disorders of the spine

Question 1

injury of C1-C4 (HIGH cervical injury)

Answer 1

Before the cervical enlargement

• if the injury is above the cerviacla enlargement = high cervical injury
  1) Trauma, herniated disc , tumour and infection
• First neurone is severed = doesn’t reach the cervical or lumbar enlargements = Hence paralysis of hands and legs= quadriplegic , spastically increased muscular tone
• Central paralysis
• Bowel and bladder function is impaired (central type impairment = retention of urine and severe constipation)
• Breathing = intercostal muscles are impaired
• Diaphragm is only partially affected as it also has innervation from brainstem

Question 2

what does the cervical enlargement do

Answer 2

2nd order motor/sensory neurone to arms => C5-C8

Question 3

what is the lumbar enlargement and where is it ?

Answer 3

1) L1-S1

2) 2nd order motor/sensory neurones to legs

Question 4

Low cervical injury (C5-T1)

Answer 4

1ST AND 2ND NEURONE to Arms = weakness and paralysis
- 2nd neurone for lower limbs (lumbar enlargements not affected) = weakness of the legs and trunk
If not fully paralysed
- Diaphragm = normal
-Horner’s syndrome (parasympathetic to eye)
@ T1 they have normal control of the neck , shoulder , arms - the lower the injury , the more upper body is preserved .

Question 5

thoracic T2-12 injury

Answer 5

2nd order neurone of arms = intact 
- lower paraplegia 
- retention of bowel and bladder
- abdominal reflex loss
(wheel chair bound)

Question 6

impairment of lumbar enlargement

Answer 6

1) arms are intact
2) normal breathing
3)no power of lower limbs
(2nd neurone for lower limbs impaired)
- lower flaccid paralysis ( muscular tone is reduced , since the 2nd neurone is impaired )
- numbness
4) Bowel and bladder central type impairment

Question 7

caudal equina syndrome

Answer 7

1) injury to cauda equina
2) peripheral impairment of bowel and bladder (incontinence = leading faeces and urine)
3) Arms and legs are intact
4) May have weakness in lower legs (subtle anaesthesia)
5) ACUTE CAUDA EQUINA / INCOMPLETE CAUDA EQUINA = NEUROLOGICAL EMERGENCY

Question 8

Brown Sequards syndrome

Answer 8

1) only involves the left side of the cord= T11
2) above lumbar enlargement so left leg is infected ( same side of injury )
- left sided weakness = spastic and central type paralysis
3)Sensation = deep sensation is going to dorsal column system ( contralateral side crosses over )
- proprioception is impaired on opposite side
= right side pain and temperature anaesthesia
-left sides proprioception loss