Complete Spinal Cord Injury Flashcards
Define complete spinal cord injury
Complete bilateral sensory + motor loss below the site of spinal cord injury
May initially present as spinal shock
Define spinal shock
Acute loss/ depression of spinal cord function; (loss of all sensorimotor functions below the level of injury) + reflexes following a spinal cord injury
Describe the aetiology of spinal shock
Mainly traumatic
Less commonly: nontraumatic (e.g., malignancy, inflammation, infection, disk degeneration, haemorrhage, infarction)
Describe the pathophysiology of spinal shock
Neuronal damage → loss of intracellular K+
into the extracellular space → hyperpolarization of neurons → poor axonal transmission + reflex depression
K+ levels between intracellular + extracellular space eventually normalize → reversal of spinal shock
Give 3 clinical features of spinal shock
Flaccid areflexic paralysis
Anaesthesia below level of lesion
Autonomic dysfunction: hypotension, paralytic ileus, urinary retention
When does complete spinal cord injury occur?
6-8w after spinal shock has resolved
List 4 clinical features of complete spinal cord injury
Below site of injury:
Impaired sensation
Spastic paralysis + Hyperreflexia
Pathological reflexes: +ve Babinski
Neurogenic bladder: involuntary urination
What imaging should be performed in suspected complete spinal cord injury?
CT spine
A complete spinal cord injury above which level represents a life threatening situation? Why?
Above C4
Risk of diaphragmatic paralysis.
Describe acute management of complete spinal cord injury
Analgesia
Insert urinary catheter
VTE prophylaxis
Describe definitive management for complete spinal cord injury
Bracing / surgical repair
C1-C4 tetraplegia: phrenic nerve pacemakers or tracheotomy +/or ventilator
Describe rehabilitation for complete spinal cord injury
Walking aids
Physio
OT
Pressure ulcer + osteoporosis prophylaxis
