Classification and Prognosis Flashcards
2 ascending tracts
Dorsal columns (fasciculus cuneatus, fasciculus gracilis) Spinothalamic tract
1 descending tract
Corticospinal tract
The dorsal column is organized in what order? (From medial to lateral)
Sacral, lumbar, thoracic, cervical
The corticospinal tract and spinothalamic tract are organized in what order? (From medial to lateral)
Cervical, thoracic, lumbar, sacral
Effects of a spinal cord injury on
- Dorsal columns
- Spinothalamic tract
- Corticospinal tract
- Ipsilateral sensory dysfunction
- Contralateral sensory dysfunction
- Ipsilateral motor dysfunction
What does 1. Dorsal column 2. Spinothalamic measure? 3. Corticospinal
- Proprioception, vibration
- Pain, temperature
- Fine motor control
Where does 1. Dorsal columns 2. Spinothalamic 3. Corticospinal cross?
- Medulla
- Spinal cord level
- Medulla
Sensation grading
2 is normal
1 is present but not normal
0 is absent
Motor grading
5 Normal power
4 Some resistance
3 Full range against gravity but not resistance
2 Full range without gravity
1 Flicker or not FULL range without gravity
0 No contraction
Tetraplegia definition
Partial or complete loss of sensory and/or motor function of arms and typically trunk and legs
If it involves the arms, you’re in the tetraplegia range
Paraplegia
No involvement of the upper extremities
Complete spinal cord injury
No sensory or motor function is preserved in sacral segments (S4-5)
Digital rectal exam is key for determining
Incomplete spinal cord injury
Some sensory and/or motor function in sacral segments (S4-5)
When is prognosis best assessed?
On the exam 3-7 days after the initial injury, not the initial exam
Assuming they’re out of spinal shock
What’s the general prognosis for complete spinal cord injuries
There is a 45-90% chance of functional recovery in the myotome below the one that was injured
Prognosis for an incomplete SCI
Variable (much better than complete)
Potential for community ambulation
Most recovery happens in the first few months, but can continue to make gains after 2 years
4 incomplete spinal cord injury syndromes
Central cord syndrome
Brown-Sequard syndrome
Anterior cord syndrome
Cauda Equina syndrome
Central Cord Syndrome
Most common
Upper extremities are more involved than the lower
Possible bladder/bowel involvement
Typically from hyperextension of the neck - causes damage to the center of the cord
Central cord syndrome prognosis
Some neurological improvement
But can be left with poor hand function which can significantly impact function
Brown Sequard syndrome
Pure syndrome is clinically rare
Mostly seen with penetrating injuries
Good prognosis
One half of the spinal cord is injured, so you get loss of pain/temp/light touch on the opposite side, and loss of motor function and vibtration/position/deep touch on the same side
Anterior cord syndrome
Problem with the anterior spinal artery, so the anterior 2/3 of the cord gets damaged
Will see motor, pain, temperature deficits
Proprioception and light touch are relatively preserved
Often bladder dysfunction
Prognosis for anterior cord syndrome
Poor motor return
Worst prognosis of the syndromes
Cauda Equina Syndrome
Often come in with lower back pain, MUST screen
Disc protruding can causes the nerve roots in the sacrum to become pinched
Various presentations
Its a lower motor injury
Signs: saddle anesthesia, new urinary dysfunction, new sexual dysfunction, bowel dysfunction, pain/weakness in legs, loss of ankle reflex
Cauda Equina Prognosis
Variable (dependent on degree of initial injury and time for treatment)
Lower motor neuron injury so there is a potential for nerve regrowth (1 inch a month for 18 months)
Lower motor bowel/bladder dysfunction and sexual dysfunction can be prolonged
