34: Spinal Symposium - Spinal Anatomy and Injury Flashcards

1
Q

describe the normal curvatures of each part of the spine i.e. cervical, thoracic, lumbar, sacral

A

cervical - lordosis
thoracic - kyphosis
lumbar - lordosis
sacral - kyphosis

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2
Q

what are the three erector spinae muscles called?

A
  • iliocostalis
  • longissimus
  • spinalis
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3
Q

where does the 8th cervical nerve exit as there are only 7 cervical vertebrae?

A

8th cervical nerve exits below C7 vertebrae

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4
Q

what is a dermatome?

A

an area of skin that is mainly supplied by a single spinal nerve

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5
Q

what is a myotome?

A

the group of muscles that a single spinal nerve innervates

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6
Q

what % of people with a spinal fracture/dislocation will also have a spinal cord injury?

A

15%

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7
Q

what are the 3 main causes of spinal cord injury?

A
  • falls
  • road traffic accidents
  • sport and recreational activities
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8
Q

what determines if there is a complete spinal cord injury?

A
  • no motor or sensory function distal to lesion
  • no anal squeeze
  • no sacral sensation
  • ASIA grade A
  • no chance of recovery
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9
Q

features of incomplete spinal cord injury

A
  • some function is present below site of injury
  • more favourable prognosis overall
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10
Q

outline the ASIA classificatopm grades from A-E

A
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11
Q

list the different patterns of spinal cord injury

A
  • tetraplegia/quadriplegia
  • paraplegia
  • central cord syndrome
  • anterior cord syndrome
  • brown-sequard syndrome
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12
Q

describe tetraplegia/quadriplegia

A
  • partial or total loss of use of all four limbs and the trunk
  • loss of motor/sensory function in cervical segments of the spinal cord
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13
Q

describe spasticity

A
  • increased muscle tone caused by an upper motor neuron lesion in the spinal cord and above
  • injuries above L1
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14
Q

what is paraplegia?

A
  • partial or total loss of use of the lower-limbs.
  • impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord.
  • possible impairment of function in the trunk.
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15
Q

clinical presentation of tetraplegia

what would u see in A&e?

A
  • Cervical fracture
  • Respiratory failure due to loss of innervation of the diaphragm
  • Phrenic nerve ‘C3-5 keeps you alive’
  • Spasticity
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16
Q

clinical presentation of paraplegia

what would you see in A&E

A
  • thoracic/lumbar fractures
  • associated chest or abdominal injuries
  • spasticity if injury of spinal cord above LI
  • bladder/bowel function affected
17
Q

describe central cord syndrome clinical presentation

A
  • older patients (arthritic neck)
  • hyperextension injury
  • centrally cervical tracts more involved
  • weakness of arms > legs
  • perianal sensation and lower extremity power preserved
18
Q

anterior cord syndrome clinical presentation

A
  • hyperflexion injury
  • anterior compression fracture
  • damaged anterior spinal artery
  • fine touch and proprioception preserved
  • profound weakness
  • Anterior cord syndrome is an incomplete spinal cord syndrome that predominantly affects the anterior two-thirds of the spinal cord, resulting in motor deficits and loss of sensory function in pain and temperature.
19
Q

brown-sequard syndrome clinical presentation

A
  • hemi-section of the cord
  • penetrating injuries
  • paralysis on affected side (corticospinal tract)
  • loss of proprioception and fine touch discrimination (dorsal columns) on affected side
  • pain and temperature loss on the opposite side below the lesion (spinothalamic tract)
20
Q

what is the management of acute spinal cord injury in order to prevent secondary injury?

A
  • ABCD, testing myotomes and dermatomes
  • ATLS
  • adequate imaging: x-rays, CT for bony anatomy, MRI if neurological deficit or children
  • surgical fixation: unstable fractures, vast majority fixed from posteriorly, pedicle screws preferred method
21
Q

spinal shock presentation

A
  • transient depression of cord function below level of ijury
  • flaccid paralysis
  • areflexia
  • last several hours to days after injury
22
Q

neurogenic shock clinical presentation

A
  • hypotension
  • bradycardia
  • hypothermia
  • injuries above T6
  • secondary to disruption of sympathetic outflow
23
Q

what does the long-term management of spinal cord injury involve?

A
  • spinal cord injury unit - intermediate term
  • physiotherapy
  • occupational therapy
  • psychological support
  • urological/sexual counselling