prognosis of anterior cord

Back 13

Direct injury to anterior cord. Loss of motor function, px & temp sensation distal to lesion. Only vibratory, position and crude touch okay. poor prognosis for recovery of fx

Front 14

Briefly discuss etiology, symptoms and prognosis of Central cord

Back 14

hyperextension injury which disrups blood flow to cord, c-spine stenosis. Quadriparesis greater in upper ext. than lower. Some px, temp loss sensation, greater in upper ext. Prog. good

Front 15

Briefly discuss etiology, symptoms and prognosis of Brown Sequard

Back 15

transverse hemisection of spinal cord, unilateral cord compression. Ipsilateral spastic paresis, loss of proprioception and vibratory and contralateral loss px, temp. sensation. Prog good

Front 16

Briefly discuss etiology, symptoms and prognosis of Cauda equine

Back 16

peripheral nerve injury. Variable motor and sensory loss in lower ext., sciatica, bowel / bladder dysfx and saddle anesthesia. Prog. good

Front 17

Briefly discuss etiology, symptoms and prognosis of Incomplete cord

Back 17

partial or complete injury usually at T6 or above. Areflexia, loss of sensation, flaccid bladder, rectal tone; bradycardia, hypoTN. Prog. some degree of recovery

Front 18

Briefly discuss etiology, symptoms and prognosis of Complete cord

Back 18

partial or complete injury usually at T6 or above. Areflexia, loss of sensation, flaccid bladder, rectal tone; bradycardia, hypoTN. Prog. poor

Front 19

Define Anterior cord injury

Back 19

damage to the corticospinal and spinothalamic pathways

Front 20

Define central cord injuries

Back 20

involves the central portion of the cord more than the peripheral. Seen in older pt's with pre-existing cervical spondylosis who sustain hyperextension injury

Front 21

Define Brow-Sequard injury

Back 21

hemisection of the cord

Front 22

Define Cauda Equine injury

Back 22

Composed entirely of lumbar, sacral and coccygeal nerve roots and produces a peripheral nerve injury rather than direct injury to cord

Front 23

Expain why airway concerns nad hypTN are paramount in the acute SCI pt

Back 23

phrenic nerve roots at C3,4,5 supply diaphragm. Loss of a-adrenergic tone and dilation of arterial and venous vessels lead on decreased systemic vascular resistance

Front 24

What spinal cord injury pt's should be intubated

Back 24

Any injury above C5.

Front 25

What injuries cause sympathetic denervation

Back 25

injuries at level of cervical or thoracic regions.

Front 26

What does sacral sparing indicate

Back 26

incomplete spinal cord level

Front 27

What does areflexia indicate

Back 27

spinal shock with partial or complete injury usually at T6 and above

Front 28

What type of SCI would cause spasticity

Back 28

Brown-sequard

Front 29

What type of SCI would cause flaccidity

Back 29

spinal shock from partial or complete injury usually at T6 or above

Front 30

Define presentation, etiology, and prognosis of spinal shock

Back 30

Blood loss presumed to be cause of hypotension until proven. PE partial/complete usually T6-above. Prog: complete poor, partial some recovery

Front 31

Define presentation, etiology, and prognosis of neurogenic shock

Back 31

warm, peripherally vasodilated and bradycardic, tolerate hypoTN well.

Front 32

Know when corticosteroids might be indicated for treatment of SCI

Back 32

high-dose methylprednisole standard for blunt SCI; shown improvement of motor and sensory fx in pt's with complete/incomplete neurologic lesion. Not effective in penetrating SPI

Front 33

What are benefits and disadvantages of plain radiography in cervical spinal injuries

Back 33

Good visualization of prevertebral swelling and spinous process. Gold standard for bony c-spine injuries with 3 views. Poor for imaging C1-2

Front 34

If ordering plain radiograph of C-spine what would they be

Back 34

AP, lateral and odontoid

Front 35

What are benefits and disadvantages of CT in cervical spinal injuries

Back 35

can visualize entire c-spine but may not identify pt's with ligamentous injuries

Front 36

What are benefits and disadvantages of MRI in cervical spinal injuries

Back 36

unreliable pt's or those with sig MOI or risk factor like age should have MRI although rarely indicated as part of initial investigation

Front 37

Identify the 5 views obtained for cervical trauma series.

Back 37

lateral, AP, odontoid, swimmer's view (thru axilla to attempt imaging lower c-spine) and oblique

Front 38

What radiographic view is most sensitive

Back 38

laeral c-spine will identify 90% of injuries to bone and ligaments

Front 39

Know how to evaluate cervical spine alignment, fracture and soft tissue spaces on plain films

Back 39

look for presence or absence of prevertebral swelling. Prevertebral space anterior to C3 should be less than 5mm. Predental space <3mm

Front 40

Identify the most common causes of cervical spine injuries

Back 40

MVC, assaults, blunt trauma, GSW, falls, sporting accidents

Front 41

Identify the factors that lower the risk for cervical spine injury

Back 41

spinal immobilization helps prevent secondary injury, athletes who wear helmets and other protective equipment, etc.

Front 42

Describe the 5 NEXUS criteria utilized to clear cervical spine

Back 42

Pt must meet all criteria in order to omit radiography: no posterior midline c-spine tenderness, no intoxication, normal level alertness, no focal neurologic deficit, no px distracting factors

Front 43

Discuss the indications for obtaining cervical spine radkographs

Back 43

often initial screening for injuries and should be performed for all pt's with suspicion of spinal injury

Front 44

Define Jefferson fracture and what vertebrea involved

Back 44

direct blow to top of head; C1

Front 45

Define transverse ligament disruption and what vertevae involved

Back 45

anteriorally on inside of ring of C1 to posterior surface of dens. Crucial to maintaining stability of 1st and 2nd vertebrae. Direct blow to occiput like in old person who falls

Front 46

Define avulsion fracture and what vertevae involved

Back 46

hyperextension injury may avulse the inferior pole of the anterior tubercle of C1; involves entire anterior arch is UNSTABLE

Front 47

Define hangman's fracture and what vertevae involved

Back 47

traumatic spondylolithesis or axis; pedicles of C2 with displacing C2 anteriorly on C3. Extension MOI like judicial hangings; not suicidal hangings. Also MVC, diving. UNSTABLE

Front 48

Define clay-shoveler's fracture and what vertevae involved

Back 48

avulsion of the spinous process of lower cervical vertebrae, classically C7. STABLE

Front 49

Define simple wedge fracture and what vertevae involved

Back 49

caused by compression between 2 vertebrae. Posterior element disruption makes injury STABLE

Front 50

Define flexion teardrop fracture and what vertevae involved

Back 50

extreme flexion associated with anterior cord syndrome due to impingment of spinal cord by fx hyperkyphosis. UNSTABLE

Front 51

Define pillar fracture and what vertevae involved

Back 51

extension and rotation causing impaction of superior vertebra on articular mass. STABLE

Front 52

Define burst fracture and what vertevae involved

Back 52

direct axial load causing vertebra to burst with fragments displacing in all directions. UNSTABLE

Front 53

Define extension teardrop and what vertevae involved

Back 53

hyperextension causing anterior longitudinal ligament to avulse inferior portion of anterior vertebral body at insertion. More common in old pt's with osteoporosis. UNSTABLE

Front 54

Define Laminar fracture and what vertevae involved

Back 54

hyperextension. CT required to define extent of spinal cord involvement

Front 55

Identify where most thoracic spine injuries occur

Back 55

thorocolumbar junction

Front 56

How would you manage a thorocolumbar junction fracture

Back 56

pt should remain in spinal immobilization unti ldefinitive diagnosis and evaluation of CT and MRI are made by spinal surgeon

Front 57

List Hx and PE that might suggest a traumatic injury to lumbar or sacral spine

Back 57

associated with fractures of pelvis; bowel or bladder dysfunction, anal sphincter tone and bulbocavernousus reflex diminished

Front 58

Identify lumbar spine cases when referral to a neurologist or neurosurgeon is indicated

Back 58

suspicion of cauda equina injury

Front 59

How would you classify a compression fracture

Back 59

major, unstable until evaluation is complete

Front 60

How would you classify an axial burst fracture

Back 60

major, unstable, CT define extent of injury

Front 61

How would you classify a flexion-distraction fracture

Back 61

major, unstable, CT and specialist consultation

Front 62

How would you classify a transverse fracture

Back 62

minor

Front 63

Spinal Trauma

Back 63

Spinal Trauma

Front 64

What associated neurological exam problems might you see with a C5-6 level SCI

Back 64

arm adbduction, elbow flexion

Front 65

What associated neurological exam problems might you see with a C6-7-8 level SCI

Back 65

wrist, elbow extension

Front 66

What associated neurological exam problems might you see with a C8-T1 level SCI

Back 66

finger abduction, hand grasp

Front 67

What associated neurological exam problems might you see with a T2-7 level SCI

Back 67

chest muscles

Front 68

What associated neurological exam problems might you see with a T9-12 level SCI

Back 68

abdominal muscles

Front 69

What associated neurological exam problems might you see with a L1-3 level SCI

Back 69

iliopsoas, hip flexion

Front 70

What associated neurological exam problems might you see with a L2-4 level SCI

Back 70

quadriceps, knee extension

Front 71

What associated neurological exam problems might you see with a L4-5 level SCI

Back 71

ankle dorsiflexion

Front 72

What associated neurological exam problems might you see with a L5-S1 level SCI

Back 72

extensor hallucis longus, great toe extension

Front 73

What associated neurological exam problems might you see with a S1-2 level SCI

Back 73

gastrocnemius, ankle plantar flexion

Front 74

What associated neurological exam problems might you see with a S2-4 level SCI

Back 74

bladder, anal sphincter, voluntary rectal tone