Cervical Spine Fractures And Dislocations

Front 1

what should be done prior to placement of Gardner-Wells tongs?

Back 1

xr or CT skull to r/o fracture

Front 2

optimal insertion site of gardner-wells tongs

Back 2

1 cm above the helix of the ear with neutral pin position aligned with the external auditory meatus

Front 3

anteriorly placed gardner-wells tongs

Back 3

gives a extension moment

Front 4

posteriorly placed gardner-wells tongs

Back 4

gives flexion moment

Front 5

application of gardner-wells tongs

Back 5

prep with betadine
no shave
lidocaine to periosteum
advance pins til engage outer cortex

Front 6

reduction technique for odontoid fractures

Back 6

in line traction for angular deformity
bolsters or towel rolls for translational deformity

Front 7

reduction technique for bilateral facet dislocation

Back 7

towel roll between scapulae
slightly posterior pins
10 lb increments every 10-15 min with lat XR
serial neuro exams

Front 8

reductions technique for unilateral facet dislocations

Back 8

more stable than bilateral dislocations
grasp tongs like steering wheel
compression to nondislocated side
longitudinal traction to dislocated side
rotated head toward dislocated side
slowly release traction

Front 9

role for prereductions MRI

Back 9

concern that intervertebral disc herniations will be pulled into spinal cord

Front 10

optimal pin sites for halo

Back 10

anterior pins = 1 cm above lateral third of orbital ring
posterior pins = 1 cm above helix of ear

Front 11

what are you trying to avoid with anterior pins to halo

Back 11

supraorbital nerve

Front 12

application of halo

Back 12

opposing pins should be tightened at the same time to avoid displacement until reaching final torque of 8 inch-pounds, retighten in 24-48 hours

Front 13

complications in halo vest treatment

Back 13

pin site infections
difficulty swallowing
pressure sores

Front 14

most useful method to assess occipitocervical dislocation

Back 14

BAI
BDI
aka Harris' rule of twelve

Front 15

Traynelis classification of occipitocervial dislocation

Back 15

I: anterior displacement of occiput
II: axial separation of occipitoatlantal junction
IIb: axial distraction through atlantoaxial junction
III: posterior displacement of occiput

Front 16

Anderson and Montesano classification for occipital condyle fractures

Back 16

I: impaction fractures
II: basilar skull fractures that involve condyle
III: avulsion fractures (instability potential)

Front 17

Tuli classification for occipital condyl fractures

Back 17

1: stable, nondisplaced
2A: displaced but stable with no ligamentous injury
2B: displaced, unstable with ligament injury
(CT/MRI to distinguish stable from unstable)

Front 18

posterior C1 arch fractures

Back 18

simplest and most benign
2 fractures posterior to lateral mass
important if planning for sublaminar wiring

Front 19

classic Jefferson fracture pattern

Back 19

bilateral fractures in anterior and posterior aspect of the ring

Front 20

how integrity of transverse ligament in assessed

Back 20

lateral overhang of C1 lateral masses on C2 - combined >7-8 mm

Front 21

diagnosis of sagittal atlantoaxial instability without fracture

Back 21

widening of ADI

Front 22

Anderson and D'Alonzo classification for odontoid fractures

Back 22

I: small avulsion from tip of dens
II: waist fracture
III: fracture through cancellous bone of C2 vertebral body

Front 23

Levine and Edwards classification for Hangman's fracture

Back 23

I: minimally or nondisplaced, no evidence of translation or angulation
Ia: where posterior C2 vertebral body in continuity with one of pars fracture fragments
II: angulation and translation
IIa: marked angulation with minimal translation
III: C2 pars fracture associated with dislocation of C2-3 facet joint

Front 24

hangman's fracture

Back 24

traumatic spondylolisthesis, C2-3

Front 25

Allen and Ferguson mechanistic classification of subaxial fractures and dislocations

Back 25

compressive flexion
vertical compression
distractive flexion
compressive extension
distractive extension
lateral flexion

Front 26

compressive flexion

Back 26

stage 1: blunting anterosuperior vertebral body margin
2: beak appearance of anterosuperior vertebral body margin, sagittal body split may be present
3: oblique primary fracture line from anterior vertebral body to inferior endplate (tear drop)
4: 3 + posterior translation of upper vertebra <3 mm
5: posterior translation of upper vertebra >3 mm

Front 27

vertical compression

Back 27

stage 1: central superior or inferior endplate fracture
2: superior and inferior endplate fractures, sometimes with body fracture lines
3: vertebral body comminution with or without retropulsion, with or without kyphotic or translational deformity

Front 28

distractive flexion

Back 28

stage 1: facet subluxation, gapping of spinous process lig, with or without some blunting of anterosuperior vertebral body
2: unilateral facet dislo, PLC usually intact, rotational deformity
3: bilateral facet dislo, 50% translation of upper vertebral body on lower one
4: close to 100% translation of upper vertebral body on lower one - floating vertebra

Front 29

compressive extension

Back 29

stage 1: posterior arch fracture (facet, pedicle, or lamina) with or without rotation, mild anterior translation [lateral mass fracture]
2: b/l lamina fractures, can be multiple levels
3: b/l lamina, facet, pedicle fractures without vertebral body displacement
4: 3 + partial anterior vertebral body displacement
5: 3 + 100% anterior vertebral body displacement

Front 30

distractive extension

Back 30

stage 1: abnormal widening of disc space, may or may not be avulsion fracture of anterior vertebral body margin, no posterior translation
2: 1+ posterior translation

Front 31

lateral flexion

Back 31

stage 1: unilateral uncovertebral vertebral fracture or asymmetric vertebral body compression
2: vertebral body or posterior arch fractures with lateral translation or unilateral facet gapping, coronal angular deformity on AP

Front 32

teardrop fracture

Back 32

characteristic primary fracture that extends obliquely from anterosuperior vertebral body to the inferior endplacte

Front 33

cervical ROM

Back 33

flex/extension C4-5 and C5-6 = 20 deg
subaxial axial rotation = 2-7 deg
C1-2 rotation = 45-60%
lateral flexion C2-5 = 10-11 deg

Front 34

relative kyphosis suggestive of PLC disruption

Back 34

>11 deg

Front 35

most frequent sites of cervical spine fracture

Back 35

upper cervical (C1-2)

Front 36

why spinal cord damage is more frequently associated with lower cervical spine versus upper

Back 36

differences in spinal canal dimensions and mechanisms of injury

Front 37

recommended arterial oxygen partial pressure in spinal injury

Back 37

100 mm hg

Front 38

neurogenic shock

Back 38

hypotension accompanied by bradycardia

Front 39

treatment for neurogenic shock

Back 39

postural manuevers (Trendelenberg)
judicious fluid infusion
vasopressors

Front 40

C5 exam

Back 40

motor: deltoid
sensory: lateral shoulder/arm
reflex: biceps

Front 41

C6 exam

Back 41

motor: biceps/wrist extension
sensory: lateral forearm/thumb and index finger
reflex: brachioradialis

Front 42

C7 exam

Back 42

motor: triceps/wrist flexion
sensory: middle finger
reflex: triceps

Front 43

C8 exam

Back 43

motor: hand intrinsics/finger flexors
sensory: ring/little finger/medial forearm
reflex: none

Front 44

T1 exam

Back 44

motor: hand intrinsics/finger abduction
sensory: medial arm/axilla
reflex: none

Front 45

S1 exam

Back 45

motor: rectal tone
sensory: perianal
reflex: bulbocavernosus

Front 46

sign of sacral nerve root sparing

Back 46

perianal sensation
positive prognostic sign for neurologic recovery

Front 47

cranial nerve injuries can be associated with

Back 47

cervical spine fractures and dislocations

Front 48

how to grade muscle group strength

Back 48

5: able to resist full force resistance
4: examiner able to overcome strength
3: can overcome gravity, no resistance
2: can move without gravity
1: visible contraction
0: no contraction

Front 49

marks the end of spinal shock

Back 49

BC reflex - typically 48 hours from injury

Front 50

lateral XR is able to detect

Back 50

85% cervical spine injuries

Front 51

ASIA scale

Back 51

A: 0/5 motor, complete sensory deficit
B: 0/5 motor, incomplete sensory deficit
C: <3/5, incomplete sensory deficit
D: >3/5, incomplete sensory deficit
E: 5/5, no sensory deficit

Front 52

power ratio

Back 52

basion to posterior C1 arch
----------------------------------
opisthion to anterior C1 arch

Front 53

significance of power ratio

Back 53

>1 suggestive of atlanto-occipital dislocation

Front 54

BAI

Back 54

basion-axis interval: measured distance between basion and a perpendicular lined drawn in relation to posterior vertebral body tangent line of C2
should be <12 mm

Front 55

BDI

Back 55

basion-dens interval:distance between basion an dtip of dens
should be <12 mm

Front 56

ADI

Back 56

atlanto-dens interval: posterior surface of anterior C1 ring to anterior surface of dens
should be 2-3 mm

Front 57

PADI

Back 57

posterior atlanto-dens interval: posterior surface of dens to anterior portion of the posterior C1 ring
<13 mm --> critical canal compromise

Front 58

prevertebral swelling

Back 58

soft tissue shadow thickness anterior to vertebral bodies
>7 mm for C2-3
>21 mm for C6-7
high likelihood of cervical spinal injury

Front 59

radiographic lines, landmarks, and measurements on lateral cervical XR

Back 59

spinolaminar line
posterior vertebral body line
anterior vertebral body line
facet joints
prevertebral soft tissue shadow

Front 60

minimal acceptable amount of excursion on flex/ex films

Back 60

30 deg to adequately rule out ligamentous injury

Front 61

determines stability of C1 Jefferson fracture

Back 61

integrity of transverse ligament

Front 62

implies transverse ligament disruption

Back 62

combined overhang of C1 lateral masses relative to C2 lateral masses >7 mm

Front 63

contusion

Back 63

physical tissue disruption leading to hemorrhage and swelling
(mc type of spinal cord injury)

Front 64

laceration

Back 64

loss of structural continuity

Front 65

area of cord that sustain most severe injury in spinal cord injury

Back 65

inner most regions

Front 66

bell cruciate paralysis

Back 66

long tract injury at level of decussation in brainstem
variable CN involvement
greater upper extremity weakness than lower
greater proximal weakness than distal

Front 67

anterior cord areas affected

Back 67

anterior gray matter
descending corticospinal motor tract
spinothalamic tract injury
preservation of dorsal columns

Front 68

symptoms of anterior cord

Back 68

variable motor and pain/temp sensory loss with preservation of proprioception and deep pressure sensation

Front 69

central cord area affected

Back 69

incomplete cevical white matter injury

Front 70

central cord symptoms

Back 70

sacral sparing and greater weakness in the upper limbs than the lower limbs

Front 71

brown-sequard areas affected

Back 71

injury to one latera half of cord and preservation of contralateral half

Front 72

brown-sequard symptoms

Back 72

ipsilateral motor and proprioception loss and contralateral pain/temp sensory loss

Front 73

conus medullaris areas affected

Back 73

injury to sacral cord and lumbar nerve roots within the spinal canal

Front 74

conus medullaris symptoms

Back 74

areflexic bladder, bowel, and lower limbs
may have preserved bulbocavernosus and micturition reflexes

Front 75

cauda equina area affected

Back 75

injury to the lumbosacral nerve roots within the spinal canal

Front 76

cauda equina symptoms

Back 76

areflexic bladder, bowel, and lower limbs

Front 77

root injury area affected

Back 77

avulsion or compression injuyr to single or multiple nerve roots (brachial plexus avulsion)

Front 78

root injury symptoms

Back 78

dermatomal sensory loss, myotomal motor loss, and absent deep tendon reflex