18. Pathophysiology and Management of Spinal Cord Injuries Flashcards
What are the forces involved in injury of the spine?
Hyperflexion - forwards movement of the head, hyperextension - backward movement, lateral stress - sideways movement, rotation - twisting of head, compression - force along the axis of spine downward from head of up from pelvis, distraction - pulling apart of vertebrae.
What are the fractures associated with flexion injury?
Anterior wedge, flexion teardrop, Clay-shoveller’s.
What are the dislocations associated with flexion injury?
Anterior subluxation, bilateral interfacet dislocation, atlanto-occipital dislocation, anterior atlanto-axial dislocation.
What are the fractures associated with extension injury?
Hangman’s, teardrop.
What is the dislocation associated with extension injury?
Anterior atlanto-axial.
What are the causes of complete cord transection syndrome?
Trauma, infarction, transverse myelitis, abscess, tumour.
What are the clinical features of complete cord transection syndrome?
Spinal shock and autonomic dysfunction and higher lesions, priapism (prolonged sustained erection), complete loss of sensation below lesion, complete paralysis below lesion.
What is Brown-Sequard syndrome?
Hemisection of the cord.
What are the causes of Brown-Sequard syndrome?
Penetrating trauma, fractured vertebrae, tumour, abscess, multiple sclerosis.
What are the clinical features of Brown-Sequard syndrome on the side of injury?
Loss of motor function (corticospinal tract); loss of conscious proprioception, vibration and touch sensation (dorsal column).
What are the clinical features of Brown-Sequard syndrome on the contralateral side of injury?
Loss of pain and temperature sensation (spinothalamic tract).
What can cause anterior cord syndrome?
Flexion injury, or anterior spinal artery injury in atherosclerotic disease or cross clamping of the aorta.
What are the clinical features of anterior cord syndrome?
Flaccid paralysis below lesion, loss of pain/temperature, autonomic dysfunction, preservation of dorsal column modalities.
What are the causes of central cord syndrome?
Hyperextension of C spine in elderly, hyperflexion of C spine in younger patients, disrupted blood flow to SC, C spinal stenosis, degenerative spinal disease, syringomyelia, central canal ependymoma.
What is syringomyelia?
Development of a syrinx/cyst in or within the central canal, central cord syndrome.
What are the symptoms of syringomyelia?
Initially obliteration of spinothalamic fibres as they decussate in the white commissure so loss of sensitivity to pain and thermal stimuli in a cape-like distribution.
What are the clinical features of central cord syndrome?
Motor > sensory, upper extremity > lower extremity, bladder dysfunction and urinary retention.
What are the causes of posterior cord syndrome?
Spondylosis, spinal stenosis, infections, vitamin B12 deficiency, occlusion/infarction of paired posterior spinal arteries.
What are the clinical features of posterior cord syndrome?
Loss of dorsal column modalities, motor function and sensation of pain/temperature/firm touch remain intact.
What are the non-surgical management of cord injuries?
Intubation if C5 or above, ICU admission, C-spine immobilisation ASAP, C-spine restriction for 6 weeks, physiotherapy, occupational therapy.
When are the surgical management of cord injuries used?
Progressive neurological deficits or unstable spinal fractures.
What is the initial management of SC injuries?
ABCDE approach; assume spine injury if head injury present, unconscious or confused, spinal tenderness, extremity weakness, loss of sensation; intubation if C5 or above; log-roll, backboard, rigid C collar.
How is the spine ‘cleared’?
Alert and oriented, no language barrier, not intoxicated, no midline posterior tenderness, no focal neurological deficit, no painful distracting injuries.
