10-06 Traumatic Spinal Cord Injury Flashcards
1
Q
Spinal Cord Injury (Traumatic/Non-Traumatic)
A
- Traumatic SCI is most common
- 39% of SCI is non-traumatic
- Non-traumatic not caused by accidents - Thrombus, Embolism, RA, Diseases, Vascular issues
2
Q
Common causes of SCI
A
- MVA (40%)
- Falls (27.9%)
- Violence (15%)
- Sports (8%)
- Men > Women (3.5:1): Men are more adventuresome, take more risks
- Average age: 16-30 yo
3
Q
SC Anatomy
A
- Spinal nerves exit below corresponding level of spine (exception is cervical, exit above)
- 31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal)
- SC ends at T12
- SC tapers into conus medullaris at lower border of T1
- Cauda Equina (LMN Lesion)
4
Q
Lesion
A
- Loss of sensation and/or motor function below segmental level of injury (ex: C6 SCI = loss of C6 motor and sensation at C6 and below C6
5
Q
Cervical Nerve Root Innervation
A
- C1-C3: Facial muscles
- C4: Diaphragm and traps
- C5: Delts
- C6: Wrist extensors
- C7: Triceps
- C8-T1: Hands and fingers
6
Q
Thoracic Nerve Root Innervation
A
- T2-T8: Chest Muscles
- T6-T12: Abdominals
7
Q
Lumbar Nerve Root Innervation
A
- L1-S1: LE muscles
- S1-S2 hip and foot muscles
- S3 bowel and bladder
8
Q
Key Muscles
A
- Elbow Flexion (Biceps Brachii @ C5)
- Wrist Extension (Extensor Digitorum @ C6)
- Elbow Extension (Triceps Brachii @ C7)
- Finger Flexion - Distal (Flexor Digitorum Profundus @ C8)
- Finger Abduction (Dorsal Interossei @ T1)
- Hip Flexion (Iliopsoas @ L2)
- Knee Extension (Quadriceps @ L3)
- Ankle DF (Tibialis Anterior @ L4)
- Great Toe Extension (Extensor Hallicus Longus @ L5)
- Ankle PF (Gastrocnemius @ S1)
9
Q
Spinal Tracts
A
- Tracts either cross at SC or brain
- SC cross section with areas/tracts labeled (pain, temp, proprioception, vibration, motor, LE)
- Autonomic (fight or flight) system, located at horns of T6 and above, innervation to systems, vitals
10
Q
Posterior Column (Dorsal Column/Medial Lemniscal Tracts (DCML)
A
- Fasciculus Gracilis + Cuneatus = Posterior Column
- FG = Proprioception (light touch) @ LE
- FC = Proprioception (light touch) @ UE
- Ascending tracts, cross at the brain (thalamus)
11
Q
Corticospinal Tract
A
- Only descending motor tract to muscles
- Crosses at the brain (medulla), possibly explains deficiency opposite side
12
Q
Spinothalamic Tract
A
- Pain and temperature (and light touch)
- Crosses at segmental SC level
- Still ascends 1-2 levels before crossing
13
Q
Shared tracts
A
- Pain and temp on same tract (Spinothalamic)
14
Q
Duplicated tracts
A
- DCML crosses at brain, spinal thalamic crosses at SC
- Light touch spared with unilateral SCI
- Duplication makes light touch not a good sensation to test
15
Q
Tetraplegia (Quadraplegia)
A
- Cervical lesion
- Paralysis of all 4 extremities and trunk
- Affected areas include respiratory muscles at level C2-C4
16
Q
Paraplegia
A
- Thoracic, lumbar or cauda equina lesion
- LE and trunk paralysis (bad postural control)
17
Q
Neurological Level (ASIA)
A
- Most caudal level of SC with NORMAL motor and sensory function on both R and L
18
Q
Motor Level (ASIA)
A
- Most caudal segment with normal MOTOR function BILATERALLY
19
Q
Sensory Level (ASIA)
A
- Most caudal segment with normal SENSORY function BILATERALLY
20
Q
Complete Injury
A
- No sensory or motor function in the lowest sacral segment (S4-S5)
21
Q
Incomplete Injury
A
- Motor and/or sensory function below the neurological level INCLUDING sensory and/or motor at S4-S5
22
Q
ASIA A (ASIA Impairment Scale)
A
- Complete Injury, “worst”
- NO motor or sensory function preserved IN THE SACRAL segments S4-S5.
23
Q
ASIA B (ASIA Impairment Scale)
A
- Incomplete
- SENSORY, but not motor function is PRESERVED BELOW the neurologial level and includes sacral segments S4-S5
24
Q
ASIA C (ASIA Impairment Scale)
A
- Incomplete
- MOTOR function preserved below neurological level, and MORE THAN HALF of key muscles BELOW neurological level have a muscle grade LESS than 3
25
Q
ASIA D (ASIA Impairment Scale)
A
- Incomplete
- MOTOR function preserved below neurological level, and AT LEAST HALF of key muscles BELOW neurological level have a muscle grade of 3 or MORE
26
Q
ASIA E (ASIA Impairment Scale)
A
- Best
- Motor and sensory function is normal
27
Q
Brown-Sequard Syndrome
A
- Injury to hemisection of SC (usually stabbing)
- Ipsilateral loss: Proprioception and vibration
- Contralateral loss: Pain and temperature
- Loss = several dermatome levels below lesion level
28
Q
Central Cord Syndrome
A
- UE involvement > LE involvement
- Pt can walk, but not move arms
- Caused by cervical hyperextension injury
- Compressive forces –> hemorrhage and edema in central SC
29
Q
Posterior Cord Syndrome
A
- Rare injury
- Loss of proprioception, epicritic sensation
- Widens basse steppage gait
- Intact pain and light touch
- Intact motor
30
Q
Anterior Cord Syndrome
A
- Preserves proprioception and balave
- Loss of pain and temperature (spinothalamac tract damaged)
- Loss of motor (corticospinal tract damaged)
- Caused by cervical flexion injury –> damage to anterior SC
31
Q
Sacral Sparring
A
- Incomplete lesion
- Sacral tracts are spared from injury (most central of sacral tracts preserved)
- Intact perianal sensation
- External sphincter muscle contracts
- Often first sign of incomplete cervial SCI
32
Q
Cauda Equina Injuries
A
- Usually incomplete
- Peripheral injury (not central), LMN
- Potential to regenerate like peripheral nerves
- Full neurological recovery is uncommon
- Long axons make location of injury far from site of innervation
- Scarring on axons may block regeneration
- Muscle may not be functional once regeneration occurs
33
Q
Spinal Shock
A
- Reflexes depressed or absent
- Flaccidity
- Loss of sensation
- Loss of motor function
- Spinal column protects itself by shutting down; takes days or weeks to open itself up again
34
Q
Motor/Sensory Impairments
A
- Complete or partial loss of muscle function below level of lesion
- Impaired or absent sensory function below level of lesion
- Dependent on type of lesion and where lesion occurs
35
Q
Autonomic Dysreflexia
A
- Medical condition is life-threatening; Treat as emergency, take pt to ER.
- Occurs in SCI T6 and above with complete and incomplete lesions
- Noxious stimulus below level of lesion
36
Q
Automatic Dysreflexia (Intervention)
A
- Immediate intervention required
- Activate code (depends on facility)
- If pt flat, bring to sitting (to lower BP)
- Identify stimulus and relieve it (usually bladder)
- If can’t immediately find stimulus, drain bladder
37
Q
Orthostatic Hypotension
A
- More common at T6 and above
- Sx: Nausea, dizziness, fainting
- Lack of muscle tone –> peripheral venous pooling
38
Q
Orthostatic Hypotension (Intervention)
A
- Gradually, slowly progress to upright position to allow CV system adaptation
- Abdominal binder or compression stockings
- Reverse sx by returning to original position
39
Q
Temperature Control
A
- Loss of internal thermo0regulatory responses
- Loss of ability to shiver
- No vasodilation response with heat
- No vasoconstriction response with cold
- Paralysis
- Loss of sweating
- Compensatory diaphoresis above level of lesion
- Educate pt that they cannot regulate body temperature, and needs to be monitored, especially with exercise
40
Q
Respiratory Impairment
A
- C1-C3 Loss or impaired spontaneous breathing
- Ventilator required, or phrenic nerve stimulator
- Decreases cough function to expel secretions on their own
41
Q
Spasticity
A
- Flaccidity during spinal shock, then muscle spasticity below level of lesion
- Spasticity increases over first 6 months, plateaus at one year
- May learn to trigger spasticity to assist with function (minimal to moderate)
- If interferes with function, medical management: oral, intrathecal injection, baclofen pump
