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Clinical Medicine (Neurology) - B3 - T2 - L22 - Thoracic and Lumbar Spine Trauma
Terms in this set (33)
What is the leading cause of spinal cord injury?
Motor vehicle accidents.
Approximately 80% of TBI patients are in what age range?
18-25 years old.
What portion of the spine is the most common site for spinal injury?
The cervical spine.
Where do most TLS fractures occur?
Between T11 & L4.
A patient presents to you with a fracture that affects the front column of the spine. Will the spine be able to carry the body's weight or not?
It will. This is more commonly known as a "wedge fracture."
A patient presents to you with a fracture of the anterior and middle column of the spine. Is this fracture stable or unstable?
Typically unstable as the spine can move as separate units.
What are the four major TLS fracture patterns?
3. Flexion-Distraction aka Chance fractures.
4. Fracture-Dislocation aka translational injuries.
A missed or delayed diagnosis of TLS injury increased the incidence of neurologic injury by how much?
TLS fractures can occur in the absence of trauma if the patient is (or has) which three things?
3. Chronic corticosteroid use.
What is the first thing we should think of when treating someone with a suspected spinal injury?
"Log Rolling" Technique
Technique used to move patients with a spinal injury from a backboard onto a hospital bed.
Why is it imperative to remove the backboard from a patient as soon as possible? (3)
Development of decubitus ulcers.
How quickly can decubitus ulcers start forming while a patient is on a hard backboard?
Within 2 hours.
A patient enters the hospital. They are unconscious with ecchymosis around their lower back. Should he be sent for imaging?
Yes, he should due to the altered mental status.
A patient enters the hospital following a motor vehicle accident. He says he is just sore, but the EMT insists that he suspects a TLS injury. Should he be sent for imaging?
Yes he should due to the high energy mechanism of injury.
What type of imaging is used to diagnose a TLS fracture?
A CT without contrast. It has a 97% sensitivity to TLS fractures.
If plain films must be ordered to evaluate a TLS injury, which views should be ordered?
AP and lateral.
Which is preferred for TLS fracture screening: MRI or CT?
CT. It is much more sensitive to osseous injuries than an MRI.
What is the primary goal in caring for patients with thoracolumbar spinal trauma?
Preservation of life!
Axial Compression Fractures (2)
1. Wedge compression fractures.
2. Burst fractures.
Wedge Compression Fracture
Flexion-Distraction Fractures (2)
1. Lap-Belt injuries.
2. Chance fractures.
Which type of fracture is the most common TLS fracture?
Wedge compression fracture.
An 83-year-old woman presents with back pain. She can't pinpoint when exactly it happened, but she wants someone to take a look. Should you image her back or not?
Yes. Anyone over 75-years-old c/o back pain should be screened.
What is the most common location for burst fractures?
How stable or unstable a burst fracture is depends on the amount of what?
While reading an AP x-ray, you notice a widening of interpedicular distance. What type of spinal fracture does this indicate?
A burst fracture.
What is the most common mechanism of injury for flexion-distraction injuries?
Incorrectly positioned lap belt and no chest restraint during MVC.
Flexion-distraction injuries involve the failure of which spinal columns?
The posterior and middle. (Anterior acts as a fulcrum).
50% of the time, bowel rupture and liver/spleen lacerations are associated with what type of spinal injury?
Fracture which begins in the spinous process, progresses through the lamina, transverse process, and pedicles before extending through the vertebral body.
What is the usual mechanism of injury for fracture-dislocation injuries?
Massive direct trauma to back combined with shear and flexion-rotation forces.
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