Spinal trauma - assessment, immediate care and appropriate referral

  1. Home
  2. Regional Basic Science
  3. Spinal trauma - assessment, immediate care and appropriate referral
Previous
Next

QUESTION 1 OF 4

A 42-year-old motor cyclist comes off her bike. She has sustained a flexion distraction injury to her cervical spine leading to a bilateral facet dislocation at level C5-6. On further assessment she is found to have decreased sensation over her left thumb and decreased power with left wrist extension. Her other injuries include a small hemopneumothorax with anterior 5th to 10th rib fractures, successfully treated with a chest drain. Her GCS is currently 15.
After ATLS assessment and adequate resuscitation an MRI of the cervical spine demonstrates a large disc herniation at level C5-6.
What is the single best option for management?

QUESTION ID: 1083

1. A. General anaesthesia with patient prone, followed by a posterior approach to the cervical spine to reduce and stabilise the spine. MRI scan of her cervical spine following reduction.
2. B. General anaesthesia with patient supine, followed by an anterior approach to the C spine for removal of the herniated disc and then reduction of the dislocation +/- fixation.
3. C. General anaesthesia with patient supine, followed by cervical in line traction with increasing weights and serial radiography until reduction is achieved. MRI scan of her cervical spine following reduction.
4. D. With patient supine perform awake in line traction with increasing weights and serial radiography in theatre and neurological examination to achieve reduction. CT scan of her cervical spine following reduction.
5. E. With patient supine perform awake in line traction with serial radiography in theatre. Once reduced place patient in a hard collar and follow up in 4 weeks with extension/flexion radiography of the cervical spine.
Submit Response

QUESTION 2 OF 4

82. A patient sustains an injury to the L1 vertebra, (as shown below) during a high-speed car accident.
Which of the following best describes the instability pattern of this injury?

QUESTION ID: 3219

1. Anterior column support is lost but the posterior tension band remains intact, the fracture is stable.
2. Both the anterior column and posterior tension band are disrupted. Due to surrounding musculature this will remain stable.
3. Both the anterior column and posterior tension band are disrupted. This is likely to be an unstable fracture.
4. Stability will depend on the plane of the disruption with a ligamentous and disc injury being more stable than a bony one.
5. The posterior tension band only is disrupted and is a stable fracture.
Submit Response

QUESTION 3 OF 4

76.Following a fall from a height, on examination, it is noted that there is a bulbocavernosus reflex but no activity in any lower limb muscle.
What does this suggest?

QUESTION ID: 3222

1. A. Central cord syndrome
2. Anterior cord syndrome
3. Complete recovery will occur.
4. Spinal cord is completely transected above T12.
5. Spinal shock is still present.
Submit Response

QUESTION 4 OF 4

79.A 50-year-old man sustains a C1 vertebral fracture with isolated anterior and posterior arch fractures. There is minimal lateral overhang of the lateral masses.
Which of the following treatments is the most appropriate initial management?

QUESTION ID: 3223

1. Bed rest with traction
2. C1 lateral mass screw fixation
3. Halo vest
4. Occipito-cervical fusion
5. Soft cervical collar
Submit Response