Spinal Dislocations Clinical Presentation

Updated: Jan 24, 2019
  • Author: J Allan Goodrich, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Presentation

History

Patients with spinal injuries should be questioned about any transient paralysis or paresthesias involving the lower extremities. The history of the accident should include attention to mechanisms, including the following:

  • Whether the patient was the driver or the passenger
  • Whether the patient was restrained or unrestrained
  • What the vehicle's rate of speed was
  • What distance the patient fell (for injuries from falls from heights)
  • What weights were applied to the spine at the time of injury

If the patient is unable to relate the history, it may be obtained from emergency medical personnel on the scene or other witnesses. Schouten et al emphasize the importance of the initial assessment. [11]

Next:

Physical Examination

The physical examination should initially include attention to the details relevant for all traumatized patients (ie, the ABCs [patent airway, spontaneous breathing, stable circulation], blood pressure, and pulse). In the spinal examination, specific attention should be paid to direct palpation for tenderness, deformity, or defects.

The unique finding in thoracolumbar dislocations is that of a fixed gibbus deformity at the level of injury. The patient is most appropriately placed in the lateral decubitus position with the knees flexed if any neurologic compromise is present. This maximizes the residual diameter of the narrowed spinal canal.

A thorough neurologic examination should include the following:

  • Graded motor function of the major muscles in the lower extremity (0-5)
  • Sensory examination to both sharp and dull stimuli
  • Reflex evaluation

In addition to the tendon reflexes, the bulbocavernosus and cremasteric reflexes and the perianal wink should be recorded. A rectal examination documenting the status of the patient's rectal tone must be routinely performed. Dermatomes can be assessed quickly, and landmarks, such as the umbilicus (T10), anterior knee (L3), dorsolateral foot (S1), and perianal region (S3-5), can be used.

Usually, an indwelling catheter is inserted into the bladder, and urine output is monitored.

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