[29] Spinal Cord Injuries Flashcards
What sensory modalities are carried in the dorsal columns?
- Vibration and conscious proprioception
- Two point-discrimination
- Light touch
What modalities are carried in the corticospinal tract?
Motor
What sensory modalities are carried in the spinothalamalic tracts?
- Pain
- Temperature
What is the most common cause of spinal injury?
Physical trauma, e.g. cars, contact sports, assault, falls, alcohol
How much more likely are males to have spinal cord trauma than womens?
4x
What % of those with a head injury have concurrent C-spine injuries?
10-20% have C-spine injures, and approx 30% of these have other spinal injuries
What % of patients with a head injury have a neurological deficit?
30%
What are the most common sites for spinal injuries?
- 50% in C6 and C7
- 30% in C2
Where are children more likely to obtain spinal injuries?
C1-C2
Why are children more likely to injure C1-C2?
They have heavier heads with lax ligaments
What forces are involved in spinal injuries?
- Hyperflexion
- Hyperextension
- Lateral stress
- Rotation
- Compression
- Distraction
What is hyperflexion?
Forward movement of the head
What is hyperextension?
Backward movement of the head
What is lateral stress?
Sideways movement of the head
What is rotation?
Twisting of the head
What is compression?
Force along the axis of the spine downward from the head or upward from the pelvis
What is distraction?
Pulling apart of the vertebrae
What are the potential injuries that can result flexion?
- Fractures
- Dislocation
- Often lead neurological injury
What fractures can be caused flexion injuries?
- Anterior wedge
- Flexion teardrop
- Clay-shoveller’s
What dislocations can be caused by flexion injuries?
- Anterior sublaxation
- Bilateral interfacet dislocation
- Antlanto-occipital dislocation
- Anterior atlanto-axial dislocation
What fractures can be caused by extension injuries?
Hangman’s teardrop
What dislocation can be caused by extension injuries?
Anterior atlanto-axial dislocation
What happens in complete cord transection syndrome?
The entire cord is gone
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 with higher lesions
- Priapism
- Complete loss of sensation below the lesion
- Complete paralysis below the lesion
What happens in Brown-Sequard Syndrome?
Get complete hemisection of cord - one side lost
How common is Brown-Sequard syndrome?
Rare
What can cause Brown-Sequard Syndrome?
- Penetrating trauma
- Fractured vertebrae
- Tumour
- Abscess
- Multiple sclerosis
What are the clinical features of Brown-Sequard Syndrome?
- Loss of motor function on side of injury
- Loss of conscious proprioception, vibration, and touch sensation on the side of injury
- Loss of pain and temperature sensation on the contralateral side of injury
What can cause anterior cord syndromes?
- Flexion injury, leading to fractures or dislocations of vertebrae or herniated discs
- Injury to the anterior spinal artery
What can cause anterior spinal artery injury?
- Vascular or atherosclerotic disease in the elderly
- Iatrogenic secondary to cross-clamping of aorta intraoperatively
What are the clinical features of anterior cord syndrome?
- Flaccid paralysis below level of lesion
- Loss of pain/temperature
- Autonomic dysfunction, including bladder, bowel, and sexual dysfunction
- Preservation of modalities carried by dorsal columns, i.e. vibration, conscious proprioception, 2-point discrimination**
Is central cord syndrome always symmetrical?
No
What are the causes of central cord syndrome?
- Trauma
- Disruption of blood flow to spinal cord
- Cervical spinal stenosis
- Degenerative spinal disease
- Syringomyelia
- Central canal ependyoma
What trauma can cause central cord syndrome?
- Hyperextension injury of cervical spine in elderly
- Hyperflexion injury of cervical spine in younger patients
How can degenerative spinal disease cause central cord syndrome?
Ligamentum flavum can compress the cord and cause contusions/bruising
What is a central canal ependymoma?
Tumour arising from ependymal cells
look at me correcting the cards!!!
What is the aetiology of syringomyelia?
Unknown
What happens in syringomyelia?
Development of syrinx (cyst) in or within the central canal
What do the initial symptoms of syringomyelia arise from?
The obliteration of spinothalamic fibres decussating in the white commissure
What are the sensory symptoms of syringomyelia?
Loss of sensitivity painful and thermal stimuli in a cape-like distribution
Sensitivity to light touch and proprioception are preserved
What are the clinical features of central cord syndromes?
- Motor more affected than sensory
- Upper extremity affected more than lower extremity
- Distal affected more than proximal
- Bladder dysfunction and urinary retention
What does posterior cord syndrome affect?
Bilateral dorsal columns
What causes posterior cord syndrome?
- Spondylosis
- Spinal stenosis
- Infections
- Vitamin B12 deficiency
- Occlusion/infarction of the paired posterior spinal arteries
What are the clinical features of posterior cord syndrome?
- Loss of conscious proprioception
- Loss of vibration sensation
- Loss of two point discrimination
- Loss of light touch
- Motor function and sensation of pain, temperature, and firm touch intact
How are spinal cord injuries managed non-surgically?
- Consider intubation if C5 or above
- ICU admission
- Early immobilisation of the C-spine
- C-spine restriction maintained for approx. 6 weeks
- Physiotherapy/occupational therapy
Why should you consider intubation if someone has a spinal cord injury at C5 or above?
Because there is a risk of loosing respiratory function, as loose the diaphragm function, and intercostal muscles tire quickly
When should you consider surgery in spinal cord injuries?
- Progressive neurological deficits
- Unstable spinal fractures
What approach should be taken in the initial evaluation and treatment of spinal cord injuries?
ABCDE
When should you assume a spine injury has occured?
- If head injury present
- If unconscious or confused
- If have spinal tenderness
- If have extremity weakness
- If have loss of sensation
How should manual inline stabilisation be performed?
- Crouching above the patient with hands placed on the patient’s mastoid processes or cradling their occiput, or
- Standing beside the patient with hands on the sides of the patients head, and forearms resting on the patients chest
How should c-spine be maintained in suspected spinal cord injury?
- Log-roll
- Backboard
- Rigid C-collar
How should hypoxia be addressed in spinal cord injuries?
Consider oxygen with or without airway adjuncts
How should hypotension be addressed in spinal cord injuries?
- Fluid challenge
- Vasopressors
How is the c-spine cleared?
NEXUS method -
- Alert and orientated to person, place, time and event
- No language barrier
- Not intoxicated
- No midline posterior tenderness
- No focal neurological deficit
- No painful distracting injuries
