CAISS Spine Injuries 4 — Questions and Answers
Question 1: An odontoid (dens) fracture type II without displacement in a 75-year-old is coded in AIS at what level compared to the same fracture with displacement causing cord compression?
- Same AIS code regardless of displacement
- Lower AIS without displacement; higher AIS with cord compression (Correct answer)
- Higher AIS without displacement due to age
- AIS not applicable to odontoid fractures
Correct answer: Lower AIS without displacement; higher AIS with cord compression
Displacement with cord compression elevates the AIS severity code because neurological compromise is a key severity determinant in spine coding.
Question 2: The AIS descriptor 'spinal cord contusion' without complete functional loss would most likely receive a severity code of:
- AIS 2
- AIS 3
- AIS 4 (Correct answer)
- AIS 5
Correct answer: AIS 4
Spinal cord contusion with incomplete neurological deficit typically earns AIS 4 (severe), reflecting significant neural tissue injury without complete functional loss.
Question 3: Which of the following is NOT a factor coded within the AIS Spine chapter severity descriptors?
- Level of vertebral injury (cervical/thoracic/lumbar)
- Neurological deficit completeness
- Patient's pre-existing degenerative disc disease (Correct answer)
- Fracture morphology (compression vs. burst vs. dislocation)
Correct answer: Patient's pre-existing degenerative disc disease
Pre-existing degenerative disease is a comorbidity, not a component of the AIS injury severity descriptor, which focuses on the acute traumatic injury.
Question 4: A MAIS (Maximum AIS) of 5 from a spinal injury means the patient:
- Has a survivable injury with moderate disability
- Has a critical injury that is life-threatening but survivable (Correct answer)
- Has an unsurvivable injury
- Requires surgical intervention
Correct answer: Has a critical injury that is life-threatening but survivable
AIS 5 (critical) indicates a life-threatening injury with uncertain survival probability, distinct from AIS 6 which is defined as unsurvivable.
Question 5: Which spinal cord syndrome is characterized by greater motor loss in the upper extremities than the lower extremities and typically results from cervical hyperextension in older patients?
- Brown-Séquard syndrome
- Anterior cord syndrome
- Central cord syndrome (Correct answer)
- Posterior cord syndrome
Correct answer: Central cord syndrome
Central cord syndrome causes disproportionately greater weakness in the arms than legs and is the most common incomplete spinal cord injury pattern.
Question 6: For AIS coding purposes, when a patient has multiple contiguous vertebral fractures (e.g., T4, T5, T6), the coder should:
- Code only the highest-level fracture
- Code each vertebral level as a separate AIS entry
- Code the most severe single fracture or the combination using the highest resulting severity (Correct answer)
- Average the severity across all levels
Correct answer: Code the most severe single fracture or the combination using the highest resulting severity
The coder identifies the most severe injury in the spine region; multiple contiguous fractures may be coded under the most severe descriptor that encompasses the injury pattern.
Question 7: Brown-Séquard syndrome produces ipsilateral motor loss and contralateral pain/temperature loss because of injury to which spinal cord structures?
- Bilateral anterior horn cells
- Dorsal columns bilaterally
- One lateral half of the spinal cord (hemicord) (Correct answer)
- Central gray matter only
Correct answer: One lateral half of the spinal cord (hemicord)
Brown-Séquard syndrome results from hemisection of the spinal cord, damaging ipsilateral corticospinal/dorsal column tracts and contralateral spinothalamic tracts.
CAISS Spine Injuries 4
An odontoid (dens) fracture type II without displacement in a 75-year-old is coded in AIS at what level compared to the same fracture with displacement causing cord compression?