Spinal Trauma

Spinal Anatomy & Initial Scan - Backbone Basics & First Look

• Vertebral Column: C(7), T(12), L(5), S(5), Coccyx. Cord: 31 segments (8C,12T,5L,5S,1Co); ends L1-L2.

• Denis 3-Column Theory: 📌 AMP (Ant, Mid, Post) for stability.

  • Ant: ALL, ant. vertebral body/annulus.
  • Mid: PLL, post. vertebral body/annulus.
  • Post: Posterior bony arch, lig. flavum, inter/supraspinous ligs.

  ⭐ The three-column theory of Denis is crucial for assessing spinal stability: injury to two or more columns often implies instability.

• Key Ligaments: ALL, PLL, Lig. Flavum, Inter/Supraspinous.

• ATLS Primary Survey (ABCDE):

  • Airway + C-spine control.
  • Breathing.
  • Circulation.
  • Disability (GCS, neuro).
  • Exposure.

• C-Spine Immobilization: Crucial; rigid collar, blocks, tape.

• Secondary Survey: Log roll (≥3 people), palpate spine, basic neuro.

Neuro Exam & Cord Syndromes - Nerve Nudges & Cord Codes

• ASIA Impairment Scale (AIS):
  • A: Complete (no S4-S5 motor/sensory).
  • B: Sensory Incomplete (S4-S5 sensory, no motor below neuro level).
  • C: Motor Incomplete (<3/5 in >half key m. below neuro level).
  • D: Motor Incomplete (≥3/5 in ≥half key m. below neuro level).
  • E: Normal.
• Key Exam Components:
  • Dermatomes (e.g., T4 nipple, T10 umbilicus, S4-S5).
  • Myotomes (e.g., C5 elbow flex, L5 big toe ext).
  • Reflexes (e.g., Biceps C5, Patellar L4, Achilles S1).
• Shocks:
  • Spinal Shock: Transient ↓reflexes, flaccid paralysis below lesion.
  • Neurogenic Shock (T6 or above): Hypotension, bradycardia (sympathetic loss).

⭐ Sacral sparing (S4-S5 sensation/motor) indicates an incomplete SCI and a better prognosis.

Spinal Cord Syndromes:

Fracture Patterns & Imaging - Spine Snap Spotting

• Fracture Types:
  • Compression: Anterior column.
  • Burst: Anterior + middle. Unstable.
  • Flexion-distraction (Chance): Posterior + middle. Unstable.
  • Fracture-dislocation: All 3 columns. Highly unstable.
• Key Named Fractures:

  Fracture	Level	Features	Stability
  Jefferson	C1	Atlas burst (# ant & post arches)	Unstable
  Hangman's	C2	Bilateral C2 pedicle/pars #	Unstable
  Odontoid (Dens)	C2	Type I (tip), II (base), III (body)	II unstable
  Chance	T-L	Horizontal # (seatbelt injury)	Unstable

  • 📌 Odontoid: Type II is Too unstable.
• Imaging:
  • X-ray: Initial (AP, Lat, Odontoid).
  • CT: Best for bone detail.
  • MRI: Cord/ligament injury.
• C-Spine Clearance: (NEXUS & Canadian C-Spine Rules)

⭐ Odontoid Type II fractures are most common, highest non-union rate; often need surgery.

Management & Complications - Mend & Mind Monitors

Pre-hospital & Hospital Care:

• Immobilization (C-collar, spinal board).
• Maintain Mean Arterial Pressure (MAP) >85-90 mmHg.

Management Strategy:

• Steroids: Controversial, generally NOT recommended.

Complications:

• Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE)
• Pressure sores
• Respiratory compromise
• Autonomic Dysreflexia
  • 📌 '6 T's': Tachycardia (initially, then bradycardia), Tremors, Tingling, Temperature (sweating), Tight chest, Throbbing headache.
• Heterotopic Ossification (HO)

⭐ Autonomic dysreflexia is a life-threatening emergency in patients with Spinal Cord Injury (SCI) at or above T6, characterized by paroxysmal hypertension, bradycardia, and flushing/sweating above the lesion level.

High‑Yield Points - ⚡ Biggest Takeaways

• ASIA scale classifies SCI severity; complete vs. incomplete.
• Neurogenic shock (hypotension, bradycardia) differs from spinal shock (areflexia, flaccidity).
• Use NEXUS criteria or Canadian C-spine rules for cervical spine clearance.
• High-yield fractures: Jefferson (C1 burst), Odontoid (C2 Type II common/unstable), Hangman's (C2 pedicles).
• Brown-Séquard syndrome: ipsilateral motor/proprioception loss, contralateral pain/temperature loss.
• Central cord syndrome: common with hyperextension, results in upper limbs weaker than lower.
• Prioritize spinal immobilization (log-roll, rigid collar) and ABCDE assessment in acute SCI management.