Investigations

• What is a burst fracture?

  A type of spinal fracture where the vertebrae shatter into multiple pieces

  Type of compression fracture

  Occurs more in falls from elderly, osteoporotic patients
• What is a compression fracture?

  Part of vertebrae collapses due to pressure or degeneration of the spinal bones
• What is a wedge fracture?

  Compression/collapse of anterior part of the vertebral body

  Due to degeneration of spine or trauma
• What is a distraction fracture?

  Vertebrae are pulled apart (can be backwards or forwards)
• What is interpedicular widening?

  An increase in the distance between the pedicles of the vertebrae
• What is retropulsion of bony fragments?

  Bone fragments from fracture move backwards into spinal cord & can compress nerves
• What is a complete spinal lesion?

  An injury that full severs the spinal cord

  All sensory & motor function is lost below the injury
• What is an incomplete spinal lesion?

  Only partially severs, compresses or injures the spinal cord at site of injury

  Better chance of recovery as still some impulses can still descend/ascend beyond the level of injury

  Some sensory & motor function is affected
• What are the 3 main key areas of the AO spine classification system?

  Morphology of fracture

  Neurological status

  Clinical modifiers = presence of ligamentous injuries or co-morbid conditions
• What are the 3 main types of morphology of fracture in AO spine classification of thoracolumbar spinal cord injuries?

  Type A = compression injury with intact tension band

  Type B = distraction injury (failure of posterior or anterior tension band), alignment of spinal axis is maintained w/o any signs of translation or dislocation

  Type C = translation injury (failure of all elements leading to dislocation, translation or displacement in any plane

  
• How is neurological status determined in the AO spine classifcation of SCI?

  N0 = neurologically intact

  N1 = transient neurological deficit, no longer present by time of clinical examination

  N2 = symptoms or signs of radiculopathy

  N3 = imcomplete spinal cord or cauda equina injury

  N4 = complete spinal cord injury

  Nx = neurology undetermined due to intubation, sedation, intoxication, cerebral trauma ect.
• What are the 2 clinical modifiers in the AO spine classification of SCI?

  M1 = presence of tension band injury is indeterminated based on spinal injury

  M2 = presence of co-morbid conditions (e.g. osteoporosis)
• How is motor function of key muscles assessed using the ASIA impairment scale?

  0 = total paralysis

  1 = visible or palpable muscle twitch

  2 = with gravity eliminated, able to perform full ROM

  3 = against gravity, able to perform full ROM

  4 = full ROM against gravity & able to generate moderate resistance

  5 = normal strength
• What is the American Spinal Injury Associated classification of SCI?

  ASIA A = complete SCI (no sensory/motor function)

  ASIA B = sesnory incomplete injury w/complete motor function loss but sensory is preserved

  ASIA C = motor incomplete injury but less than 1/2 muscle groups are anti-gravity (muscle that acts to counterbalance the pull of gravity)

  ASIA D = motor incomplete injury but more than 1/2 muscles gtoups are anti-gravity

  ASIA E = normal
• What is the significance of being conscious & breathing after a fall?

  Patient can communicate what happened

  Reveals spinal cord segments & phrenic nerve (C3,4,5) are still functional
• Why is creatinine clearance decreased in UTIs/E.coli infection?

  Damage to kidney by inflammation (due to immune response against E.coli) -> decreased filtration of creatinine at glomerulus

  P.fimbriae on E.coli causes adhesion to uroepithelial cells -> acute inflammatory response = actue pyelonephritis
• What are urinary casts?

  Solid materials that form in the kidneys and are excreted in the urine.

  May be made up of WBCs, RBCs, kidney cells or other substances (protein or fat)
• What are chance fractures?

  Flexion/distraction

  Happens when vertebrae are suddenly pulled away from each other

  Like the opposite of a burst