19) Spinal Cord Injuries Flashcards
What are some causes of spinal injuries?
Car collision, contact sports, assault, falls, alcohol
Where do most spinal injuries occur? How does this differ in children?
C6/7
In children C1/2
What are the mechanisms of injury to the spine?
Hyperflexion Hyperextension Lateral stress Rotation Compression Distraction - pulling apart of vertebrae
What fractures are due to flexion injuries of the spine?
Anterior wedge
Flexion teardrop
Clay-shoveler’s
What dislocations are due to flexion injuries of the spine?
Anterior subluxation
Bilateral interfacet dislocation
Atlanto-occipital
Anterior atlanto-axial
What fractures are due to extension injuries of the spine?
Hangman’s
Teardrop
What dislocation is due to extension injury of the spine?
Anterior atlanto-axial dislocation
Which is more likely to cause neurological injury: flexion of extension injury of the spine?
Flexion
What are the causes of complete cord transection syndrome?
Trauma Infarction Transverse myelitis Abscess Tumour
What are the features of complete cord transection syndrome?
Spinal shock and autonomic dysfunction (high lesion)
Priapism - prolonged, sustained erection
Complete loss of sensation and paralysis below lesion
Hypotension (loss of sympathetic)
What is Brown-Séquard syndrome?
Hemisection of spinal cord (rare to be complete)
What are the causes of Brown-Séquard syndrome?
Penetrating trauma Fractured verebrae Tumour Abscess MS
What are the features of Brown-Séquard syndrome?
Same side - loss of motor function, conscious proprioception, vibration and touch sensations (DC)
Contralateral - loss of pain and temp sensation
What are the causes of anterior cord syndrome?
Flexion injury - fracture, dislocation or disc herniation
Injury to ant spinal artery (cross clamp of aorta)
What are the features of anterior cord syndrome?
Flaccid paralysis below level (corticospinal)
Loss of pain and temp sensation below
Autonomic dysfunction
What are the causes of central cord syndrome?
Trauma - hyperextension (elderly), hyperflexion (young) Disruption of blood flow to cord Cervical spinal stenosis Degenerative spinal disease Syringomyelia Cervical canal ependymoma
What is syringomyelia?
Development of syrinx (cyst) in or within the central canal
What signs would someone with syringomyelia present with?
Loss of sensitivity to painful and thermal stimuli in cape like distribution (medial parts of spinothalamic tract affected first)
What are the features of central cord syndrome?
Motor loss > sensory loss
Distal > proximal
Upper extremity > lower extremity
Bladder dysfunction and urinary retention
What are the causes of posterior cord syndrome?
Spondylosis Spinal stenosis Infections Vit B12 def Occlusion of posterior spinal artery
What are the features of posterior cord syndrome?
Loss of conscious proprioception, vibration, 2-point discrimination and light touch (DC) below level of lesion
What is the general management for spinal cord injuries?
Consider intubation (C5 and above)
ICU
Early immobilisation of C spine
Physio
When should surgery be used in spinal cord injuries?
Progressive neurological defects
Unstable spinal fractures
Describe the immediate management of spinal cord injuries:
ABCDE
Consider intubation
Use log roll, backboard and rigid C collar
What is manual inline stabilisation?
Crouching above patient with hands placed on the patient’s mastoid process or cradling their occiput
Describe the emergency management of spinal cord injuries:
ABCDE - HR, RR, BP
Address hypoxia - O2
Address hypotension - fluid challenge, vasopressors
Address hypothermia, blankets
Neuro exam, bladder volume and distension
