Spinal Pearls Key points for your Board Review

  • NEXUS criteria to assess need for radiographic imaging of cervical spine trauma: 1) no midline tenderness to palpation; 2) no focal neurologic deficits; 3) normal alertness/mental status; 4) no intoxication; 5) no distracting injuries

  • Unstable cervical fractures: “Jefferson Bit Off A Hangman’s Tit” (Jefferson C1 burst fracture, Bilateral facet dislocation, Odontoid Types 2 and 3, Atlantoaxial or atlantooccipital dislocation, Hangman’s C2 pedicular fracture, Teardrop fracture)

  • Lumbar fracture is unstable if >1 of Denis’ 3 spinal columns are involved

  • 50% of spinal column fractures are located at the thoracolumbar junction (T11-L2)

  • There is no clear consensus on the use of steroids in spinal injury

  • Central Cord Syndrome: “centenarian clipped his chin, now with cape-like neurologic distribution” (hyperextension, upper>lower extremity motor deficit)

  • Anterior Cord Syndrome: “car has motor in front and GPS in back” (front-end car crash, anterior cord damage, causes motor paralysis but sparing of proprioception)

  • Brown-Sequard Syndrome: “hot knife cuts muscle and half of cord, and the opposite side can’t feel the hot knife” (ipsilateral motor paralysis, contralateral loss of pain/temperature sensation)

  • Cauda Equina Syndrome: saddle anesthesia, bowel/bladder incontinence, decreased rectal tone, bilateral lower extremity neurologic deficits

  • Neurogenic shock (warm shock): loss of sympathetic nervous system causes hypotension, bradycardia, flushing secondary to vasodilation (warm/dry skin)

  • Spinal shock (not shock, but stun) = NO circulatory involvement; loss of reflexes; stun is over when bulbocavernosus reflex returns

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