Critical Care Medicine-Neurologic Disorders>>>>>Spinal Cord Injury
Question 3#

Which of the following injuries is LEAST likely to result in spine instability?

A. A 78-year-old male brought to the ED after a 70-pound box of books fell on his head at the library
B. A 34-year-old NASCAR driver flown in as a level 1 trauma after a being involved in a head on collision at 120 miles per hour
C. A 57-year-old female who jumped out of a 7th story window after her curling iron caught on fire and is transferred from outside hospital with bilateral calcaneus fractures
D. A 18-year-old male involved in a car theft found to have multiple gunshot wounds to his lower back with exit wounds in close proximity to lumbar spine

Correct Answer is D

Comment:

Correct Answer: D

Spinal cord instability results when at least two of the three spinal columns (anterior, middle, and posterior) are disrupted. The most common mechanism of injury is blunt force involving acceleration-deceleration; these patients should be approached with a high degree of suspicion until injuries have been ruled out radiographically. Injuries to the thoracolumbar region are common in the setting of flexion forces and typically involve T11-L3. Bilateral calcaneus fractures typically result from high impact forces and are also associated with an increased incidence of spinal fractures and require a thorough thoracolumbar evaluation. In contrast to blunt spinal cord trauma, penetrating injuries are less likely to result in spinal instability and may not require placement of c-collars and immobilization. Damage caused by penetrating injuries occur at the time of the initial trauma making the risk of subsequent exacerbation less likely than with blunt spinal cord trauma.

References:

1. Stuke LE, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain NE. Prehospital spine immobilization for penetrating trauma–review and recommendations from the prehospital Trauma Life Support Executive Committee. J Trauma. 2011;71(3):763-769; discussion 769-770.