Podcast
Questions and Answers
Which of the following is a common stimulus for autonomic hyperreflexia?
Which of the following is a common stimulus for autonomic hyperreflexia?
What is the characteristic response of the sympathetic nervous system (SNS) in the presence of a spinal cord lesion?
What is the characteristic response of the sympathetic nervous system (SNS) in the presence of a spinal cord lesion?
What is the early finding following cervical spinal cord injury?
What is the early finding following cervical spinal cord injury?
How many individual vertebrae make up the vertebral column?
How many individual vertebrae make up the vertebral column?
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Which spinal cord lesions are more likely to exhibit autonomic hyperreflexia?
Which spinal cord lesions are more likely to exhibit autonomic hyperreflexia?
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Which part of the vertebrae carries efferent information from the brain through the spinal cord?
Which part of the vertebrae carries efferent information from the brain through the spinal cord?
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What supplies blood to the spinal cord?
What supplies blood to the spinal cord?
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Where does the spinal cord extend from and to?
Where does the spinal cord extend from and to?
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Which of the following is a characteristic feature of syringobulbia?
Which of the following is a characteristic feature of syringobulbia?
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What distinguishes Amyotrophic Lateral Sclerosis (ALS) from chronic polymyositis?
What distinguishes Amyotrophic Lateral Sclerosis (ALS) from chronic polymyositis?
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Which condition is characterized by degeneration of the spinocerebellar and pyramidal tracts?
Which condition is characterized by degeneration of the spinocerebellar and pyramidal tracts?
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What is a key consideration for anesthesia management in patients with Friedreich Ataxia?
What is a key consideration for anesthesia management in patients with Friedreich Ataxia?
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Which classification system characterizes spinal cord injury in terms of motor and sensory impairment?
Which classification system characterizes spinal cord injury in terms of motor and sensory impairment?
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Reductions in blood pressure, especially with C-spine injury, are influenced by:
Reductions in blood pressure, especially with C-spine injury, are influenced by:
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What percentage of trauma patients have multiple injuries that interfere with C-spine evaluation?
What percentage of trauma patients have multiple injuries that interfere with C-spine evaluation?
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The management of anesthesia for chronic spinal cord injury involves addressing sequelae such as all of the following except:
The management of anesthesia for chronic spinal cord injury involves addressing sequelae such as all of the following except:
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Which condition may require spinal fusion surgery in progressive or severe cases?
Which condition may require spinal fusion surgery in progressive or severe cases?
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What is the most common severe congenital anomaly of the spine associated with sensory and motor deficits?
What is the most common severe congenital anomaly of the spine associated with sensory and motor deficits?
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Which anesthesia consideration is related to the risk of hyperkalemia in patients with specific congenital anomaly of the spine?
Which anesthesia consideration is related to the risk of hyperkalemia in patients with specific congenital anomaly of the spine?
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What can result from abnormal attachments of the spinal cord to the vertebral column, leading to dysfunction and requiring surgical release of tethering if possible?
What can result from abnormal attachments of the spinal cord to the vertebral column, leading to dysfunction and requiring surgical release of tethering if possible?
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Which medication can be used to manage spasticity by potentiating the inhibitory effects of GABA?
Which medication can be used to manage spasticity by potentiating the inhibitory effects of GABA?
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What is the early finding following cervical spinal cord injury?
What is the early finding following cervical spinal cord injury?
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What percentage of patients with lesions above T6 are likely to exhibit autonomic hyperreflexia?
What percentage of patients with lesions above T6 are likely to exhibit autonomic hyperreflexia?
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What is the characteristic response of the sympathetic nervous system in the presence of a spinal cord lesion?
What is the characteristic response of the sympathetic nervous system in the presence of a spinal cord lesion?
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Which condition may require spinal fusion surgery in progressive or severe cases?
Which condition may require spinal fusion surgery in progressive or severe cases?
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What is the most common severe congenital anomaly of the spine associated with sensory and motor deficits?
What is the most common severe congenital anomaly of the spine associated with sensory and motor deficits?
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Which anesthesia consideration is related to the risk of hyperkalemia in patients with specific congenital anomaly of the spine?
Which anesthesia consideration is related to the risk of hyperkalemia in patients with specific congenital anomaly of the spine?
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What can result from abnormal attachments of the spinal cord to the vertebral column, leading to dysfunction and requiring surgical release of tethering if possible?
What can result from abnormal attachments of the spinal cord to the vertebral column, leading to dysfunction and requiring surgical release of tethering if possible?
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Which of the following is a common physiological effect of spinal cord injuries?
Which of the following is a common physiological effect of spinal cord injuries?
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What is the probability of C-spine injury in patients under 60 years who meet specific criteria?
What is the probability of C-spine injury in patients under 60 years who meet specific criteria?
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What is frequently relied upon to evaluate for the presence of cervical spine injury and associated instability?
What is frequently relied upon to evaluate for the presence of cervical spine injury and associated instability?
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What are common sequelae addressed in the management of anesthesia for chronic spinal cord injury?
What are common sequelae addressed in the management of anesthesia for chronic spinal cord injury?
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Which of the following is a characteristic feature of noncommunication syringomyelia?
Which of the following is a characteristic feature of noncommunication syringomyelia?
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What distinguishes Amyotrophic Lateral Sclerosis (ALS) from Werdnig-Hoffmann disease?
What distinguishes Amyotrophic Lateral Sclerosis (ALS) from Werdnig-Hoffmann disease?
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What is the main cause of death in Friedreich Ataxia?
What is the main cause of death in Friedreich Ataxia?
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What is a key consideration for anesthesia management in patients with syringobulbia?
What is a key consideration for anesthesia management in patients with syringobulbia?
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Which of the following arteries predominantly supplies the posterior spinal roots and posterior columns of the spinal cord?
Which of the following arteries predominantly supplies the posterior spinal roots and posterior columns of the spinal cord?
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Where does the spinal cord extend from and to?
Where does the spinal cord extend from and to?
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Which part of the vertebrae carries efferent information from the brain through the spinal cord?
Which part of the vertebrae carries efferent information from the brain through the spinal cord?
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What type of sensation is carried by the spinal cord to the brain via the lateral spinothalamic tracts?
What type of sensation is carried by the spinal cord to the brain via the lateral spinothalamic tracts?
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Study Notes
Elective Spine Surgery and Anesthesia Management
- Spine surgery is indicated for various conditions including disk disease, spondylosis, spondylolisthesis, scoliosis, and spinal cord tumors
- Disk disease involves the compressible nucleus pulposus and can lead to nerve root or spinal cord compression, which may require surgical decompression
- Spondylosis, characterized by osteophyte formation, can cause spinal cord dysfunction and may require surgery to arrest symptom progression
- Spondylolisthesis, referring to anterior subluxation of vertebral bodies, may require surgery for myelopathy, radiculopathy, or neurogenic claudication
- Scoliosis, an incidental finding, may require spinal fusion surgery in progressive or severe cases
- Spinal cord tumors are divided into intramedullary and extramedullary tumors, with symptoms of cord compression and treatment options including corticosteroids, radiation, chemo, and surgical decompression
- Anesthesia management for congenital anomalies and degenerative diseases of the vertebral column includes considerations for conditions like spina bifida, meningocele, myelomeningocele, and tethered spinal cord syndrome
- Spina bifida occulta is a congenital defect which usually produces no symptoms and does not pose an increased risk with spinal anesthesia
- Meningocele and myelomeningocele are neural tube defects, with myelomeningocele being the most common severe congenital anomaly of the spine associated with sensory and motor deficits
- Anesthesia management for myelomeningocele includes avoiding succinylcholine due to the risk of hyperkalemia and being aware of neuro deficits related to hydrocephalus
- Tethered spinal cord syndrome can result from abnormal attachments of the spinal cord to the vertebral column, leading to dysfunction and requiring surgical release of tethering if possible
- Patients with tethered spinal cord syndrome may present with motor and sensory deficits, bladder and bowel incontinence, and are at increased risk of cord injury with spinal anesthesia
Managing Spinal Cord Injuries and Hyperextension Injuries
- Spinal cord injuries often occur in major trauma victims, particularly in the upper C-spine.
- The clinical manifestations of acute spinal cord injury depend on the extent and site of the injury, initially producing a state of spinal shock.
- The American Spinal Injury Association (ASIA) classification system characterizes the injury in terms of motor and sensory impairment.
- Physiologic effects from spinal cord injuries depend on the level and extent of the injury, with the most severe derangements occurring with complete cervical cord injury.
- Reductions in blood pressure are common, especially with C-spine injury, influenced by loss of sympathetic nervous system activity and bradycardia.
- C-spine radiographs are obtained for trauma patients to identify suspected and occult C-spine injuries.
- The probability of C-spine injury is minimal in patients under 60 years who meet specific criteria, allowing them to avoid routine imaging studies.
- Two-thirds of trauma patients have multiple injuries that interfere with C-spine evaluation.
- Portable X-rays are frequently relied upon to evaluate for the presence of cervical spine injury and associated instability, as imaging may not be practical in some cases.
- The management of anesthesia for chronic spinal cord injury involves addressing various sequelae such as impaired alveolar ventilation, autonomic hyperreflexia, chronic infections, renal stones, anemia, and altered thermoregulation.
- Chronic spinal cord injury can lead to a range of health issues including renal failure, osteoporosis, muscle atrophy, and pressure ulcers.
- Chronic pain and depression are common following spinal cord injury, often requiring the use of antidepressants and analgesics, including opioids, which need attention during anesthetic management.
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Description
Test your knowledge of elective spine surgery and anesthesia management with this quiz. Explore conditions like disk disease, spondylosis, spondylolisthesis, scoliosis, and spinal cord tumors, as well as anesthesia considerations for congenital anomalies and degenerative diseases of the vertebral column.
