Name: ________________________
INTERNATIONAL SPINE TRAUMA QUESTIONNAIRE
Please review the following cases with the following assumptions.
1. All are single system injuries with no major medical co-morbidities.
2. All patients have the health care coverage that is most common in your region.
3. All patients have normal neurology unless otherwise specified.
4. All patients have the usual family or social support systems in place.
For each case presented please consider your response to the following questions based on
what is the most common practice in your REGION, NOT just at the hospital in which you
practice.
I. A 22 y.o. male construction worker has a ‘stable’ Jefferson Fracture.
1. Who is he most likely to see for treatment of this injury?
a. a physician (non-surgeon)
b. a surgeon (general surgeon or trauma surgeon)
c. an orthopaedic surgeon
d. a neurosurgeon
e. a fellowship trained spine surgeon (ortho or neuro)
f. other ____________________
2. In the region in which I work, this patient is most likely to receive the following treatment:
a. soft collar or no orthosis
b. rigid cervical orthosis
c. halo thoracic brace or cast
d. posterior surgery
e. other _______________________
3. How long will it most likely take for this patient to return to his heavy labour job?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return to work
II. A 41 y.o. female has a type 2 Hangman’s fracture of C2 which is 5 mm anteriorly
displaced.
1. In the region in which I work, this patient is most likely to receive the following treatment:
a. soft collar or no orthosis
b. rigid cervical orthosis
c. halo thoracic brace or cast
d. posterior surgery
e. anterior surgery
f. combined anterior and posterior surgery
g. other _______________________
2. How long will it most likely take for this patient to return to her full duties at home?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return to full activity
A 36 y.o. male teacher has a unilateral C5 – 6 facet fracture with 4 mm
translation between C5-6. The patient has tingling in his fingers without any
motor weakness.
1. Who is he most likely to see for treatment of this injury?
a. a physician (non-surgeon)
b. a surgeon (general surgeon or trauma surgeon)
c. an orthopaedic surgeon
d. a neurosurgeon
e. a fellowship trained spine surgeon (ortho or neuro)
f. other ____________________
III.
2. In the region in which I work, the provision of spine trauma care is funded in the following
proportion:
a. paid by the patient privately
__________%
b. paid by private insurance purchased by the patient
__________%
c. paid for by a workers compensation board funded by employers __________%
d. paid for by government sponsored health care
__________%
e. other funding(describe) ___________________________
__________%
3. In the region in which I work, this patient is most likely to receive the following treatment:
a. soft collar or no orthosis
b. rigid cervical orthosis
c. halo thoracic brace or cast
d. posterior surgery
e. anterior surgery
f. combined anterior and posterior surgery
g. other _______________________
4. How long will it most likely take for this patient to return to her full duties at home?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return to full activity
IV. A 31 y.o. male heavy laborer sustains an L1 Burst Fracture with normal
neurology and 20 degrees of kyphosis when he falls at work.
1. Who is he most likely to see for treatment of this injury?
a. a physician (non-surgeon)
b. a surgeon (general surgeon or trauma surgeon)
c. an orthopaedic surgeon
d. a neurosurgeon
e. a fellowship trained spine surgeon (ortho or neuro)
f. other ____________________
2. Because this patient was injured at his work, his health care expenses are most likely to be
paid for by:
a. himself privately
b. his private insurance if available
c. a workers compensation board funded by his employer
d. government sponsored health care
e. other ____________________
3. In the region in which I work, this patient is most likely to receive the following treatment:
a. no orthosis
b. a body cast
c. a thoraco lumbar brace
d. posterior surgery
e. anterior surgery
f. combined anterior and posterior surgery
g. other _______________________
4. How long will it most likely take for this patient to return to his work as a labourer?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return to full activity
V. A 30 y.o. male accountant has an L2 flexion distraction injury (seat-belt type
fracture) with numbness and very mild weakness in his thighs.
1. In the region in which I work, this patient is most likely to receive the following treatment:
a. no orthosis
b. a body cast
c. a thoraco lumbar brace
d. posterior surgery
e. anterior surgery
f. combined anterior and posterior surgery
g. other _______________________
2. How long will it most likely take for this patient to return to his work at a desk job?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return to full activity
VI. A 75 y.o. female who lives with her family has a T9 osteoporotic compression
fracture.
1. Who is she most likely to see for treatment of this injury?
a. a physician (non-surgeon)
b. a surgeon (general surgeon or trauma surgeon)
c. an orthopaedic surgeon
d. a neurosurgeon
e. a fellowship trained spine surgeon (ortho or neuro)
f. a physical medicine specialist
g. other ____________________
3. In the region in which I work, this patient is most likely to receive the following treatment
(check all that apply):
a. no treatment
b. medical pain management
c. hospitalization if her pain is severe
d. optimal medical treatment of her osteoporosis
e. vertebroplasty
f. kyphoplasty
g. surgical stabilization
g. other _______________________
VII.
A 65 y.o. male falls at home causing hyperextension to his neck. Xrays and
CT show spondylosis with no fracture or instability. Lower extremity ASIA
motor score is 10 out of possible 50. Motor score is 0 in each of C7, C8, and
T1. He is slowly improving from one hour to the next.
1. Who is he most likely to see for treatment of this injury?
a. a physician (non-surgeon)
b. a surgeon (general surgeon or trauma surgeon)
c. an orthopaedic surgeon
d. a neurosurgeon
e. a fellowship trained spine surgeon (ortho or neuro)
f. a physical medicine and rehabilitation physician
g. other ____________________
2. In the region in which I work, this patient is most likely to receive (check all that apply):
a. high quality CT Scan
b. every patient with this injury would obtain an MRI
c. an MRI but only if he can pay for it
d. other _______________________
3. If this patient has a high degree of spinal stenosis from C3-6 without a fracture, in the
region in which I work, this patient is most likely to receive the following treatment:
a. soft collar or no orthosis
b. rigid cervical orthosis
c. halo thoracic brace or cast
d. posterior surgery within the first 72 hours
e. anterior surgery within the first 72 hours
f. combined anterior and posterior surgery within the first 72 hours
g. possible surgery at a later date depending on his neurological recovery
h. other _______________________
4. How long will this patient most likely be in hospital?
a. 0-1 days.
b. 2–7 days
c. 7-14 days
d. 2-4 weeks
e. greater than 4 weeks.
5. How long will it most likely take for this patient to return to his full activity at home?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return to full activity
VIII.
A 22 y.o. female has a complete C6 quadriplegia (4/5 wrist extensors and no
motor distally) ASIA A secondary to C5-6 fracture dislocation from a motor
vehicle accident.
1. In the region in which I work, this patient is most likely to receive the following
prehospital care:
a. unpredictable transport to hospital by civilian or unorganized means
b.transport to hospital by emergency personell (police, firemen) but not paramedics
c.transport to hospital by private ambulance
d.transport to hospital by trained paramedics as part of a national ambulance service
g. other ____________________
2. The probability that this patient will receive appropriate cervical spine precautions and
appropriate resuscitation in the pre-hospital transport is
__________%
3. The probability that this patient may suffer neurological worsening as a result of
prehospital care is approximately __________%
4. In the region in which I work, this patient is most likely to receive (check all that apply):
a. high quality CT Scan
b. every patient with this injury would obtain an MRI
c. an MRI but only if he can pay for it
d. other _______________________
5. Who is she most likely to see for treatment of her quadriplegia and spine fracture?
a. a physician (non-surgeon)
b. a surgeon (general surgeon or trauma surgeon)
c. an orthopaedic surgeon
d. a neurosurgeon
e. a fellowship trained spine surgeon (ortho or neuro)
f. a physical medicine and rehabilitation physician
g. other ____________________
6. In the region in which I work, this patient is most likely to receive the following treatment:
a. supportive treatment only
b. a cervical orthosis
c. halo thoracic brace or cast
d. posterior surgery
e. anterior surgery
f. combined anterior and posterior surgery
g. comprehensive inpatient rehabilitation
h. other _______________________
7. What is the estimated early (within the first month) mortality from this injury?________%
8. What is the estimated one year mortality from this injury?_____________%
9. How long will it most likely take for this patient to return to her home?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return home
IX. A 35 y.o. male sustains a T5 complete ASIA A Paraplegia.
1. Who is he most likely to see for treatment of this injury?
a. a physician (non-surgeon)
b. a surgeon (general surgeon or trauma surgeon)
c. an orthopaedic surgeon
d. a neurosurgeon
e. a fellowship trained spine surgeon (ortho or neuro)
f. a physical medicine and rehabilitation physician
g. other ____________________
2. In the region in which I work, this patient is most likely to receive (check all that apply):
a. high quality CT Scan
b. every patient with this injury would obtain an MRI
c. an MRI but only if he can pay for it
d. other _______________________
3. In the region in which I work, this patient is most likely to receive the following treatment:
a. supportive treatment only
b. thoraco lumbar orthosis or cast
d. posterior surgery
e. anterior surgery
f. combined anterior and posterior surgery
g. comprehensive inpatient rehabilitation
h. other _______________________
4. What is the estimated early (within the first month) mortality from this injury?________%
5. What is the estimated one year mortality from this injury?_____________%
6. How long will it most likely take for this patient to return to his home?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return home
X. A 68 y. o. male sustains a C3 Burst fracture and has C3 Complete paralysis without
any spontaneous diaphragm movement.
1. What kind of treatment is he most likely to receive (check all that apply)?
a. he is unlikely to survive the accident scene
b. supportive medical care only
c. he would be intubated in the emergency room
d. he would be mechanically ventilated in an Intensive Care Unit
e. he would receive a high quality CT scan if indicated
f. he would receive MRI if indicated
g. he would be surgically stabilized if indicated
g. other ____________________
2. What is the estimated early (within the first month) mortality from this injury?________%
3. What is the estimated one year mortality from this injury?_____________%
4. How long will it most likely take for this patient to return to his home?
a. less than 4 weeks.
b. 4–8 weeks
c. 9-16 weeks
d. 17-26 weeks
e. greater than 26 weeks (6 months)
f. unlikely to ever return home
Please answer the following questions about who you are and where you practice;
Name:____________________
Country:______________________ Province or Region: _________________________
City: _______________________
I am a:
Population that my practice serves:______________
a. physician (non-surgeon)
b. surgeon (general surgeon or trauma surgeon)
c. orthopaedic surgeon
d. neurosurgeon
e. fellowship trained spine surgeon (ortho or neuro)
f. physical medicine and rehabilitation physician
g. other ____________________
I work in the following medical setting (check all that apply):
a. a private hospital where patients or private insurance pays for their care
b. a public run hospital where all care is paid by government
c. an academic teaching hospital
d. other ____________________
The majority of the spine trauma patients that I treat pay for their care through:
a. the patient pays for his/her care privately
b. the patient pays privately for insurance that pays for their care
c. the patient’s employer pays for health insurance
d. the government provides health care for all patients
e. other ____________________
In the region in which I work, the majority of the population pays for their health care
through:
a. the patient pays for his/her care privately
b. the patient pays privately for insurance that pays for their care
c. the patient’s employer pays for health insurance
d. the government provides health care for all patients
e. other ____________________
In the region in which I work, the Majority of General trauma care is provided:
a. in the local general hospital without specific trauma physicians or protocols
b. in a regional trauma centre with dedicated trauma specialist physicians
c. based upon the patient’s ability to pay for care
d. other ____________________
In the region in which I work, the Majority of Spinal trauma care is provided:
a. in the local general hospital by orthopaedic and neurosurgeons who do not have specific
spine training
b. in a regional trauma centre with dedicated spine surgeons
c. other ____________________