Spinal Cord and Vertebral Trauma Flashcards

A patient with a C5 spinal cord injury would be expected to retain which motor function?

Answer: Biceps function and shoulder movement

C5 innervates the deltoid and biceps muscles, allowing shoulder abduction/flexion and elbow flexion. Wrist extension (C6), triceps (C7), and hand intrinsics (T1) are lost.

Spinal shock is characterized by:

Answer: Temporary loss of reflexes, motor function, and sensation below the injury level

Spinal shock is the temporary, physiological suppression of all spinal cord function (reflexes, motor, sensory, autonomic) below the injury level, which may last hours to weeks.

Which mechanism of injury is most associated with a Jefferson fracture (C1 burst fracture)?

Answer: Axial loading (compression) force to the top of the head

A Jefferson fracture results from axial loading transmitted through the occipital condyles to the C1 lateral masses, causing the ring of C1 to burst outward. Common mechanisms include diving into shallow water or objects falling onto the head.

A patient with a T10 complete spinal cord injury is most likely to experience which bladder dysfunction?

Answer: Upper motor neuron (spastic/reflex) bladder

Injuries above the conus medullaris (L1-L2) produce an upper motor neuron bladder — the sacral micturition reflex arc (S2-S4) is intact but disconnected from voluntary control, resulting in a spastic, reflex bladder.

When logrolling a patient with a suspected spinal injury, the minimum number of personnel required is:

Answer: Four — one at the head plus three supporting the body

A minimum of four persons is recommended for logrolling: one maintains manual in-line stabilization of the head/neck and directs the maneuver, while three support the torso, pelvis, and legs to maintain spinal alignment.

Which clinical finding differentiates Brown-Sequard syndrome from other incomplete spinal cord injury patterns?

Answer: Ipsilateral motor loss and proprioception loss with contralateral pain and temperature loss

Brown-Sequard syndrome results from hemisection of the spinal cord, producing ipsilateral motor paralysis and proprioception loss (posterior columns) with contralateral pain and temperature loss (spinothalamic tract) below the injury.

A patient with a suspected unstable cervical spine fracture has vomited. To manage the airway while protecting the spine, the nurse should:

Answer: Logroll the patient to a lateral position while maintaining spinal alignment, then suction

The patient should be logrolled as a unit to a lateral position to allow vomitus to drain by gravity, while maintaining strict spinal alignment to prevent secondary cord injury.

Central cord syndrome is most commonly seen in which patient population and mechanism?

Answer: Elderly patients with pre-existing cervical spondylosis after hyperextension injuries

Central cord syndrome most commonly occurs in elderly patients with pre-existing cervical spondylosis (narrow spinal canal) who sustain a hyperextension injury, often from a ground-level fall.

During the secondary survey, the nurse palpates a palpable step-off deformity in the thoracolumbar spine. This finding suggests:

Answer: Vertebral fracture with possible posterior element disruption

A step-off deformity (one spinous process displaced anteriorly or posteriorly relative to adjacent processes) indicates a vertebral fracture-dislocation with disruption of the posterior spinal elements, suggesting an unstable injury.

Which medication used in spinal cord injury management acts by reducing secondary injury from free radical damage?

Answer: Methylprednisolone

Methylprednisolone was historically used in acute SCI as a neuroprotective agent to reduce secondary injury from lipid peroxidation and free radical damage, though its use is now controversial.

A patient is brought in on a long spine board after a motorcycle collision. The nurse should prioritize removing the patient from the board because:

Answer: Prolonged immobilization on rigid boards causes pressure injuries and respiratory compromise

Rigid spine boards cause pressure ulcers (within 30 minutes on bony prominences), restrict respiratory excursion, increase pain, and provide no therapeutic benefit beyond transport. Patients should be transferred off the board as soon as possible.

SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) is most common in which population?

Answer: Pediatric patients under age 8

SCIWORA occurs predominantly in children under 8 due to the hypermobility of the pediatric spine — elastic ligaments and cartilaginous vertebrae allow the spine to stretch beyond the tolerance of the spinal cord without bony fracture.