27 - spinal trauma

what are the most common spinal segments affected in spinal cord injury

1. C1-T1

2. T1-T11

3. T11-L2

4. L2-S5

primary spinal cord injury results in

immediate death of local cells

1. direct damage to cell bodies - die and not replaced

2. damage to spinal axons - wallerian degeneration

secondary spinal injury is caused by...

inflammation

vascular events

chronic phase of injury

what is spinal shock

transient loss of all neurological function below level of spinal injury causing flaccid paralysis and areflexia lasting around 72hours - 2 weeks

what is spinal shock caused by

interruption of sympathetic - injury above T1

loss of vascular tone

relative hypovolaemia

true hypovolaemia - blood loss

types of spinal injuries

complete

incomplete

complete spinal cord injury

complete loss of motor and/or sensory function BELOW level of injury in absence of spinal shock

indications of incomplete spinal cord injury

sacral opening - preserved sensation around anus

voluntary anal sphincter contraction

voluntary toe flexion

incomplete spinal injury

residual motor or sensory function below level of spinal injury

types of incomplete spinal injury

central cord syndrome

brown sequard syndrome - cord hemisection

anterior cord syndrome

posterior cord syndrome

what does central cord syndrome result from

hyperextension

what is central cord syndrome associated with

cervical fracture or dislocation

acute traumatic cervical disc herniation

symptoms of central cord syndrome

motor weakness in upper limb

sensory loss below level of injury

urinary retention

anterior cord syndrome definition

cord infarction in territory supplied by anterior spinal artery

clinical presentation of anterior cord syndrome

paraplegia

quadriplegia if above C7

dissociated sensory loss below lesion

- loss of pain and temperature sensation

- preservation of 2 point discrimination, joint position sense, deep pressure sensation - reserved posterior column

spinal cord injury management

primary assessment

- ABCDE

secondary assessment

- GCS

- identification of axial skeleton fractures, appendicular skeleton, pelvic fracture

investigations for spinal cord injury

X-ray - AP, lateral and mouth

CT

MRI - ligamentous injuries , cord compression, haematomas

occipital condole fracture

rare

usually stable

due to direct blow to head

presentation of occipital condole fractures

loss of consciousness

cranio-cervical pain

atlanta-occipital dislocation

common in children

mechanism of injury in atlanta-occipital dislocation

hyperextension

distraction

rotation

symptoms of atlanto-occipital injury

instantly fatal

neuro deficits in survivors

types of C1 fractures

anterior or posterior arch

anterior AND posterior arch with either intact transverse ligament (stable) or disrupted transverse ligament (unstable)

lateral mass fracture

3 categories of axis fractures

fractures of odontoceti process

traumatic spondyloisthesis of axis - hangman's fracture

fracture of body of axis

how are subaxial cervical spine fractures divided

ligamentous - facet dislocation

osseous - tear drop and burst fractures

4 categories of thoracolumbar spine injuries

compression

burst

seatbelt

fracture dislocation

sacral spine injuries

- zone 1

either L5 nerve root or sciatic nerve damaged

sacral spine injuries

- zone 2

no sphincter involvement - neuro deficit

sacral spine injuries

- zone 3

involved area medial to foramina and central canal

neuro deficit

bowel and bladder dysfunction