L17: Spinal Cord Injury

Question 1

Answer 1

Question 2

_____________________=> loss of control of anal sphincter/urethral sphincter control

Answer 2

Loss of function for sacral segments 2,3,4 (Complete Cord Injury)=> loss of control of anal sphincter/urethral sphincter control

Question 3

Most common incomplete spinal cord injury?

Answer 3

Central Cord Syndrome

Question 4

Incomplete spinal cord injury with the worst prognosis?

Answer 4

Anterior Cord Syndrome

Question 5

Incomplete spinal cord injury with the best prognosis?

Answer 5

Brown-Sequard Syndrome

Question 6

Central Cord Syndrome

• _______ injury
• _______ prognosis
• _______ gait
• _______ limbs affected more than _______ limbs

Answer 6

Central Cord Syndrome

• extension injury
• fair prognosis
• spastic gait (Must have extended to lumbar)
• upper limbs affected more than lower limbs (cervical impacted first)

Question 7

Anterior Cord Syndrome:

• complete ____________________________ (______________ and ____________)
• ____________________ spared (______________ and ____________)
• fair prognosis if ________________________________

Answer 7

Anterior Cord Syndrome:

• complete motor paralysis and sensory anaesthesia (pain and coarse touch)
• dorsal columns spared (fine touch and vibration)
• fair prognosis if recovery is evident and progressive in first 24 hours

Question 8

Significance of Denis Three Column Theory?

Answer 8

Unstable when 2 or more contiguous columns are affected (Anterior, Middle, Posterior)

Three column system has been superceded by AOSpine Trauma Classification System that is radiologically based

Question 9

AOSpine Spine Trauma Classification System Types?

Answer 9

Compression: Type A

Distraction: Type B

Displacement: Type C

Question 10

What clinically clears cervical spine fractures without imaging?

Answer 10

Canadian C-Spine Rule

National Emergency X-Radiography Utilization Group (NEXUS) Criteria for C-Spine Imaging

Check S2,3,4 by checking if external anal sphincter still functioning (Rectal Exam)

Question 11

Check for L1/2 Lumbosacral Reflexes?

Input/Output?

Answer 11

Cremaster Reflex

Input: Ilioinguinal
Output: Genitofemoral

Question 12

Check for L2-4 Lumbosacral Reflexes?

Input/Output?

Answer 12

Knee Reflex

Input: Femoral Nerve
Output: Femoral Nerve

Question 13

Check for L5-S2 Lumbosacral Reflexes?

Input/Output?

Answer 13

Ankle Reflex

Input: Tibial Nerve
Output: Tibial Nerve

Question 14

Check for S2-S4 Lumbosacral Reflexes?

Input/Output?

Answer 14

Bulbocavernosus Reflex

Input: Pudendal Nerve
Output: Pudendal Nerve

Question 15

Characteristics of Spinal Shock?

First reflex to return when spinal shock ending?

Answer 15

Spinal Shock: Flaccid paralysis and areflexia

Bulbocavernosus Reflex => Anal Wink

Question 16

Characteristics of Neurogenic Shock?

Answer 16

hypotension, bradycardia, distributive shock, potential hypothermia

Sympathetic preganglionic neurones (Ach) => Recover because they have intrinsic pacemaker activity

Question 17

• Spinal cord injury with COMPLETE Impairment
• No sensory or motor function in sacral segments (S2-S5)
• Loss of external anal sphincter tone
• Perineal anaesthesia

Answer 17

ASIA Impairment A (Worst Situation)

Question 18

• Spinal cord injury with INCOMPLETE Impairment
• Sensory function in sacral segments (S2-S5)
• Sensory function below the lesion is preserved
• Loss of all motor function below lesion

Answer 18

ASIA Impairment B

Question 19

• Spinal cord injury with INCOMPLETE Impairment
• Motor function below the lesion is present
• More than half of muscles have strength grade < 3

Answer 19

ASIA Impairment C

Question 20

• Spinal cord injury with INCOMPLETE Impairment
• Motor function below the lesion is present
• At least half of muscles have strength ≥ grade 3

Answer 20

ASIA Impairment D

Question 21

Surgical attempt to deal w/ pressure/edema in vertebral column?

Answer 21

Duroplasty