Acute Spinal Cord Injury

Question 1

Most common causes of spinal cord injuries in individuals less than 10 years of age

Answer 1

MVAs

Falls

Question 2

Below what age do we say kids should only be in the back seat of the car to avoid spinal cord injury in the setting of air bag deployment

Answer 2

13

Question 3

Brown Sequard syndrome

Answer 3

• Aka spinal cord hemisection syndrome
• Lost at the level of the lesion:
  
  • Ipsilateral motor function, fine touch, and vibration
  • Ipsilateral pain and temperature sensation
• Lost below the level of the lesion:
  
  • Ipsilateral motor function, fine touch, and vibration
  • Contralateral pain and temperature sensation
• Note: Remember that the anterolateral tract/spinothalamic tract decussates at the level it enters the spinal canals

Question 4

Etiologies of central cord syndrome

Answer 4

• Traumatic flexion/extension injury (especially in the context of cervical spondylosis)
• Intra-axial neoplasms
• Dilation of the central canal (aka syringomyelia)

Question 5

Distribution of deficits in central cord syndrome

Answer 5

Question 6

Fasciculus gracilis and cuneatus

Answer 6

Cuneatus = motor fibers to arms

Gracilis = motor fibers to legs

Question 7

In any patient younger than ___, spinal cord imaging is recommended regardless of clinical status in the setting of blunt trauma involving the head/spine

Answer 7

In any patient younger than 9, spinal cord imaging is recommended regardless of clinical status in the setting of blunt trauma involving the head/spine

Question 8

Spinal cord injury without radiographic abnormality

Answer 8

Most common in those under 9 years of age

Question 9

Suspicion for cervical spine injury warrants. . .

Answer 9

. . . usually a C spine focused CT and an MRI

CT is for bone, MRI is for nerves

Question 10

Principal indications for surgery in traumatic spinal cord injury

Answer 10

• Significant compromise of spinal canal
• Fixation of a very unstable spine that is unamenable to closed reduction

Question 11

Principal goal in the management of acute spinal cord injury

Answer 11

To prevent secondary injury

Question 12

Corticosteroids in traumatic spinal cord injury

Answer 12

• Well established for subacute injury (such as compression by a tumor)
• Jurry is still out for acute injury, but early evidence suggests benefit IF:
  
  • Administered IV within 8 hours of injury
  • Continued for 24-48 hours
    
    • Continuing beyond 48 hours may increase risk of infection and wound dehiscence

Question 13

Corticosteroids in TBI

Answer 13

Contraindicated

Question 14

General inpatient management principals for acute spinal cord injury

Answer 14

• Pressure sore prophylaxis: Remove backboard as soon as the C spine is stabilized and follow with q2-3 hour rolling
• DVT prophylaxis: Begin LMWH within 72 hours of injury
• Urinary retention management: Insert indwelling Foley acutely followed by intermittent catheterization thereafter
• Stress ulcer prophylaxis: PPI
• Paralytic ileus prophylaxis: Bowel reg (stool softeners)
• Dysautonomia - Pressure management: IV fluids, pressors as needed
• Dysautonomia - Temperature management: Cooling and warming blankets, antipyretics as needed

Question 15

Superficial abdominal reflexes

Answer 15

• Elicited by scratching the skin in all four quadrants around the umbilicus
• Response is contraction of the underlying abdominal musculature in that quadrant
  
  • Above umbilicus tests T8 to T10
  • Below umbilicus tests T10 to T12
• May be used to help localize spinal cord lesions on exam
• Link: https://www.youtube.com/watch?v=v4FyZydgHs0