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74 Cards in this Set

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  • Back
Define radiculopathy
disorder of the spinal nerve roots
Define myelopathy
disorder of the spinal cord
Define pathologic fracture
fx occurring at a site of weakened preexisting disease; especially neoplasm or necrosis of the bone
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
90% due to blunt trauma (MVC, assaults, GSW, falls, sport accidents). C-spine most common 61%, thoracolumbar jct 19%, thoracic spine 16%, lubosacral 4%
Describe the 4 categories of major spinal injuries
Compression (wedge), burst, flexion-distraction (seatbelt type injuries), fracture/dislocations
Define compression (wedge) fractures
result from axial loading and flexion. Failure of anterior column, middle column remains intact. Usually stable
Define burst fractures
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
Define felxion-distraction fractures (seatbelt type injuries)
seatbelt serves as axis of rotation during distraction, failure of posterior and middle columns, intact anteror column prevents subluxation
Define fracture / dislocations
most damaging of injuries; compression, flexion and distraction, rotation or shearing forces lead to failure of all 3 columns
Identify the area of the spine most likely to be affected in motor vehicle injuries and in falls from a height
cervical spine
Describe the corticospinal tract and what happens when it is damaged in a SCI
Damage results in ipsilateral clinical findings such as muscle weakness, spasticity, increased deep tendon relfexes and babinski sign.
What pathway is the corticospinal tract
descending motor pathway
Briefly discuss etiology, symptoms and prognosis of anterior cord
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
Briefly discuss etiology, symptoms and prognosis of Central cord
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
Briefly discuss etiology, symptoms and prognosis of Brown Sequard
transverse hemisection of spinal cord, unilateral cord compression. Ipsilateral spastic paresis, loss of proprioception and vibratory and contralateral loss px, temp. sensation. Prog good
Briefly discuss etiology, symptoms and prognosis of Cauda equine
peripheral nerve injury. Variable motor and sensory loss in lower ext., sciatica, bowel / bladder dysfx and saddle anesthesia. Prog. good
Briefly discuss etiology, symptoms and prognosis of Incomplete cord
partial or complete injury usually at T6 or above. Areflexia, loss of sensation, flaccid bladder, rectal tone; bradycardia, hypoTN. Prog. some degree of recovery
Briefly discuss etiology, symptoms and prognosis of Complete cord
partial or complete injury usually at T6 or above. Areflexia, loss of sensation, flaccid bladder, rectal tone; bradycardia, hypoTN. Prog. poor
Define Anterior cord injury
damage to the corticospinal and spinothalamic pathways
Define central cord injuries
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
Define Brow-Sequard injury
hemisection of the cord
Define Cauda Equine injury
Composed entirely of lumbar, sacral and coccygeal nerve roots and produces a peripheral nerve injury rather than direct injury to cord
Expain why airway concerns nad hypTN are paramount in the acute SCI pt
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
What spinal cord injury pt's should be intubated
Any injury above C5.
What injuries cause sympathetic denervation
injuries at level of cervical or thoracic regions.
What does sacral sparing indicate
incomplete spinal cord level
What does areflexia indicate
spinal shock with partial or complete injury usually at T6 and above
What type of SCI would cause spasticity
Brown-sequard
What type of SCI would cause flaccidity
spinal shock from partial or complete injury usually at T6 or above
Define presentation, etiology, and prognosis of spinal shock
Blood loss presumed to be cause of hypotension until proven. PE partial/complete usually T6-above. Prog: complete poor, partial some recovery
Define presentation, etiology, and prognosis of neurogenic shock
warm, peripherally vasodilated and bradycardic, tolerate hypoTN well.
Know when corticosteroids might be indicated for treatment of SCI
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
What are benefits and disadvantages of plain radiography in cervical spinal injuries
Good visualization of prevertebral swelling and spinous process. Gold standard for bony c-spine injuries with 3 views. Poor for imaging C1-2
If ordering plain radiograph of C-spine what would they be
AP, lateral and odontoid
What are benefits and disadvantages of CT in cervical spinal injuries
can visualize entire c-spine but may not identify pt's with ligamentous injuries
What are benefits and disadvantages of MRI in cervical spinal injuries
unreliable pt's or those with sig MOI or risk factor like age should have MRI although rarely indicated as part of initial investigation
Identify the 5 views obtained for cervical trauma series.
lateral, AP, odontoid, swimmer's view (thru axilla to attempt imaging lower c-spine) and oblique
What radiographic view is most sensitive
laeral c-spine will identify 90% of injuries to bone and ligaments
Know how to evaluate cervical spine alignment, fracture and soft tissue spaces on plain films
look for presence or absence of prevertebral swelling. Prevertebral space anterior to C3 should be less than 5mm. Predental space <3mm
Identify the most common causes of cervical spine injuries
MVC, assaults, blunt trauma, GSW, falls, sporting accidents
Identify the factors that lower the risk for cervical spine injury
spinal immobilization helps prevent secondary injury, athletes who wear helmets and other protective equipment, etc.
Describe the 5 NEXUS criteria utilized to clear cervical spine
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
Discuss the indications for obtaining cervical spine radkographs
often initial screening for injuries and should be performed for all pt's with suspicion of spinal injury
Define Jefferson fracture and what vertebrea involved
direct blow to top of head; C1
Define transverse ligament disruption and what vertevae involved
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
Define avulsion fracture and what vertevae involved
hyperextension injury may avulse the inferior pole of the anterior tubercle of C1; involves entire anterior arch is UNSTABLE
Define hangman's fracture and what vertevae involved
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
Define clay-shoveler's fracture and what vertevae involved
avulsion of the spinous process of lower cervical vertebrae, classically C7. STABLE
Define simple wedge fracture and what vertevae involved
caused by compression between 2 vertebrae. Posterior element disruption makes injury STABLE
Define flexion teardrop fracture and what vertevae involved
extreme flexion associated with anterior cord syndrome due to impingment of spinal cord by fx hyperkyphosis. UNSTABLE
Define pillar fracture and what vertevae involved
extension and rotation causing impaction of superior vertebra on articular mass. STABLE
Define burst fracture and what vertevae involved
direct axial load causing vertebra to burst with fragments displacing in all directions. UNSTABLE
Define extension teardrop and what vertevae involved
hyperextension causing anterior longitudinal ligament to avulse inferior portion of anterior vertebral body at insertion. More common in old pt's with osteoporosis. UNSTABLE
Define Laminar fracture and what vertevae involved
hyperextension. CT required to define extent of spinal cord involvement
Identify where most thoracic spine injuries occur
thorocolumbar junction
How would you manage a thorocolumbar junction fracture
pt should remain in spinal immobilization unti ldefinitive diagnosis and evaluation of CT and MRI are made by spinal surgeon
List Hx and PE that might suggest a traumatic injury to lumbar or sacral spine
associated with fractures of pelvis; bowel or bladder dysfunction, anal sphincter tone and bulbocavernousus reflex diminished
Identify lumbar spine cases when referral to a neurologist or neurosurgeon is indicated
suspicion of cauda equina injury
How would you classify a compression fracture
major, unstable until evaluation is complete
How would you classify an axial burst fracture
major, unstable, CT define extent of injury
How would you classify a flexion-distraction fracture
major, unstable, CT and specialist consultation
How would you classify a transverse fracture
minor
Spinal Trauma
Spinal Trauma
What associated neurological exam problems might you see with a C5-6 level SCI
arm adbduction, elbow flexion
What associated neurological exam problems might you see with a C6-7-8 level SCI
wrist, elbow extension
What associated neurological exam problems might you see with a C8-T1 level SCI
finger abduction, hand grasp
What associated neurological exam problems might you see with a T2-7 level SCI
chest muscles
What associated neurological exam problems might you see with a T9-12 level SCI
abdominal muscles
What associated neurological exam problems might you see with a L1-3 level SCI
iliopsoas, hip flexion
What associated neurological exam problems might you see with a L2-4 level SCI
quadriceps, knee extension
What associated neurological exam problems might you see with a L4-5 level SCI
ankle dorsiflexion
What associated neurological exam problems might you see with a L5-S1 level SCI
extensor hallucis longus, great toe extension
What associated neurological exam problems might you see with a S1-2 level SCI
gastrocnemius, ankle plantar flexion
What associated neurological exam problems might you see with a S2-4 level SCI
bladder, anal sphincter, voluntary rectal tone