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2413008052435NEXUS Criteria00NEXUS Criteria15481308053070Not applicable to infants; 99% sensitivity for any injury, 99.6% sensitivity for significant injury, 13% specificity; results in 12% ? C spine imagingNo XR if blunt injury and: no FND No ETOH No Xtra (distracting) injury No Unconscious (ie. Normal LOC) No Spinal tenderness of neck Assess rotation 45° only XR if can’t do00Not applicable to infants; 99% sensitivity for any injury, 99.6% sensitivity for significant injury, 13% specificity; results in 12% ? C spine imagingNo XR if blunt injury and: no FND No ETOH No Xtra (distracting) injury No Unconscious (ie. Normal LOC) No Spinal tenderness of neck Assess rotation 45° only XR if can’t do15481307520305Lower incidence; more upper C spine and atlanto-occipital (large head, lax ligaments, horizontal plane of facet joints); dens fuses at 6-8yrs; treat children >8yrs as would adults; use CT sparingly00Lower incidence; more upper C spine and atlanto-occipital (large head, lax ligaments, horizontal plane of facet joints); dens fuses at 6-8yrs; treat children >8yrs as would adults; use CT sparingly15481306597650C spine: Male:female 4:1; risk factor from MVAs are HI (most important), ejection, roll over, no seat belt, facial burns, extensive car damage, death of occupant; C2 most common fracture (25%); C5-6 / 6-7 most common dislocationT/L spine: T/L junction most at risk; 65% fractures between T12 and L2, 90% between T11 and L4; 95% are vertical / oblique, 5% horizontal; 20% with fractures have 2nd fracture; 50% have other injury00C spine: Male:female 4:1; risk factor from MVAs are HI (most important), ejection, roll over, no seat belt, facial burns, extensive car damage, death of occupant; C2 most common fracture (25%); C5-6 / 6-7 most common dislocationT/L spine: T/L junction most at risk; 65% fractures between T12 and L2, 90% between T11 and L4; 95% are vertical / oblique, 5% horizontal; 20% with fractures have 2nd fracture; 50% have other injury2413007520940Paediatrics00Paediatrics2413006598285Epidemiology00Epidemiology2286001141730Anatomy00Anatomy15481303258820Unstable when:2/3 columns affected>3mm displacement of vertebral bodyAngle >11° between vertebraeAnterior height <? posterior height (>25% height of affected vertebral body)Fanning of interspinous distancePost lig involvement suggested by: avulsion # tip spinous process, wide separation of vertebral spines, facet joint fracture, neural arch fracture, shift of 1 vertebrae on another, shearing fracture of vertebral body. If present = ?unstable, ?neural involvementMovements: C3-7 all directions C1-2 rotation Atlanto-occipital joint flexion/extensionSpinal cord: spinal cord ends at L1-2; lumbar and sacral segments of spinal cord lie between T10-L1 (T12 vertebrae = L1 spinal cord)Spinothalamic Crosses at spinal cord; cervical sensation medial, sacral sensation at periphery Anterior: touch and pressure Lateral: pain and temp Dorsal Crosses at medulla; sacral sensation medial, cervical peripheral Touch, pressure, vibration, proprioceptionCorticospinal Anterior crosses at spinal cord, lateral crosses at medulla Anterior: axial and proximal muscles, posture, gross motor, 20% Lateral: distal muscles, fine motor, 80%00Unstable when:2/3 columns affected>3mm displacement of vertebral bodyAngle >11° between vertebraeAnterior height <? posterior height (>25% height of affected vertebral body)Fanning of interspinous distancePost lig involvement suggested by: avulsion # tip spinous process, wide separation of vertebral spines, facet joint fracture, neural arch fracture, shift of 1 vertebrae on another, shearing fracture of vertebral body. If present = ?unstable, ?neural involvementMovements: C3-7 all directions C1-2 rotation Atlanto-occipital joint flexion/extensionSpinal cord: spinal cord ends at L1-2; lumbar and sacral segments of spinal cord lie between T10-L1 (T12 vertebrae = L1 spinal cord)Spinothalamic Crosses at spinal cord; cervical sensation medial, sacral sensation at periphery Anterior: touch and pressure Lateral: pain and temp Dorsal Crosses at medulla; sacral sensation medial, cervical peripheral Touch, pressure, vibration, proprioceptionCorticospinal Anterior crosses at spinal cord, lateral crosses at medulla Anterior: axial and proximal muscles, posture, gross motor, 20% Lateral: distal muscles, fine motor, 80%43764201141730Anterior column: Ant long lig, ant part annular lig Ant ? vertebraeMiddle column: Post long lig, post part annular lig Post ? vertebraePosterior column: Interspinous lig, lig flavum IV facet joint, pedicles, laminae, spinous processes, neural arch00Anterior column: Ant long lig, ant part annular lig Ant ? vertebraeMiddle column: Post long lig, post part annular lig Post ? vertebraePosterior column: Interspinous lig, lig flavum IV facet joint, pedicles, laminae, spinous processes, neural arch1575435114236500246380539750Spinal Trauma00Spinal Trauma 29895808420100Hangman’s fracture: extension +/- distraction injury; bilateral fracture of pedicles of axis (through pars interarticularis) anterior movement of C2 on 3 of >2mm, avulsion of ant-inf corner of C2 associated with rupture of ant long lig; prevertebral soft tissue swelling; unstable; cord injury rare; causes Horner’s syndrome (ipsilateral constricted pupil due to damage of sympathetic trunk); treat with external immobilisation00Hangman’s fracture: extension +/- distraction injury; bilateral fracture of pedicles of axis (through pars interarticularis) anterior movement of C2 on 3 of >2mm, avulsion of ant-inf corner of C2 associated with rupture of ant long lig; prevertebral soft tissue swelling; unstable; cord injury rare; causes Horner’s syndrome (ipsilateral constricted pupil due to damage of sympathetic trunk); treat with external immobilisation16167108424545003060708424545C2Most commonly fractured vertebraeUsually associated with C1 injury00C2Most commonly fractured vertebraeUsually associated with C1 injury3060705619115C115-20% associated with C2 injury25% associated with lower C spine injury00C115-20% associated with C2 injury25% associated with lower C spine injury16167107129781Fracture posterior arch atlas: extension injury; maybe unstable; treat in collar / traction for 6/52Atlanto-occipital dislocation: flexion injury; fatal; unstableAnterior atlanto-axial dislocation: flexion injury; rupture of transverse ligament of dens; often fatal; unstablePosterior atlanto-axial dislocation: extension injury; unstableRotatory atlanto-axial dislocation: rotational injury; torticollis; may be associated with anterior displacement; unstable00Fracture posterior arch atlas: extension injury; maybe unstable; treat in collar / traction for 6/52Atlanto-occipital dislocation: flexion injury; fatal; unstableAnterior atlanto-axial dislocation: flexion injury; rupture of transverse ligament of dens; often fatal; unstablePosterior atlanto-axial dislocation: extension injury; unstableRotatory atlanto-axial dislocation: rotational injury; torticollis; may be associated with anterior displacement; unstable33489905619750 Jefferson fracture: vertical compression injury; blowout fracture anterior and posterior arch, disrupts transverse ligament; lateral masses C1 driven laterally; wide pre-dental space, but post spinal line may be OK; displacement of lateral masses >2mm or unilateral displacement; unstable; 50% survive without deficit; ? associated with C2 fracture; ? associated with other C spine fracture00 Jefferson fracture: vertical compression injury; blowout fracture anterior and posterior arch, disrupts transverse ligament; lateral masses C1 driven laterally; wide pre-dental space, but post spinal line may be OK; displacement of lateral masses >2mm or unilateral displacement; unstable; 50% survive without deficit; ? associated with C2 fracture; ? associated with other C spine fracture325056556197510016167105619750003060701976120Investigation00Investigation16167101976120C spine XR: anterior intervertebral line, posterior intervertebral line, spinolaminar line, interspinous line (displacement of 2 lines suggests unstable injury; <1mm anterior subluxation (<3mm in children) may be normal); predental space (<3mm adult, <5mm children); vertebral body height (posterior height should be at least 3mm more than anterior height); soft tissue swelling (present in 60% anterior fracture, 30% posterior fracture, 15% patients with no injury – due to ETT, pooled pharyngeal secretions, child) Penning’s criteria: C1 <10mm / C2 <7mm / C6 <22mm (15mm in children) (or <width vertebral body) Sensitivity 95% if adequate films (70-85% with lateral shoot-through in trauma room); 0.2% risk of missing unstable injury; inadequate views in up to 35% Flexion/extension views not recommended, risk of neurological injury, false negative from spasm, no clinically validated criteria for interpretation, do MRI insteadC spine CT: Indications: any fracture/?fracture on XR (25% will have 2nd fracture, 35% will not have been visible on XR), head CT, high index suspicion despite normal XR Sensitvity >95% for fracture / dislocation; may miss ligamentous injury at C1-2; if altered LOC, no FND, normal CT false neg rate 0.1%C spine MRI: better than CT for ligaments, discs, spinal cord; Sensitivity 100% for cord injury, 55% for fracture, 80% for dislocations; in spinal cord, hypoattenuation = haemorrhage, hyperattenuation = oedema / transection; investigation of choice if neuro symptomsL/T spine XR: widened mediastinum; displacement of L paraspinal line; pleural cap; interpedicular distances should gradually increase from L-5; lack of concavity of post vertebral body cortex (?burst fracture); sensitivity 75%L/T spine CT: sensitivity 95%00C spine XR: anterior intervertebral line, posterior intervertebral line, spinolaminar line, interspinous line (displacement of 2 lines suggests unstable injury; <1mm anterior subluxation (<3mm in children) may be normal); predental space (<3mm adult, <5mm children); vertebral body height (posterior height should be at least 3mm more than anterior height); soft tissue swelling (present in 60% anterior fracture, 30% posterior fracture, 15% patients with no injury – due to ETT, pooled pharyngeal secretions, child) Penning’s criteria: C1 <10mm / C2 <7mm / C6 <22mm (15mm in children) (or <width vertebral body) Sensitivity 95% if adequate films (70-85% with lateral shoot-through in trauma room); 0.2% risk of missing unstable injury; inadequate views in up to 35% Flexion/extension views not recommended, risk of neurological injury, false negative from spasm, no clinically validated criteria for interpretation, do MRI insteadC spine CT: Indications: any fracture/?fracture on XR (25% will have 2nd fracture, 35% will not have been visible on XR), head CT, high index suspicion despite normal XR Sensitvity >95% for fracture / dislocation; may miss ligamentous injury at C1-2; if altered LOC, no FND, normal CT false neg rate 0.1%C spine MRI: better than CT for ligaments, discs, spinal cord; Sensitivity 100% for cord injury, 55% for fracture, 80% for dislocations; in spinal cord, hypoattenuation = haemorrhage, hyperattenuation = oedema / transection; investigation of choice if neuro symptomsL/T spine XR: widened mediastinum; displacement of L paraspinal line; pleural cap; interpedicular distances should gradually increase from L-5; lack of concavity of post vertebral body cortex (?burst fracture); sensitivity 75%L/T spine CT: sensitivity 95%1616710539750Incorporates MOI and examination findings; for alert, stable patients; sensitivity 100%, specificity 43% for clinically important injury; results in 15% ? C spine imaging; compares favourably with NEXUSHigh risk therefore do XR if: >65yrs / extremity paraesthesia / fall >1m / fall >5 stairs / axial load to head / high speed MVA, roll over, ejection / bike collision / motorised recreational vehicle Low risk therefore no XR needed if: walking after injury / sitting in ED / simple rear shunt / delayed onset neck pain / no midline tenderness If low risk criteria fulfilled, assess rotation 45° only XR if can’t doIf low risk criteria not fulfilled, do XR00Incorporates MOI and examination findings; for alert, stable patients; sensitivity 100%, specificity 43% for clinically important injury; results in 15% ? C spine imaging; compares favourably with NEXUSHigh risk therefore do XR if: >65yrs / extremity paraesthesia / fall >1m / fall >5 stairs / axial load to head / high speed MVA, roll over, ejection / bike collision / motorised recreational vehicle Low risk therefore no XR needed if: walking after injury / sitting in ED / simple rear shunt / delayed onset neck pain / no midline tenderness If low risk criteria fulfilled, assess rotation 45° only XR if can’t doIf low risk criteria not fulfilled, do XR306070539750Canadian C Spine Rule00Canadian C Spine Rule 3060708691245Chance FracturePOSTERIOR INVOLVEMENT00Chance FracturePOSTERIOR INVOLVEMENT164338088963500033489908691245Flexion/distraction injury, seatbelt injuyry, distraction injury occurs as pivot pushed more anteriorly, around anterior abdominal wall; major; failure of posterior column: complete disruption of spinous process, laminae, transverse process, pedicles, vertebral bodies; oblique / horizontal splitting of spinous process and neural arch, pushing post-sup aspect of vertebral body into intervertebral disc; widened interpedicular distance seen; suggested by vacant appearance of vertebral body on AP film, discontinuity of cortex of pedicles / spinous processes on AP failure of posterior and middle columns; ligamentous involvement; unstable; 65% have intestinal / mesenteric injury00Flexion/distraction injury, seatbelt injuyry, distraction injury occurs as pivot pushed more anteriorly, around anterior abdominal wall; major; failure of posterior column: complete disruption of spinous process, laminae, transverse process, pedicles, vertebral bodies; oblique / horizontal splitting of spinous process and neural arch, pushing post-sup aspect of vertebral body into intervertebral disc; widened interpedicular distance seen; suggested by vacant appearance of vertebral body on AP film, discontinuity of cortex of pedicles / spinous processes on AP failure of posterior and middle columns; ligamentous involvement; unstable; 65% have intestinal / mesenteric injury27533606868795C spine: Flexion injury; Stable; cervical collar 6/52T/L spine: major; flexion / axial load; most common at T12-L2; middle and posterior column intact; may be associated with ant-sup marginal shearing #; neural injury rare (more common if lateral wedging and nerve root involvement; if post wedging present, suggests more violence, ?burst fracture and ?spinal cord involvement); stable usually; unstable if anterior margin reduced >50% and posterior ligament injured; symptomatic treatment00C spine: Flexion injury; Stable; cervical collar 6/52T/L spine: major; flexion / axial load; most common at T12-L2; middle and posterior column intact; may be associated with ant-sup marginal shearing #; neural injury rare (more common if lateral wedging and nerve root involvement; if post wedging present, suggests more violence, ?burst fracture and ?spinal cord involvement); stable usually; unstable if anterior margin reduced >50% and posterior ligament injured; symptomatic treatment16433806861176003060706861175Anterior Wedge / Compression Fracture00Anterior Wedge / Compression Fracture164338050444400031546805044440Flexion injuryWedge-shaped antero-inferior fractureLigamentous (anterior longitudinal ligament) and neurological involvement common due to retropulsion of fragmentsUnstable00Flexion injuryWedge-shaped antero-inferior fractureLigamentous (anterior longitudinal ligament) and neurological involvement common due to retropulsion of fragmentsUnstable3060705044440Anterior Teardrop Fracture00Anterior Teardrop Fracture31540453208655Clay shoveller’s fracture: flexion injury; avulsion / direct blow to lower spinous processes; ghost sign on AP view (displaced fractured spinous process); stable; cervical collar 2-3/5200Clay shoveller’s fracture: flexion injury; avulsion / direct blow to lower spinous processes; ghost sign on AP view (displaced fractured spinous process); stable; cervical collar 2-3/523060703209290C700C71643380320929000306070539750C2(cntd)00C2(cntd)1643380539750003348990539115Dens Fracture: flexion injury; 10-15%; complicated by soft tissue swelling I = 5-8% = tip, above transverse ligament II = 55-70% = junction of body and dens; unstable; needs OT if displaced >6mm III = 30-35% = through body of dens; unstable but good prognosisExtension teardrop fracture: usually involves axis; extension injury; unstable; causes central cord syndromeOs odonotoideum: failure of fusion of tip to body of dens (ossification centre should appear at 2yrs, fuse by 12yrs); unstable, requires post fusionC2-3 pseudosubluxation: common in infants and children (40% <8yrs) – will disrupt posterior interspinous line but spinolaminar line conserved, will cause ? pre-dental space in children; less commonly occurs at C3-4, 4-5 levels00Dens Fracture: flexion injury; 10-15%; complicated by soft tissue swelling I = 5-8% = tip, above transverse ligament II = 55-70% = junction of body and dens; unstable; needs OT if displaced >6mm III = 30-35% = through body of dens; unstable but good prognosisExtension teardrop fracture: usually involves axis; extension injury; unstable; causes central cord syndromeOs odonotoideum: failure of fusion of tip to body of dens (ossification centre should appear at 2yrs, fuse by 12yrs); unstable, requires post fusionC2-3 pseudosubluxation: common in infants and children (40% <8yrs) – will disrupt posterior interspinous line but spinolaminar line conserved, will cause ? pre-dental space in children; less commonly occurs at C3-4, 4-5 levels 3060708505190C Spine Immobilisation00C Spine Immobilisation16433808494395Indication: recommended if for XR; no evidence of efficacy in prevention of spinal cord injury in conscious patients (may worsen outcome by uncontrolled reduction); optimal position with 2cm occiput elevationMethod: Use C spine collar, sandbags + tape (better than collar), headblock and spinal board, strapping, Vac PacComplications: ? ICP, ? access to neck, discomfort, prompts unnecessary investigation, patient anxiety, cutaneous pressure ulceration (especially if prolonged use), requirement for log rolling, aspiration, DVT, may worsen neurological injury (if displaced fracture, pre-existing cervical deformity), masks other injuries, ? pulmonary function00Indication: recommended if for XR; no evidence of efficacy in prevention of spinal cord injury in conscious patients (may worsen outcome by uncontrolled reduction); optimal position with 2cm occiput elevationMethod: Use C spine collar, sandbags + tape (better than collar), headblock and spinal board, strapping, Vac PacComplications: ? ICP, ? access to neck, discomfort, prompts unnecessary investigation, patient anxiety, cutaneous pressure ulceration (especially if prolonged use), requirement for log rolling, aspiration, DVT, may worsen neurological injury (if displaced fracture, pre-existing cervical deformity), masks other injuries, ? pulmonary function3060706859905Unilateral Facet Joint Dislocation00Unilateral Facet Joint Dislocation38392106860540Flexion injury; Disruption of anterior ligament and annulus of disc; bow tie / bat wing appearance of locked facets; subluxation >? vertebral body width; unstable; require reduction / fusion00Flexion injury; Disruption of anterior ligament and annulus of disc; bow tie / bat wing appearance of locked facets; subluxation >? vertebral body width; unstable; require reduction / fusion16433806860540003060705537199Unilateral Facet Joint Dislocation00Unilateral Facet Joint Dislocation38392105537200Rotational injury; disruption (>2mm) of spinolaminar line and spinous processes on AP / lateral film; wide interspinous distances; widening of disc space; subluxation <? vertebral body width of vertebra above over vertebra below; angulation of spine by >11° on AP view; better view available on oblique films; unstable if associated facet fracture; treat by reduction00Rotational injury; disruption (>2mm) of spinolaminar line and spinous processes on AP / lateral film; wide interspinous distances; widening of disc space; subluxation <? vertebral body width of vertebra above over vertebra below; angulation of spine by >11° on AP view; better view available on oblique films; unstable if associated facet fracture; treat by reduction164338055372000016433804961890Flexion injury; loss of normal cervical lordosis, fnaning of interspinous distance; only anterior intervertebral ligament intact; unstable; requires reduction / fusion00Flexion injury; loss of normal cervical lordosis, fnaning of interspinous distance; only anterior intervertebral ligament intact; unstable; requires reduction / fusion3060704972685Subluxation00Subluxation16433804388485Shear forces; AP/PA trauma; affects neural canal00Shear forces; AP/PA trauma; affects neural canal3060704399280Translational Injury00Translational Injury16433803815080Associated with renal / ureteric / splenic / hepatic / pancreatic injury, adrenal haematoma, diaphragmatic hernia, pelvic fracture; L3 most common (30%)00Associated with renal / ureteric / splenic / hepatic / pancreatic injury, adrenal haematoma, diaphragmatic hernia, pelvic fracture; L3 most common (30%)3060703825875Transverse Process Fracture00Transverse Process Fracture3060701760855Burst Fracture00Burst Fracture37191951750060C spine: Vertical compression injury; comminuted but ligaments intact; fracture fragments may still injure cord; stable unless severe (>15-20°); traction 6/52T/L spine: major; vertical compression injury; loss of vertebral height anteriorly and posteriorly pedicles widened on AP; fracture fragments may injure cord; failure of anterior and middle columns; unstable00C spine: Vertical compression injury; comminuted but ligaments intact; fracture fragments may still injure cord; stable unless severe (>15-20°); traction 6/52T/L spine: major; vertical compression injury; loss of vertebral height anteriorly and posteriorly pedicles widened on AP; fracture fragments may injure cord; failure of anterior and middle columns; unstable164338117608550016433801176655Fracture through superior articular processes, arch and sup-post vertebral body, but spares posterior spinous processes; posterior ligaments disrupted00Fracture through superior articular processes, arch and sup-post vertebral body, but spares posterior spinous processes; posterior ligaments disrupted3060701187450Smith Fracture00Smith Fracture1643380603250Similar to Chance fracture, but fracture line extends horizontally through vertebral body to anterior aspect00Similar to Chance fracture, but fracture line extends horizontally through vertebral body to anterior aspect306070614045Horizontal Fissure Fracture00Horizontal Fissure Fracture4114806416040Cord Injury00Cord Injury17487906405880Treatment:A: insert NGT (high risk of aspiration); consider ETT; have atropine available as exaggerated vagal response to instrumentation; C spine immobilisation; pre-vertebral haematoma can obstruction; RSI best if urgent, fibreoptic if notB: paradoxical breathing; assess vital capacity; O2 to prevent 2Y injury (as in HI)C: assess GCS, UO, CVP; early insertion of IDC; suspect hypovolaemia until proven otherwise if ? BP bolus IVF; may require inotrope / chronotrope; neurogenic shock makes it hard to assess degree of bleedingD: look for Horner’s if injury at/above T4; PR; anal and bulbocavernosus reflex; analgesia; attention to temperature; place IDC early to avoid bladder overdistensionE: care for pressure areasSteroids: indicated if <8hrs / recommended by spinal unit; 30mg/kg IV methylpred over 15mins 5.4mg/kg VI infusion over 23hrs; contraindicated if heavily contaminated wounds, bowel perforation, sepsis, diabetesPrognosis: 50% good recovery if preservation of S4-5 sensation at 3-7/7 (10-15% without); areas of sparing in dermatome gives 50% chance recovery in that myotome; incr age, worse prognosis00Treatment:A: insert NGT (high risk of aspiration); consider ETT; have atropine available as exaggerated vagal response to instrumentation; C spine immobilisation; pre-vertebral haematoma can obstruction; RSI best if urgent, fibreoptic if notB: paradoxical breathing; assess vital capacity; O2 to prevent 2Y injury (as in HI)C: assess GCS, UO, CVP; early insertion of IDC; suspect hypovolaemia until proven otherwise if ? BP bolus IVF; may require inotrope / chronotrope; neurogenic shock makes it hard to assess degree of bleedingD: look for Horner’s if injury at/above T4; PR; anal and bulbocavernosus reflex; analgesia; attention to temperature; place IDC early to avoid bladder overdistensionE: care for pressure areasSteroids: indicated if <8hrs / recommended by spinal unit; 30mg/kg IV methylpred over 15mins 5.4mg/kg VI infusion over 23hrs; contraindicated if heavily contaminated wounds, bowel perforation, sepsis, diabetesPrognosis: 50% good recovery if preservation of S4-5 sensation at 3-7/7 (10-15% without); areas of sparing in dermatome gives 50% chance recovery in that myotome; incr age, worse prognosis4114805454015Autonomic Dysreflexia00Autonomic Dysreflexia29470355454015As per old lesion00As per old lesion41941755454015As per old lesion00As per old lesion55987955458460Impaired total body SNS, pelvic PNS; ?HR; ?BP; headache; sweating; erection; flushing above lesion; cold; piloerection below lesion; bowel/bladder contraction; mydriasis; headache00Impaired total body SNS, pelvic PNS; ?HR; ?BP; headache; sweating; erection; flushing above lesion; cold; piloerection below lesion; bowel/bladder contraction; mydriasis; headache16090905454015Any lesion at/above T6; trigger eg. Bladder distension, p soreTreat: elevate head, 10mg SL nifedipine, remove cause00Any lesion at/above T6; trigger eg. Bladder distension, p soreTreat: elevate head, 10mg SL nifedipine, remove cause16090904993005Lasts few hrs - several wks00Lasts few hrs - several wks4114804980940Spinal Shock00Spinal Shock55987954993005?autonomic reflexes below level of lesion00?autonomic reflexes below level of lesion41941754993005Loss of sensation00Loss of sensation29470354993005Loss of voluntary movement and reflexes00Loss of voluntary movement and reflexes16090904326890Temporary cessation of SC neuro functionComplete injury above T1-4; resolves in 48hrs00Temporary cessation of SC neuro functionComplete injury above T1-4; resolves in 48hrs4114804326890Neurogenic Shock00Neurogenic Shock55987954326890?HR/BP; vasoD; poikilothermia; no sweating; erection; paralytic ileus; sphincter paralysis; flaccid bladder paralysis00?HR/BP; vasoD; poikilothermia; no sweating; erection; paralytic ileus; sphincter paralysis; flaccid bladder paralysis41941754326890?00?29470354327524Quadriplegia / high paraplegia00Quadriplegia / high paraplegia16090902125980Hyperextension injury in elderly; 50% good recovery00Hyperextension injury in elderly; 50% good recovery16090902668905Flexion / vertical compression; 10-15% full recovery00Flexion / vertical compression; 10-15% full recovery16090903282315Hyperextension / penetrating inj from back00Hyperextension / penetrating inj from back16090903785235Penetrating injury / unilateral facet joint inj; mod outcome00Penetrating injury / unilateral facet joint inj; mod outcome411480603250Cord Injury00Cord Injury4114802127250Central Cord Syndrome00Central Cord Syndrome4114802668905Anterior Cord Syndrome00Anterior Cord Syndrome4114803282315Posterior Column Syndrome00Posterior Column Syndrome4114803773170Brown-Sequard Lesion00Brown-Sequard Lesion55987953282315-00-55987953785235No sphincter involvement00No sphincter involvement29470353785235Ipsilateral weaknessReflexes variable00Ipsilateral weaknessReflexes variable41941753785235Ipsilat ? vibration, light touch and proprioception; contralat ? pain and temp00Ipsilat ? vibration, light touch and proprioception; contralat ? pain and temp41941753282315Bilat ? vibration, light touch + proprioception00Bilat ? vibration, light touch + proprioception29470353282315No motor involvement00No motor involvement29470352668905Bilateral leg > arm weakness00Bilateral leg > arm weakness41941752668905Bilat ? pain, temp, coarse touch (some dorsal column sensation still OK)00Bilat ? pain, temp, coarse touch (some dorsal column sensation still OK)55987952668905-00-29470352125980Bilat arm > leg weak Bilat prox > distal weakReflexes variable00Bilat arm > leg weak Bilat prox > distal weakReflexes variable41941752125980Bilat arm > leg numbBilat prox > distal numb00Bilat arm > leg numbBilat prox > distal numb55987952125980-00-55994301735455Autonomic00Autonomic41941751733550Sensory00Sensory29476701733550Motor00Motor1748790592455Usually associated with bony / ligamentous injury (SCIWORA rare, more in children, more in C spine); most common in C5-T1, mid-thoracic, L1-T12, close to bony fusion; “level” refers to last unaffected level; “complete” if ongoing symptoms after reflexes return (implied incomplete if sacral sparing); paralysis flaccid and areflexia in spinal cord injuryMOI: direct trauma, 2Y oedema, excitatory neurotransmitter release, epidural haematoma, vascular injury, delayed apoptosis of oligodendrocytes00Usually associated with bony / ligamentous injury (SCIWORA rare, more in children, more in C spine); most common in C5-T1, mid-thoracic, L1-T12, close to bony fusion; “level” refers to last unaffected level; “complete” if ongoing symptoms after reflexes return (implied incomplete if sacral sparing); paralysis flaccid and areflexia in spinal cord injuryMOI: direct trauma, 2Y oedema, excitatory neurotransmitter release, epidural haematoma, vascular injury, delayed apoptosis of oligodendrocytes49275949276000 ................
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