Common spinal trauma exam questions for medical finals, OSCEs and MRCP PACES
List four causes of spinal trauma.
What are the different types and number of vertebrae that make up the vertebral column?
- Seven cervical vertebrae
- Twelve thoracic vertebrae
- Five lumbar vertebrae
At what level does the spinal cord begin?
- The spinal cord begins at the caudal medulla oblongata at the level of the foramen magnum
At what level does the spinal cord terminate?
- The spinal cord terminates as the conus medullaris at the level of the L1 vertebra
What are the three tracts of the spinal cord that can be assessed clinically? Give their location and function.
- Corticospinal tract
- Location: posterolateral cord
- Function: motor innervation
- Dorsal columns
- Location: posteromedial cord
- Function: light touch and proprioception innervation
- Spinothalamic tract
- Location: anterolateral cord
- Function: pain and temperature innervation
What is neurogenic shock?
- A form of shock that is caused by damage to descending sympathetic pathways in the cervical and upper thoracic spinal cord resulting in loss of vasomotor tone and cardiac sympathetic innervation.
What is spinal shock?
- Refers to flaccidity and areflexia seen after spinal cord injury
What is the MRC grading of power?
- 5 = normal power
- 4 = weak
- 3 = movement against gravity
- 2 = movement with gravity eliminated
- 1 = flicker of movement
- 0 = complete paralysis
What are three contraindications to use of the Canadian C-spine rules?
- Glasgow coma scale (GCS) <15
- Presence of distracting injuries
What are three high-risk factors that mandate radiography in the Canadian C-spine rules?
- Age >65 years
- Dangerous mechanism
- Paraesthesia in extremities
Give five low-risk factors, any one of which allow for clinical assessment of the cervical spine.
- Simple rearend MVC
- Sitting in Emergency Department
- Ambulatory at any time since
- Delayed onset of neck pain
- Absence of midline cervical spine tenderness
What are seven indications for requesting a CT cervical spine as opposed to the standard 3-view plain radiographs?
- Elderly patients
- Patients with known or presumed cervical spine degenerative disease
- GCS <13
- Intubated patients
- Inadequate plain film series
- Suspicion or certainty of abnormality on plain film series
- Patients being scanned for head trauma and/or multi-region trauma as well
What are two methods of protecting the cervical spine?
- MILS (manual inline stabilisation)
- Triple immobilisation (collar, blocks, tape)
If required, what airway manoeuvre would you use in a patient with suspected spinal trauma?
- Jaw thrust; head-tilt and chin-lift are contraindicated