Chapter 7 - Spine and Spinal Cord Trauma Flashcards
do we need to assess spinal cord immediately
if the patients spine is protected, evaluation and exclusion of spinal injury can be deferred, especially in the event of systemic instability
which is the most vulnerable part of the spine
the cervical spine
how many vertebrae are in each part of the spine
C7
T12
L5
coccyx abd sacrum
what type of injury causes loss of sensory and motor function below a certain level
complete spinal cord injury
what is the type of injury where some motor or sensory function remains
incomplete spinal cord injury
what does the corticospinal tract do
it controls motor function on the same side of the body. Test it by voluntary muscle contractions or response to pain
what does the spinothalamic tract do
transmits pain and temperature from the opposite side of the body. Tested by pinprick
what do the dorsal columns do
carries proprioception, vibration, light touch on the same side of the body. Tested by position sense in the toes to vibration sense using tuning fork
what is neurogenic shock
loss of vasomotor tone and sympathetic innervation to the heart as a result of injury from T6 and above causing damage to the descending sympathetic pathways.
The resulting loss of vasomotor tone causes vasodilation, pooling of blood and hypotension. Loss of sympathetic innervation to the heart inhibits tachycardia response and can cause bradycardia
what is spinal shock
muscle flaccidity and loss of reflexes that occurs directly after spinal cord injury. This can lead to spasticity
what is central cord syndrome
disproportionately greater loss of motor strength in upper limbs than lower limbs. varying degrees of sensory loss
Hyperextension injury
usually forward fall with facial impact
usually underlying cervical canal stenosis
what is anterior cord syndrome
paraplegia and bilateral loss of pain and temperature
dorsal column preserved (vibration, proprioception)
poorest prognosis, usually after cord ischaemia
what is brown-sequard syndrome
results from semi-section of the cord, usually penetrating trauma
ipsilateral motor loss and loss of position sense with contralateral loss of pain and temperature.
in which part of the spinal column does fracture subluxation commonly result in complete neurological defecits
the thoracic spine as the thoracic spinal canal is narrow
what percentage of patients with a c spine # also have a vertebral # elsewhere
10%
where does the spinal cord run
from brain (medulla) to around L1. Below this is the cauda equina
what is a complete spinal cord injury
when the patient has no motor or sensory function below a level
what is an incomplete cord injury
when the patient has some degree of motor or sensory function
what is a dermatome
it is an area of skin that is innervated by sensory axons within a particular nerve root.
what is the sensory level
the lowest dermatome with normal sensory function
what is the corticospinal tract
controls MOTOR function on SAME side of body. Anterior and lateral sides of cord. Tested by assessing motor function
what is spinothalamic tract
controls PAIN and TEMPERATURE on OPPOSITE side of body. located in anterolateral aspect of cord. tested by pinprick
what are dorsal columns
control PROPRIOCEPTION, VIBRATION, and light touch on SAME side of body. located in posteromedial aspect of cord. Tested by position sense of fingers or toes or using tuning fork
C5
S: area over deltoid
M: elbow flexors
C6
S: thumb
M: wrist extensors
C7
S: middle finger
M: elbow extensors
C8
S: little finger
M: finger flexors
T4
nipple
T8
xiphisternum
T10
umbilicus
T12
Symphysis pubis
L4
S: medial calf
M: ankle dorsiflexion
L5
S: web space between big toe
M: long one extensors
S1
S: lateral border of foot
M: ankle plantarfelxors
S3
ischial tuberosity area
S4 S5
perianal region
T1
finger abductors
L2
hip flexors
L3
knee extensors
what can injury above T6 cause
neurogenic shock as a result of impairment of descending sympathetic pathways leading to loss of vasomotor tone and sympathetic innervation to the heart
what is the bony level of injury
the vertebral level at which damage has occurred
what is the neurological level
most caudal segment of the spinal cord that has normal motor and sensory function
what are the 4 types of thoracic fracture
anterior wedge compression #, burst injuries, chance # and fracture dislocations
what are chance fractures associated with
retroperitoneal and abdominal visceral injuries
what do fracture dislocations in thoracic spine often result in
complete neurological defecits
