Spinal Trauma and Acute Spinal Cord Injury — WACS Viva & Clinical Scenarios (Spinal Neurosurgery and Spinal Cord Disorders)

Exam-style spinal trauma and acute spinal cord injury viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old male is brought to the emergency department following a high-speed motor vehicle collision with complete quadriplegia below C5 and profound hypotension. Outline the systematic primary survey and resuscitation protocols according to Advanced Trauma Life Support guidelines. Detail the precise hemodynamic targets, differentiate neurogenic shock from spinal shock, and describe the emergency airway considerations and closed reduction protocols using skull traction.
• SCENARIO 2: A 34-year-old construction worker presents after a fall from a height with an unstable L1 burst fracture and progressive motor weakness (ASIA C). Explain your diagnostic workup including multidetector CT and urgent MRI findings. Discuss the application of the Thoracolumbar Injury Classification and Severity Score (TLICS), the rationale and evidence surrounding ultra-early versus delayed canal decompression, and the biomechanical principles governing the choice between anterior, posterior, or circumferential stabilization.
• SCENARIO 3: A 7-year-old child presents with flaccid paraparesis following a pedestrian-vehicle collision, but standard multiplanar plain radiographs and non-contrast CT scans of the spine demonstrate no osseous fractures or malalignment. Formulate the differential diagnosis, define Spinal Cord Injury Without Radiographic Abnormality (SCIWORA), describe the underlying biomechanical susceptibility of the paediatric spine, and detail your definitive imaging protocol and non-operative management strategy.
• SCENARIO 4: A 42-year-old female presents with bilateral locked facets at C5-C6 following a road traffic crash. She is conscious and exhibits incomplete quadriparesis. Walk the examiners through the stepwise protocol of pre-reduction MRI versus immediate closed traction reduction with Gardner-Wells tongs, intraoperative patient positioning, surgical approach selection (anterior cervical discectomy and fusion versus posterior open reduction and instrumentation), and intraoperative salvage steps if closed reduction fails.
• SCENARIO 5: A 30-year-old male with a complete T4 spinal cord injury (ASIA A) on day 14 post-injury suddenly develops a severe throbbing headache, profuse diaphoresis and flushing above the level of injury, nasal congestion, and severe hypertension with a blood pressure of 210/115 mmHg and bradycardia. Define this clinical entity, explain its pathophysiology, outline immediate bedside diagnostic and therapeutic interventions, and summarize the systemic prevention of secondary spinal cord injury including venous thromboembolism and pressure ulcer care.