2.24 SCI Flashcards
SCI causes due to trauma in order of most to least prevalent
- MVA
- falls (esp in elderly)
- acts of violence/passion
- sports act
- other
percentage of SCI causes: MVA
38%
percentage of SCI causes: falls
30%
percentage of SCI causes: acts of violence/passion
14%
percentage of SCI causes: sports act
9%
percentage of SCI causes: other
9%
What are some of the “other” causes of SCI?
- surgical
- transverse myelitis
- infection
- spinal stroke
- bone growths
- stenosis
- cancer
- Down syndrome
If someone presents like a SC injury, how should it be treated?
treat it like a SC injury
spinal stroke
artery blocked that supplies te spine
Why would pts with Downs be likely to get SCI?
alar ligament laxity
spinal nerves 3, 4, and 5…
keep the diaphragm alive
Living through initial injury with SCI
- most important thing initially is that they live through it
- Most people who live do so because there was immediate healthcare provided
Which region of SC injury carries with it a high risk of death?
upper cervical
Out of all the cervical vertebrae that could be fractured, which one could be considered ideal and why?
- better to fracture C1 or C2 than any of the others
- most with one of these either walk out of the hospital or die
- more space between the two vertebrae
rehab issues for SCI pts
- functional skills (ADLs, clear cut, etc.)
- psychosocial
- sexuality
- equipment
- home
- job
- recreation
Rehab for SCI PTs: Why would it be better for them to go to a place like Shepherd if it’s available to them?
- Most places can do functional skills, equipment, home
- Shephard is the one that deals with EVERYTHING
Rehab for SCI PTs: length of time
- looking at months and years
- every aspect of their lives has changed in a moment
typical SCI pts
- 18-30 y.o. white male
- because they do stupid stuff
quadriplegic
all four limbs involved (typically indicative of cervical injury)
paraplegic
arms are full functioning
hand placement and SCI pts
- Hand touching a SCI pt at all time
- the only time hands should be off the patient is when they are supine on the bed
most to least likely region to get a SCI
cervical
lumbar
thoracic
Why is c-spine more likely to get injured?
- more mobile
- less stability
types of c-spine SCI mechanisms
- flexion injury
- flexion rotation injury
- extension injury
- axial loading
With a flexion injury, what gets ruptured and how?
- PLL ruptured
- c-spine flexed and pressure added (axial loading—football players)
- allows for increased posterior separation and teardrop fx
- can get anterior translation of vertebral body
teardrop fx
when a piece of prox vertebral body breaks out and moves anteriorly
What can happen to the spinal cord in a flexion injury?
- ruptured
- stretched
- pinched
could also rupture an artery
burst fracture
get bone fragment that enters spinal canal
flexion rotation injury
lock down one side and the other side becomes hypermobile
Which types of injuries could lead to Brown sequard?
- flexion rotation injury
- shootings, stabbings
Brown sequard
half of spinal cord gets injured
example of extension injury
falling and hitting your chin on the tub
With extension injuries, get rupture of this
ALL
rupture of ALL in extension injury
- takes tremendous amount of force to rupture
- get subsequent fracture of facets and posterior structures
- head stays still and body keeps translating down » shear force
axial loading cervical injury
- often a diving injury
- burst fracture of a vertebrae
- no more stability, head wobbles around
major causes of lumbar SCI
falls: compression and vertebral wedging
Why is t-spine less likely to get SCI?
- ribs, abs, bigger vertebral bodies
- super stable
What is needed to create an SCI in the thoracic spine?
- requires a LOT of force
- or an outside force penetrates T-spine, typically with enough force that it stays that way
- typically what would be considered a complete injury
What type of injury does an MVA often produce?
SCI at interface between thoracic and lumbar where seatbelt locks us in
- high likelihood of injury
- pelvis stays still and the rest of us moves
What are the main ways to get a thoracic SCI?
- MVA
- shootings, stabbings
- elderly
Why are elderly people susceptible to SCI in thoracic spine?
- kyphotic
- osteoporotic
- falls, get vertebral wedging and compression fracture (often get domino effect » line of force anterior to spinal column)
transfers: assistance level
depends on how much the pt helps
max A
usu 1-20% pt help from the pt
dependent
100% assistance req
