15. Spinal Cord Injuries

Question 1

Why are C1-C2 more likely to be injured in children?

Answer 1

Have heavier heads with lax ligaments.

Question 2

What is a distraction force causing a spinal injury?

Answer 2

Pulling apart of the vertebrae.

Question 3

Name 3 causes of complete cord transaction syndrome.

Answer 3

Trauma.
Infarction.
Transverse myelitis.
Abscess.
Tumour.

Question 4

What clinical features are seen in complete cord transaction syndrome?

Answer 4

Complete bilateral loss of sensation below the lesion (dorsal column and spinothalamic tract).
Complete bilateral paralysis below the lesion (corticospinal tract).
Spinal shock and autonomic dysfunction with higher lesions.
Hypotension.
Priapism.

Question 5

Why can a patient get hypotension and priapism (prolonged sustained erection) with complete cord transaction syndrome?

Answer 5

Loss of sympathetic input, so increased parasympathetic input, vasodilation so hypotension and increased blood flow to pelvis, so increased penile blood flow.

Question 6

Give 3 causes of Brown-Sequard syndrome.

Answer 6

Penetrating trauma.
Fractured vertebrae.
Tumour.
Abscess.
Multiple sclerosis.
*Leading to unilateral cord compression/injury*

Question 7

What clinical features are seen in Brown-Sequard syndrome?

Answer 7

Loss of motor function (corticospinal tract) on the side of injury.
Loss of conscious proprioception, vibration and touch sensations (dorsal column) on the side of injury.
Loss of pain and temperature sensation (spinothalamic tract) on the contralateral side of injury.

Question 8

Give 2 causes of anterior cord syndrome.

Answer 8

Flexion injury leading to fractures, dislocations of vertebrae or herniated discs.
Vascular disease or atherosclerotic disease in the elderly, or iatrogenic secondary to cross-clamping of the aorta intraoperatively leading to injury of the anterior spinal artery.

Question 9

What clinical features are seen in anterior cord syndrome?

Answer 9

Bilateral flaccid paralysis below the level of the lesion (corticospinal tract).
Bilateral loss of pain and temperature sensation (spinothalamic tract).
Autonomic dysfunction eg bowel, bladder and sexual function.
Preservation of dorsal column.

Question 10

Give 3 causes of central cord syndrome.

Answer 10

Trauma - hyperextension injury of cervical spine in the elderly and hyperflexion injury of cervical spine in younger patients.
Disruption of blood flow to the spinal cord.
Cervical spinal stenosis.
Degenerative spinal disease.
Syringomyelia.
Central canal ependymoma.

Question 11

What is synringomyelia?

Answer 11

Development of a syrinx (cyst) in or within the central canal.

Question 12

What clinical features are seen in syringomyelia and why?

Answer 12

Loss of sensitivity to painful and thermal stimuli in a cape-like distribution as a result of obliteration of the spinothalamic fibres decussating in the white commissure.
Sensitivity to light touch and proprioception (dorsal column) preserved.

Question 13

What clinical features are seen in central cord syndrome?

Answer 13

Loss of motor function (corticospinal tracts) affected more than sensory.
Upper extremity affected more than the lower and distal affected more than proximal.
Bladder dysfunction and urinary retention.

Question 14

Give 3 causes of posterior cord syndrome.

Answer 14

Spondylosis.
Spinal stenosis.
Infections.
Vitamin B12 deficiency.
Occlusion/infarction of the paired posterior spinal arteries.

Question 15

What clinical features are seen in posterior cord syndrome?

Answer 15

Bilateral loss of conscious proprioception, vibration sensation, two point discrimination and light touch (dorsal column).
Preservation of motor function and pain and temperature sensation.

Question 16

How would you manage a patient with a spinal cord injury non-surgically?

Answer 16

Non-surgical:
Consider intubation if C5 or above.
ICU admission.
Early immobilisation of the C-spine.
C-spine restriction is maintained for approximately 6 weeks.
Physio/OT.

Question 17

When would you consider surgical management of the a patient with a spinal cord injury?

Answer 17

For progressive neurological deficits and unstable spinal fractures.

Question 18

Give 3 occasions when you should assume a spine injury.

Answer 18

Head injury present.
Unconscious or confused.
Spinal tenderness.
Extremity weakness.
Loss of sensation.

Question 19

What are the 6 criteria to clear the c-spine?

Answer 19

NEXUS method:
Alert and oriented.
No language barrier.
Not intoxicated.
No midline posterior tenderness.
No focal neurological deficit.
No painful distracting injuries.