34: Spinal Symposium - Spinal Anatomy and Injury Flashcards
describe the normal curvatures of each part of the spine i.e. cervical, thoracic, lumbar, sacral
cervical - lordosis
thoracic - kyphosis
lumbar - lordosis
sacral - kyphosis
what are the three erector spinae muscles called?
- iliocostalis
- longissimus
- spinalis
where does the 8th cervical nerve exit as there are only 7 cervical vertebrae?
8th cervical nerve exits below C7 vertebrae
what is a dermatome?
an area of skin that is mainly supplied by a single spinal nerve
what is a myotome?
the group of muscles that a single spinal nerve innervates
what % of people with a spinal fracture/dislocation will also have a spinal cord injury?
15%
what are the 3 main causes of spinal cord injury?
- falls
- road traffic accidents
- sport and recreational activities
what determines if there is a complete spinal cord injury?
- no motor or sensory function distal to lesion
- no anal squeeze
- no sacral sensation
- ASIA grade A
- no chance of recovery
features of incomplete spinal cord injury
- some function is present below site of injury
- more favourable prognosis overall
outline the ASIA classificatopm grades from A-E
list the different patterns of spinal cord injury
- tetraplegia/quadriplegia
- paraplegia
- central cord syndrome
- anterior cord syndrome
- brown-sequard syndrome
describe tetraplegia/quadriplegia
- 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
describe spasticity
- increased muscle tone caused by an upper motor neuron lesion in the spinal cord and above
- injuries above L1
what is paraplegia?
- 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.
clinical presentation of tetraplegia
what would u see in A&e?
- Cervical fracture
- Respiratory failure due to loss of innervation of the diaphragm
- Phrenic nerve ‘C3-5 keeps you alive’
- Spasticity
clinical presentation of paraplegia
what would you see in A&E
- thoracic/lumbar fractures
- associated chest or abdominal injuries
- spasticity if injury of spinal cord above LI
- bladder/bowel function affected
describe central cord syndrome clinical presentation
- older patients (arthritic neck)
- hyperextension injury
- centrally cervical tracts more involved
- weakness of arms > legs
- perianal sensation and lower extremity power preserved
anterior cord syndrome clinical presentation
- 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.
brown-sequard syndrome clinical presentation
- 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)
what is the management of acute spinal cord injury in order to prevent secondary injury?
- 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
spinal shock presentation
- transient depression of cord function below level of ijury
- flaccid paralysis
- areflexia
- last several hours to days after injury
neurogenic shock clinical presentation
- hypotension
- bradycardia
- hypothermia
- injuries above T6
- secondary to disruption of sympathetic outflow
what does the long-term management of spinal cord injury involve?
- spinal cord injury unit - intermediate term
- physiotherapy
- occupational therapy
- psychological support
- urological/sexual counselling
