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Neuro Behavioral Med 2 > 18 - Spinal Cord Injury > Flashcards

18 - Spinal Cord Injury Flashcards

1
Q

Describe the epidemiology of spinal cord injuries

A
  • About 273,000 people living with SCI
  • Ave age 42 (up from 28 in 70’s)
  • 80% male
  • Length of stay inpatient in 70’s was 24 days, now 11 days
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2
Q

What are the common causes of spinal cord injuries?

A
  • MVC (low impact/lap restraint)
  • Falls (1/4 falls greater or equal to 1 story)
  • Sports
  • Penetrating

Notes – falls increasing and sports decreasing

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3
Q

What are the two types of spinal cord injuries?

A

2 types
- Complete
I- ncomplete

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4
Q

Describe a LMN injury

A
  • Decreased reflexes
  • Decreased tone
  • Muscle atrophy
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5
Q

Describe an UMN injury

A
  • Spasticity
  • Increased tone
  • Increased reflexes
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6
Q

What are spinal cord syndromes?

A
  • Anterior cord
  • Central cord
  • Brown-sequard
  • Cauda equina
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7
Q

Describe anterior cord

A

Anterior cord – paralysis below lesion with loss of pain/temp (posterior columns spared)

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8
Q

Describe central cord

A

Central cord – corticospinal tract injury; worse upper extremities than lower; some loss pain/temp

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9
Q

Describe Brown Sequard

A

Brown-sequard – ipsilateral paresis, loss of vibration and proprioception; contralateral loss pain and temp

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10
Q

Describe cauda equina

A
  • Cauda equina – from peripheral nerve injury; motor/sensory loss LE; bowel bladder dysfunction; saddle anesthesia
  • This is an emergency
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11
Q

Describe spinal shock

A
  • Common in c-spine
  • Concussion to spine
  • Flaccid paralysis, areflexia, loss sphincter tone, priapism, incontinence
  • Resolves in 24 hours
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12
Q

Describe neurogenic shock

A
  • Loss of sympathetic tone
  • Hypotensive + bradycardia (instead of tachycardia)
  • Flushed, dry, warm
  • Urinary retention
  • More common in injuries above T6
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13
Q

What is the “prehospital” care in a spinal cord injry?

A
  • Packaging

- Airway

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14
Q

Describe hospital care suspected spine injury

A
  • ABCDEs
    Life threatening injuries get priority
    GET THEM OFF THE BOARD***

Decide proper imaging – if suspect injury get CT (some have MRI)

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15
Q

Describe C spine injuries

A
  • 5-10% of unconscious MVCs or falls have major c-spine injury
  • Most fatal at c1 or c2
  • 1/3 at c2
  • ½ at c6 or 7
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16
Q

What does it mean to “clear” a C spine?

A

NEXUS Criteria

  • No bony tenderness
  • No neuro deficits
  • No intox
  • No altered level of consciousness
  • No distracting injuries

This criteria is 99% sensitive; 12% specific

17
Q

What are the Canadian C-spine rules?

A
  • From the makers of the Ottawa Ankle Rules:
  • Too many xrays from nexus
  • 100% sensitive, 42% specific
18
Q

What does trauma.org say about a c spine injury?

A

No asymptomatic patient in literature has had unstable fracture or suffered neurological damage.

19
Q

On the other hand…

A

On the other hand, an intubated trauma patient has an incidence of 10% - likely to miss on xrays (get the CT scan)

20
Q

Describe an unstable injury

A

2 columns disrupted (anterior, middle, posterior)

21
Q

Describe preveterbral edema

A

If prevetebral space is widened, hematoma often secondary to fx.

22
Q

WHat is Hangman’s fracture?

Not testing this

A
  • Typically occurs with hyperextension of neck
  • Line through pedicles
  • Many survive
  • In hanging death more likely from asphyxia
23
Q

What is a tear drop?

A
  • Flexion mechanism is stable (nutcracker) but extension is avulsion and is unstable
  • Unstable because so much force to do this the ligaments have been disrupted
24
Q

What is a Jefferson’s fracture?

A
  • Burst Fx of C1
  • Lots of preveterbral edema
    unstable
25
Q

What is Clay Schoveler’s?

A
  • Flexion results in oblique fracture of spinous process
  • Often C7 or T1
    stable
26
Q

What do you need to remember a lower spinal injury?

A

Back boards hurt, cause ulcers, get off ASAP

27
Q

Describe an L spine injury

A

Very common with calcaneal fractures

Transverse fractures of L1 associated with renal injury

28
Q

What is spondololithiasis?

A

Slippage of superior body in relation to one below.

Often asymptomatic until severe

29
Q

What is spondlolysis?

A
  • Defect in pars articularis; see scotty dog in oblique view
  • Not acute, but can cause pain
  • Usually genetic but can be microtrauma
30
Q

What is a chance fracture?

A
  • Horizontal fx through spinous process, lamina, pedicle and vertebral body
  • 50% have organ involvement
  • MVCs (seatbelt) and falls

“Seatbelt” injury

31
Q

What can spinal stenosis cause?

A

Lower limb numbness and pain - clinically relevant for us

32
Q

What is the long term life expectancy of spinal cord injuries

A

Life expectancy of SCI is decreased by 15 to 20 year

Cause of death usually PE, infection (used to be renal failure)

33
Q

Describe a calcaneal fracture

A
  • 10% of calcaneal fractures have associated lumbar (jump out of window)
  • 26% of calcaneal fractures have other injury
  • Check UA (urine analysis) if suspicious of bleeding or organ damage
34
Q

What are the clinically relevant things you will see in your podiatric office in long term spinal cord injury patients?

A
  • Increased fractures…how to treat?
  • Hypertrophic skin changes – higher lesion/longer injury
  • Hypertrophic nail changes – higher the lesion/longer injury
  • Pressure ulcers
  • DVT
35
Q

Describe spinal cord injruy without radiographic abnormaliity

A

Seen in KIDS ***

  • 25-50% peds spinal injury
  • Vertebral bodied are displaced, then return into place so not visible on xray
  • Weak, burning, paresthesia

Neuro Behavioral Med 2 (15 decks)

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