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3rd Year - MSK Diseases > 13. Spinal Injuries > Flashcards

13. Spinal Injuries Flashcards

1
Q

Where does the Spinal Cord travel, in relation to Vertebrae?

A

Within the Vertebral Foramen

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2
Q

What type of curvature exists in the:

  1. Cervical Spine?
  2. Thoracic Spine?
  3. Lumbar Spine?
A
  1. Lordosis
  2. Kyphosis
  3. Lordosis
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3
Q

In which plane is the Spine Straight?

A

The Coronal Plane

Note - If the Spine is not straight then that = Scoliosis

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4
Q

Where are the nerves of the Lumbar Plexus found?

A

Within the Psoas Major Muscle

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5
Q

What is found in the Intervertebral Foramen?

A

Spinal Nerves

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6
Q

At what level does the Spinal Cord end?

A

L1 - Below that is the Conus Medularis

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7
Q

What is the definition of a Dermatome?

A

An area of Skin that is mainly supplied by a Single Spinal Nerve

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8
Q

What is the definition of a Myotome?

A

The group of Muscles that a Single Spinal Nerve innervates

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9
Q

What are the Myotomes of the Upper Limb?

A
  1. C5 - Deltoid (Shoulder Abduction)
  2. C6 - Biceps Brachii (Elbow Flexion / Wrist Extension)
  3. C7 - Triceps Brachii (Elbow Extensors)
  4. C8 - Flexor Digitorum Superficialis / Flexor Digitorum Profundus (Long Finger Flexors)
  5. T1 - Interossei (Finger Abduction
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10
Q

What are the Myotomes of the Lower Limb?

A
  1. L2 - Iliopsoas (Hip Flexion)
  2. L3, L4 - Quadriceps (Knee Extension)
  3. L4 - Tibialis Anterior Muscle (Ankle Dorsiflexion)
  4. L5 - Extensor Hallicus Longus (Big Toe Extension)
  5. S1 - Gastrocnemius Muscle (Ankle Plantar Flexion)
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11
Q

What is the relationship between a Spinal Injury (Bone) and a Spinal Cord Injury (SCI)?

A

15% of people with a Fracture / Dislocation will have a Spinal Cord Injury (SCI)
Note - The majority of people with an SCI will have an accompanying Column Injury

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12
Q

Who is most likely to get a Spinal Cord Injury?

A
  1. Male
  2. Peak at 20-29 years old
  3. Second Peak at <65 years old
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13
Q

What are the most common causes of Spinal Cord Injury?

A
  1. Falls (41.7%)
  2. Road Traffic Accidents (36.8%)
  3. Sport (11.6%)
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14
Q

What are the ASIA Classifications for Spinal Cord Injury?

A
  1. Grade A - Complete. No Sensory or Motor Function in Sacral Segments S4-S5
  2. Grade B - Incomplete. Sensory but not Motor Function Preserved in Sacral Segments S4-S5
    3 / 4. Grade C / D - Incomplete. Motor Function Preserved below the Neurological Level
  3. Grade E - Normal Motor / Sensory Function
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15
Q

What are the 2 Broad Categories of Spinal Cord Injury? What is the difference?

A
  1. Complete - no motor / sensory function distal to the Lesion - No chance of recovery
  2. Incomplete - Some function is present below the site of Injury - more favorable prognosis
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16
Q

What are the different Patterns of Spinal Cord Injury?

A
  1. Tetraplegia / Quadriplegia
  2. Paraplegia
  3. Partial Cord Syndromes:
  4. a) Central Cord Syndrome
  5. b) Anterior Cord Syndrome
  6. c) Brown-Sequard Syndrome
17
Q

What does Tetraplegia (Quadriplegia) mean?

A
  1. Partial / Total loss of use of all 4 limbs and the Trunk

2. Loss of Motor / Sensory Function in Cervical Segments of the Spinal Cord

18
Q

What is the most common cause of Tetraplegia (Quadriplegia)?

A

Cervical Fracture

19
Q

What is the main concerns with Tetraplegia (Quadriplegia), after a Cervical Fracture?

A
  1. Respiratory Failure due to loss of innervation of the Diaphragm (Phrenic Nerve (C3-5))
  2. Spasticity - UMN Lesion (Above L1) causing increased Muscle Tone
20
Q

What does Paraplegia mean?

A
  1. Partial / Total loss of the use of the Lower Limbs (Arm Function is Spared)
  2. Impairment of Motor / Sensory Function in Thoracic, Lumbar, and Sacral Segments of the Spinal Cord
21
Q

What is the most common cause of Paraplegia?

A

Thoracic / Lumbar Fracture +/- associated Chest / Abdominal Injuries

22
Q

What is also commonly affected with patients with Paraplegia?

A
  1. Spasticity - UMN Lesion (Above L1) causing increased Muscle Tone
  2. Bladder / Bowel Function
23
Q

What are the 3 Partial Cord Syndromes?

A
  1. Central Cord Syndrome
  2. Anterior Cord Syndrome
  3. Brown-Sequard Syndrome
24
Q

What is the common presentation of a Central Cord Syndrome?

A
  1. Older Patient with a Hyper-Extension injury
  2. Centrally Cervical Tracts more Involved
  3. Weakness of Arms > Legs
  4. Perianal Sensation and Lower Extremity Power is Preserved
25
Q

What is the common presentation of an Anterior Cord Syndrome?

A
  1. Anterior Compression Fracture (damaging the Anterior Spinal Artery) due to a Hyper-Flexion Injury
  2. Fine Touch and Proprioception is Preserved
  3. Profound Weakness
26
Q

What is the common presentation of Brown-Sequard Syndrome?

A
  1. Penetrating Injury causing Hemi-Section of the Spinal Cord
  2. Paralysis on the affected side
  3. Loss of Proprioception and Fine Discrimination
  4. Pain and Temperature Loss on the Opposite Side of the Lesion
27
Q

What is key to the management of Patients with a Spinal Cord Injury?

A

Prevent a Secondary Insult

28
Q

What is the initial management of a Spinal Cord Injury?

A
  1. ABCD approach - See “Multiply Injured Patient” deck

2. Advanced Trauma Life Support (ATLS)

29
Q

What is Spinal Shock?

A

Transient Depression of Cord Function, Below the Level of Injury

30
Q

How does Spinal Shock present?

A
  1. Flaccid Paralysis
  2. Areflexia
  3. Last several hours to days after the injury
31
Q

How does Neurogenic Shock present?

A
  1. Hypotension
  2. Bradycardia
  3. Hypothermia
  4. Injuries above T6
  5. Secondary Disruption of Symptathetic Outflow
32
Q

What imaging is required after a Spinal Injury?

A
  1. X-Rays
  2. CT Scanning (Bony Anatomy)
  3. MRI - If Neurological Deficit / Children
33
Q

What is the management of a Spinal Cord Injury?

A
  1. Surgical Fixation
  2. Spinal Cord Injury Unit
  3. Physiotherapy / Occupational Therapy
  4. Psychological Support
  5. Urological / Sexual Counseling
34
Q

When is Surgical Fixation used?

A

Unstable Fractures - Vast Majority fixed from Posteriorly with Pedicle Screws

3rd Year - MSK Diseases (43 decks)

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