4.3 of 82 Ratings
A 55-year-old male presents with severe neck pain and quadriparesis after falling off a 2-story balcony while intoxicated. The patient is GCS 9 on presentation with notable weakness of the bilateral upper and lower extremities. Current imaging is shown in figure A. The decision was made to send the patient for a cervical spine MRI prior to attempted closed reduction and surgical fixation. If a closed reduction is planned, which MRI finding would require immediate surgical treatment rather than closed reduction?
Presence of spinal cord edema at the injury level
Identify a herniated disc at the dislocated level
Disruption of the posterior longitudinal ligamentous complex
Presence of an occult fractures of the lamina at the affected level
Increased T2 signal in the anterior longitudinal ligament of the affected level
Select Answer to see Preferred Response
A 40-year-old male sustains subaxial cervical spine fracture and after a motor vehicle accident. Physical exam is significant for an incomplete upper cervical spinal cord injury. Which of the following CT scans is associated with the worst ultimate clinical outcome?
A 21-year-old patient is evaluated in the trauma bay after a motor vehicle accident. He was found to have a GCS of 3 on the scene and is presently intubated. His bulbocavernosus reflex is not intact. Radiographs and representative CT scan sequences are shown in Figures A through E. What is the next best step in management?
Closed reduction under anesthesia
Open reduction under anesthesia
Closed reduction with internal stabilization
A 35-year-old female is involved in a high speed motorcycle crash. Work-up reveals the presence of an open right femur fracture, and neck pain. A CT scan of the cervical spine is obtained and shows a right sided C6/7 facet dislocation. Which of the following images is most representative of this injury?
Cervical facet dislocations are characteristically caused by which of the following mechanisms of injury?
A 36-year-old woman is brought to the emergency department intubated and sedated following a motor vehicle accident. She is moving her upper and lower extremities spontaneously. She cannot follow commands. CT scans are shown in Figures 7a through 7c. The initial survey does not reveal any other injuries. Initial management of the cervical injury should consist of immediate
immobilization with a halo ring and vest with reduction when medically stable.
closed traction reduction using Gardner-Wells tongs.
posterior open reduction, stabilization, and fusion.
cervical MRI followed by reduction.
anterior open reduction, stabilization, and fusion.
An awake and cooperative patient presents to the emergency room with the injury seen in the CT scan in Figure A. Prior to the CT scan he had an ASIA Impairment Scale of E. Upon returning from the CT scanner he has an ASIA Impairment Scale of D. What is the most appropriate first step in management?
Immediate closed reduction with cervical traction
Immediate anterior open reduction and surgical fixation
Spinal dose steroids
Cervical immobilization, observation, and serial neurologic exams