June 2018

26 year old male with spinal cord injury

 

History

History: 26 year old male presented to the trauma center following a motor vehicle collision.

Exam: Awake and alert, intubated

Sensation is intact to T4 dermatome

Motor strength is 0/5 in all extremities

Hospital Course

The patient is taken to the operating room for emergent decompression and fusion, with a planned second stage posterior approach to be performed later.

Postoperatively he remained intubated and had bicep movement graded at 2/5 on the left and 3/5 on the right.

Preop and postop CT images of the spine are shown. A follow up head CT was performed to check the status of a small parietal contusion. 

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Questions

Your answers will be added to those already obtained and tabulated at the end of the month.

References

  • Drain JP1, Weinberg DS, Ramey JS, Moore TA, Vallier HA. Indications for CT-Angiography of the Vertebral Arteries After Trauma. Spine (Phila Pa 1976). 2018 May 1;43(9):E520-E524. 
  • Beliaev AM, Barber PA, Marshall RJ, Civil I. Denver screening protocol for blunt cerebrovascular injury reduces the use of multi-detector computed tomography angiography. ANZ J Surg. 2014 Jun;84(6):429-32. 
  • Sliker CW. Blunt cerebrovascular injuries: imaging with multidetector CT angiography. 
  • Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE Jr, Johnson JL, Moore JB, Burch JM. Cervical spine fracture patterns predictive of blunt vertebral artery injury. J Trauma. 2003 Nov;55(5):811-3.
  • Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM.
  • Optimizing screening for blunt cerebrovascular injuries. Am J Surg 1999. Dec;178(6): 517-22.
  • Biffl WL, Moore EE, Ryu RK, Offner PJ, Novak Z, Coldwell DM, Franciose RJ, Burch JM.The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann Surg. 1998 Oct;228(4):462-70.

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