Spine and Spinal Cord Trauma Flashcards

A 28-year-old is involved in a motorcycle crash and presents with a blood pressure of 85/45 mmHg, a heart rate of 55 bpm, and warm, dry extremities. There is no obvious external hemorrhage. Which type of shock is most likely responsible for this clinical picture?

Answer: Neurogenic shock

The patient's presentation of hypotension with paradoxical bradycardia and peripheral vasodilation (warm, dry skin) is the classic triad for neurogenic shock. This results from the loss of sympathetic tone due to a spinal cord injury, typically above T6. Hemorrhagic shock would typically present with hypotension and tachycardia, with cool, clammy skin.

A patient with a flexion injury to the cervical spine demonstrates complete paralysis and loss of pain and temperature sensation below the level of the injury. However, their sense of vibration and proprioception remains intact. Which incomplete spinal cord syndrome do these findings represent?

Answer: Anterior cord syndrome

Anterior cord syndrome results from damage to the anterior two-thirds of the spinal cord, affecting the corticospinal tracts (motor function) and spinothalamic tracts (pain and temperature). The posterior columns, which carry vibration and proprioception signals, are spared.

A 30-year-old trauma patient is alert (GCS 15), not intoxicated, and has no focal neurological deficits. According to the NEXUS low-risk criteria for clinical clearance of the cervical spine, which of the following findings would mandate radiographic imaging?

Answer: Presence of a painful wrist fracture

The NEXUS criteria require five conditions to be met for clinical clearance: no posterior midline cervical tenderness, no evidence of intoxication, a normal level of alertness, no focal neurologic deficit, and no painful distracting injury. A painful wrist fracture is considered a distracting injury that could mask the pain from a significant cervical spine injury, thus requiring imaging.

During the secondary survey of a patient with paraplegia following a severe fall, the examiner assesses for sacral sparing. Which of the following findings indicates an incomplete spinal cord injury?

Answer: Voluntary anal contraction

Sacral sparing refers to the preservation of sensory or motor function in the lowest sacral segments (S4-S5). Evidence of this, such as voluntary anal contraction, perianal sensation, or great toe flexion, indicates that the spinal cord injury is incomplete and carries a better prognosis for recovery. The other options are signs associated with spinal shock or a complete injury.

A patient suffers a penetrating stab wound to the right side of the neck, resulting in a Brown-Séquard syndrome at the C7 level. Which pattern of neurological deficits would be expected below the injury?

Answer: Paralysis and loss of proprioception on the right; loss of pain and temperature on the left

Brown-Séquard syndrome is caused by hemisection of the spinal cord. This damages the ipsilateral (same side) corticospinal tracts (motor) and posterior columns (proprioception/vibration). It also damages the spinothalamic tracts, which cross over; therefore, the loss of pain and temperature sensation occurs on the contralateral (opposite) side.

Which statement best reflects the current ATLS-aligned principle of managing a patient with a potential spinal injury in the prehospital and emergency department setting?

Answer: The primary goal is spinal motion restriction, using a rigid collar and securing the patient to a firm surface to minimize gross movement.

Modern trauma care has shifted from the concept of 'spinal immobilization' to 'spinal motion restriction' (SMR). This acknowledges that complete immobilization is impossible and potentially harmful (e.g., pain, pressure sores, respiratory compromise). The goal is to minimize gross movement of the spine by using a cervical collar and securing the patient to the cot or another surface, while removing rigid backboards as soon as feasible.