What is a burst fx?
-results from vertical compression, loss of vertebral ht
-anterior and middle column ruptured
-can injure superior or inferior endplate or both
-may have retropulsion into the spinal canal
-generally a stable fx because ligaments remain intact, but retropulsion may injure spinal cord
What is the treatment for burst fx?
-TLSO brace if: canal compromise is less than 40%, fx appears stable
-surgical intervention if: canal compromise greater than 40%, kyphotic deformity greater than 25 degrees, any neuro deficit
What is a compression (wedge) fx?
-similar to burst fx, but only anterior column injured
-results from compression or flexion
-unstable if vertebral ht is reduced by 50% or if multiple compression fx's in a row
What is the NEXUS criteria for imaging?
-imaging unnecessary if meets all the following criteria? absence of posterior midline cervical tenderness, normal level of alertness, no evidence of intoxication, no abnormal neurologic findings, no painful distracting injuries
What are dangerous mechanisms?
-fall from 3 feet or 5 stairs
-axial load to head
-MVC at greater than 100kph or with rollover or ejection
-collision involving motorized recreational vehicle
Which is better CCR or NEXUS?
-nexus had sensitivity of 90%
-CCR had sensitivity of 99%
How do you decide between xray or CT?
-depends on mechanism, suspicion for injury, other injuries present, which institution you work at, etc.
-multi-trauma pt's generally have CT's done. Less injured pts can often start with plain films but may need CT scan to obtain better image of injury, or if xrays are negative but suspicion for injury is still high
What is a Jefferson fracture?
-burst fracture of the C1 ring
-caused by axial loading
-highly unstable if transverse ligament disrupted
-treatment: c-collar vs Halo depending on stability
What is a chance fracture?
-common from lap belt only, sudden deceleration
-most common from T10-L2
-bone or ligament injury to all 3 columns
-often compression of anterior and middle column with fracture extending through posterior column
-can be only fractured through 1 or 2 columns with ligamentous injury to others
What is the treatment for a chance fx?
-may be non operative if only partial vertebral body involvement (fx not through all 3 columns) and if kyphosis is less than 15 degrees
-non operative treatment is TLSO for 2-3 mo
What is a hangman's fx?
-traumatic spondylolysis of C2
-spondylolysis: defect in pars interarticularis, which is part of the facet between the superior and inferior articular surfaces
-essentially a fx of the C2 facet, unstable fx, but often minimal spinal cord injury because vertebral foramen is large at C2
-halo versus surgical fixation to C3
What is spondylolysis?
-defect in pars interarticularis, which is part of the facet between the superior and inferior articular surfaces. Can be traumatic or congenital
What is spondylolysthesis?
-forward movement of one vertebrae over the other
What is spondylosis?
-fixation or stiffness or a vertebral joint due to degenerative changes (arthritis)
What is ligamentous injury?
-possible to have ligamentous injury that can make spine unstable with normal CT scan
-further work up/treatment: MRI, flexion, extension xrays, c-collar for 2 weeks then re-evaluate
What are causes of spinal cord injuries?
-fx of one or more bony elements
-dislocatin at one or more joints
-tearing of ligaments
-disruption or herniation of intervertebral disk
-SCIWORA (spinal cord injury without radiographic abnormality)
What is the motor level?
-defined as lowest level with at least 3/5 strength, while level above has 5/5 strength
What levels correspond with what upper limb mucles?
-C6: wrist extensors
-C8: long finger flexors
-T1: small finger abductors
What levels correspond with what lower limb muscles?
-L2: hip flexors
-L3: knee extensors
-L4: ankle dorsiflexors
-L5: extensor hallucis
-S1: ankle plantar flexors
What is the sensory level?
-lowest dermatome to have 2/2 sensation
What is an incomplete SCI?
-sacral sparing: presence of either motor function or sensation at the anus, meaning spinal cord is at least partially intact
-various degrees of muscle function and sensation below the level of the injury
-sensation often more preserved than muscle function
What is central cord syndrome?
-results from hyperextension injury, with or without fx
-cord is pinched, compressed, confused or there is bleeding into the cord itself
-weakness greater in upper extremities than in lower extremities, most prevalent in hands
-sensory loss variable
What is the treatment for central cord syndrome?
-treatment is primarily physical and occupational therapy
-recovery is highly variable
What is Brown Sequard syndrome?
-hemisection of spinal cord, usually from penetrating wound (stab or gunshot)
-results in ipsilateral loss of motor function and contralateral loss of sensitivity to pain and temp
-treatment is PT and OT
What is spinal shock?
-occurs in incomplete injuries
-transient complete loss of sensation and reflexes and flaccid paralysis below level of injury
-may resolve in hours to days
-may mimic complete injury
What is neurogenic shock?
-loss of sympathetic stimulation causes vasodilation, resulting in hypotension
-triad of hypotension, bradycardia, and hypothermia
-in cases of trauma this must be differentiated from hypovolemic shock
-treat with pressors, inotropes, and fluids as needed
What is SCI treatment?
-surgical repair/decompression of any fx or dislocation causing the SCI
-halo, c-collar, TLSO
-pressors, inotropes, fluids as needed in case of neurogenic shock
Should you give steroids?
-steroid use seems to be declining
-depends on what institution you are working at, and with which surgeon
-if going to use them, the earlier the better
What is spine injury management?
-do the best to protect the spine and maintain airway. Jaw thrust instead of chin tilt, surgical airway if all else fails
What is full spinal immobilization?
-rigid cervical collar, head blocks and/or tape, back board