ATLS Spine and Spinal Cord Trauma 2 — Questions and Answers
Question 1: A diving accident patient has bilateral motor loss and pain/temperature loss but preserved proprioception and light touch. Which syndrome?
- Brown-Sequard syndrome
- Anterior cord syndrome (Correct answer)
- Central cord syndrome
- Posterior cord syndrome
Correct answer: Anterior cord syndrome
Anterior cord syndrome affects motor (corticospinal tracts) and pain/temperature (spinothalamic tracts) while sparing posterior columns.
Anterior cord syndrome has the worst prognosis of incomplete syndromes (10-20% recover functional motor). Typically results from flexion injuries, burst fractures, or anterior spinal artery occlusion.
Question 2: An elderly patient falls and develops upper extremity weakness greater than lower. Most likely diagnosis?
- Anterior cord syndrome
- Central cord syndrome (Correct answer)
- Cauda equina syndrome
- Brown-Sequard syndrome
Correct answer: Central cord syndrome
Central cord syndrome characteristically affects upper extremities more due to somatotopic organization of corticospinal tracts.
Most common incomplete SCI, typically in elderly with cervical spondylosis after hyperextension. Best prognosis of incomplete syndromes: ~75% regain ambulatory function.
Question 3: According to ATLS, what is the preferred method for log-rolling a patient with suspected spinal injury?
- Two-person roll
- Minimum four-person team with one maintaining cervical stabilization (Correct answer)
- Single-person roll with collar
- Mechanical lift
Correct answer: Minimum four-person team with one maintaining cervical stabilization
ATLS recommends minimum four people: one for cervical stabilization, three for coordinated body roll.
The person maintaining cervical stabilization gives the command to roll. The spine must remain aligned without rotation or flexion. The backboard should be removed within 2 hours.
Question 4: A C5 SCI patient has hypotension with HR 52 and warm extremities. After fluids, BP remains low. Best pharmacologic intervention?
- Epinephrine infusion
- Norepinephrine or phenylephrine infusion (Correct answer)
- Dopamine bolus only
- Atropine alone
Correct answer: Norepinephrine or phenylephrine infusion
Neurogenic shock requires vasopressors after volume resuscitation fails. Norepinephrine provides combined alpha and beta effects.
Goal MAP >85-90 mmHg for 7 days to maximize spinal cord perfusion. Norepinephrine is first-line (alpha + beta1). Atropine for symptomatic bradycardia. Always rule out concurrent hemorrhage.
Question 5: Which imaging study is the gold standard for evaluating spinal cord injury and ligamentous disruption?
- Plain radiographs
- CT scan
- MRI (Correct answer)
- Flexion-extension radiographs
Correct answer: MRI
MRI is the gold standard for evaluating the cord itself, ligaments, disc herniations, and epidural hematomas.
CT is gold standard for bony injury; MRI for soft tissue. MRI is indicated when neurological deficit exists or CT shows concerning fracture patterns. MRI changes management in 25% of cases with deficits.
Question 6: A patient has an L1 burst fracture with 60% canal compromise but intact neurological function. What determines need for surgery?
- Canal compromise alone mandates surgery
- Kyphosis degree and posterior ligamentous complex integrity (Correct answer)
- All burst fractures require surgery
- Only neurological deficit warrants surgery
Correct answer: Kyphosis degree and posterior ligamentous complex integrity
Surgical decision depends on spinal stability: kyphotic deformity degree and PLC integrity, not canal compromise alone.
TLICS score guides management: morphology + PLC integrity + neurological status. Score <4: nonoperative; >4: surgical. PLC integrity (assessed by MRI) is the most critical factor.
ATLS Spine and Spinal Cord Trauma 2
A diving accident patient has bilateral motor loss and pain/temperature loss but preserved proprioception and light touch.
Which syndrome?