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MSK Week 1 > ICL 2.4: Spinal Cord Injuries > Flashcards

ICL 2.4: Spinal Cord Injuries Flashcards

1
Q

what are the biggest causes of spinal cord injuries?

A
  1. MVA

2. falls

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2
Q

what are the most common types spinal cord injuries?

A
  1. incomplete quadriplegia (C5)

2. incomplete paraplegia (T12)

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3
Q

which arteries supply the spinal cord?

A
  1. posterior spinal arteries (2)

they supply the posterior 1/3 of the cord

  1. anterior spinal artery

supplies the rest of the spinal cord = 2/3

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4
Q

what is the artery of adamkiewicz?

A

it’s a large, lumbar radicular artery that’s between T6 and L3

it’s a branch of the descending aorta

it connects with the anterior spinal artery so it’s a major source of blood for the anterior 2/3 of the cord!!!!!!

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5
Q

what is a compression fracture? which vertebra is most commonly effected?

A

C5 is the most common

it’s a wedge deformity; one side of the vertebra is squished

bony fragments may project into the spinal cord

nerve and cord damage is possible but not always if there isn’t protrusion

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6
Q

what is a unilateral facet joint dislocation? which vertebra is most commonly effected?

A

C5-C6 most common

usually caused by a flexion-rotation injury where one of the facets is more than 50% dislocated

if there is cord injury, most likely incomplete injury because the other facet joint will still be intact!

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7
Q

what’s the hallmark thing you’ll see on the x-ray of a unilateral facet dislocation?

A

bow tie sign

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8
Q

what is bilateral facet dislocation?

A

complete dislocation of vertebral body because both facets are dislocated

associated w/ very high risk of cord damage

due to extreme hyperflexion like whiplash (not as commonly caused by rotation)

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9
Q

what causes cervical hyperextension injuries? which vertebra is most commonly effected?

A

you’ll usually get a pinched off spinal cord from the hyperextension

C4-C5 most commonly effected

  1. acceleration-deceleration injuries like MVC
  2. falls in elderly with spondylosis**

spondylosis refers to degenerative changes in the spine such as bone spurs and degenerating intervertebral discs between the vertebrae

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10
Q

what is the mechanism of injury, stability, potential injury and most common level of a compression fracture?

A

caused by flexion/axial loading

stable if ligaments remain intact

could lead to crush fracture with fragmentation of vertebral body and projection of bony pieces into canal

most common at C5 level

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11
Q

what is the mechanism of injury, stability, potential injury and most common level of a unilateral facet dislocation?

A

caused by flexion rotation injury; the vertebral body has to be LESS than 50% displaced on x-ray

unstable if PLL is disrupted

if the spinal cord is effected it’ll be an incomplete SCI

C5-C6 is most likely to be effected

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12
Q

what is the mechanism of injury, stability, potential injury and most common level of a bilateral facet dislocation?

A

caused by extreme flexion

caused by flexion rotation injury; the vertebral body has to be MORE than 50% displaced on x-ray

could lead to anterior dislocation of cervical spine with spinal cord compression/compromise which could lead to a complete SCI

C5-C6 are most effected

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13
Q

what is the mechanism of injury, stability, potential injury and most common level of a cervical hyperextension injury?

A

leads to central cord syndrome

usually stable but anterior longitudinal ligament may be disrupted

hyperextension of the cervical spine could lead to the upper body because weaker than the lower body = incomplete

C4-C5 most likely to be effected

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14
Q

what is a Jefferson fracture?

A

burst fracture of C1 ring

usually stable with no neurological findings

caused by axial load that breaks both the anterior and posterior parts of the atlas

ex. pile driving someone or diving or something falling on your head

in an x-ray of the mouth, C1 won’t be lined up with C2

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15
Q

what is a Hangman’s fracture?

A

C2 burst fracture

usually bilateral from an abrupt deceleration injury aka like when you hang someone this is what breaks

most often stable with only transient neurological findings

looks like the pedicles of C2 are broken

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16
Q

what are the different types of odontoid fracture?

A

aka dens fracture of C2

type 1-3 with increasing severity

Type I: fracture through the tip of dens

Type II (most common): fracture through the base of odontoid at junction with the C2 vertebra

Type III: fracture extends from base of odontoid into the body of the C2 vertebra proper

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17
Q

what are the two main types of thoraco-lumbar fractures?

A
  1. chance fracture

2. vertebral compression fracture

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18
Q

what is a chance fracture?

A

most common thoraco-lumbar fracture

it’s a transverse fracture through the body and pedicles into posterior elements = literally goes straight through the vertebra from the front to the back in a sagittal view

usually caused by your seatbelt in a MVC but also seen in falls/crush injury w/ acute hyperflexion of thorax

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19
Q

what is a vertebral compression fracture?

A

an axial compression with or without flexion

causes a wedge deformity of the vertebral body (just like the compression fracture of a cervical vertebra!)

caused by trauma, osteoporosis, infection, or metastatic lesions

20
Q

what are some of the non-traumatic causes of SCI?

A
  1. tumors
  2. transverse myelitis
  3. epidural abscess
  4. multiple sclerosis
  5. infection
21
Q

which types of injuries are more likely to cause a complete loss of motor and sensory function?

TEST QUESTION

A
  1. bilateral cervical facet dislocations
  2. thoracolumbar flexion-rotation injuries
  3. trans-canal gunshot wounds
22
Q

which types of injuries are more likely to cause an incomplete loss of motor and sensory function?

TEST QUESTION

A
  1. cervical spondylosis - falls
  2. unilateral facet joint dislocations
  3. non-canal penetrating gunshot/stab injuries
23
Q

what 3 things do you assess during a neurologic assessment?

A
  1. motor strength, weakness = myotome
  2. sensory disturbances = dermatome
  3. reflex changes
24
Q

which motor functions are controlled by which cervical vertebra?

A

C5 = elbow flexors

C6 = wrist flexors

C7 = elbow extensors

C8 = finger flexors

T1 = finger abductors (little finger)

25
Q

which motor functions are controlled by which lumbar vertebra?

A

L1 = hip flexors

L3 = knee extensors

L4 = ankle dorsiflexors

L5 = long toe extensors

S1 = ankle plantar flexors

26
Q

what is a dermatome?

A

an area of skin innervated by one sensory nerve root

27
Q

how do you score motor function?

A

0-5

0 = Total Paralysis

1 = Palpable or visible contraction

2 = Active movement, gravity eliminated

3 = Active movement, against gravity

4 = Active movement, against some resistance

5 = Active movement, against full resistance
5+ = Normal corrected for pain/disease

NT = Not testable

28
Q

how can you tell the neurological level of injury?

A

after you do motor and sensory testing and then you see how far down everything is intact

so you find the most caudal segment of the spinal cord with both normal sensory and motor function on both sides of the body

you need more than a 3/5 motor and 2/2 for light touch to pass

29
Q

Which of the follow will most likely lead to an incomplete spinal cord injury?

A. Bilateral cervical facet dislocation

B. Thoracolumbar flexion-rotation injuries

C. Cervical spondylosis - falls

D. Gunshot wound through the spinal canal

A

C. Cervical spondylosis - falls

30
Q

what are the 4 types of spinal cord syndromes?

A
  1. central cord syndrome
  2. anterior cord syndrome
  3. brown-sequard syndrome
  4. posterior cord syndrome

**they are all incomplete SCI!!

31
Q

what is central cord syndrome?

A

the most common form of cervical spinal cord injury

characterized by loss of motion and sensation in arms and hands but lower extremities are fine so you can walk to the door but can’t turn the knob

due to major hyperextension injury to the central corticospinal tract of the spinal cord (injury to the central part of the spinal cord)

32
Q

central cord syndrome is more common in which population?

A

elderly

due to hyperextension injury

33
Q

what is anterior cord syndrome?

A

caused by ischemia of the anterior spinal artery which effects the anterior 2/3 of the spinal cord so you have motor and pain loss with preservation of position, vibration and deep pressure sensation

often seen with artery of adamkowitz injury so it’s usually seen at the thoracic level and below

leads to loss of movement, pain and temperature

still able to feel position, vibration, and touch

34
Q

what is Brown-Sequard syndrome?

A

one half of the spinal cord is effected

you lose motor function on the same side as the cord damage but you lose sensory function on the opposite side = not pain, temperature, sensation

35
Q

what is posterior cord syndrome?

A

the poster 1/3 of the spinal cord is effected

this causes ataxia, poor balance but normal senses and strength; almost as if the person was drunk

36
Q

what is the point where the spinal cord ends called?

A

conus medullaris

37
Q

what would happen if you have a conus medullaris injury?

A

this would be a T12-L2 vertebral level injury of sacral cord &; LS nerve roots

you’d have normal motor function but sadly distribution sensory loss; the abnormalities would be symmetric

bowel, bladder, sexual dysfunction

hyperreflexic

38
Q

what would happen if you have a cauda equina injury?

A

this would be if you had an injury below L1-L2 to sacrum vertebral level nerve roots

sensory loss in nerve root distribution with asymmetric symptoms

pain is more significant than conus medullaris injury but bowel, bladder, sexual function is normal

hyporeflexic

39
Q

what are the most common complications of a spinal cord injury?

A
  1. pneumonia
  2. dcubitus ulcers
  3. DVT
  4. PE
  5. infection

the 3 most common secondary medical complications that lead to a higher risk of dying post SCI, when compared to the general population are pneumonia, septicemia and pulmonary emboli

40
Q

which spinal cord syndrome has the highest prevalence?

A

central cord syndrome –> can happen in the elderly and MVA

more common than anterior cord syndrome, posterior cord syndrome and brown-sequard syndrome

41
Q

what are some of the cardiovascular complications of SCI?

A

Hypotension

Autonomic

Dysreflexia

DVT

Pulmonary Embolus

Poikylothermia = can’t control body temperature

42
Q

what are some of the pulmonary complications of SCI?

A
  1. pneumonia
  2. atelectasis
  3. ventilatory failure
  4. sleep apnea

“C3, 4, 5 keep the diaphragm alive!”

43
Q

where is pressure ulcer formation most common?

A
  1. sacrum
  2. heel
  3. ischium
  4. scapula
  5. scapula
44
Q

what are the types of fractures associated with the spine that may lead to spinal cord compromise?

A
  1. Jefferson
  2. Hangman
  3. odontoid
  4. chance
45
Q

what is the test done to assess spinal cord function?

A

the ASIA exam is the current international standard utilized to identify neurologic level of spinal cord injury and to classify either complete or incomplete SCI

MSK Week 1 (11 decks)

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