Lecture SCI - Intro and Syndromes Flashcards
SCI goal for PT
Empower
Enable
Inspire
What is a complete injury
Sensory and motor are lost below the level of injury
What is an incomplete injury
So many different things can happen depending on the level and extent of the injury and how many tracks are affected.
This leads to how the patent presents
How do spinal cord injuries occur and what is the most common cause
Traumatic - 50%
other 50% is from non-traumatic
-myelopathies
(Disc herniation, spondylosis, neoplasms)
-circulatory compromise (CVA in SC)
-transverse myelitis (inflammation of the SC)
What are the most common risks of mortality for SCI (5)
- Respiratory
- Cardiac –> deconditioning
- Sepsis –> could have injuries that they are unaware of
- PE –> DVT
- Suicide –> from their condition
What level of SCI would you be totally ventilatory dependent
C3
What would people with a C4 to T1 injury have difficulty doing
Coughing –> aspiration
Have trouble with deep breathing because of intercostal muscles
What is a tetra or quadriplegic and what level
Uppers and lowers affected
T1? would have problems with hands
What is a paraplegic and what level
uppers are spared and lowers are affected
T6 and below
Where are the most vulnerable SC sites on injury
C5-6 (most common level of tetraplegia)
T4-7
T12-L1 (most common level of paraplegia)
What is a complete lesion
Spinal reflex function is present below the level of the lesion, but no ascending or descending influences are present
Is due to complete transection, compression or vascular impairment of the cord
What is a incomplete lesion
Some amount of sensory and/or motor function; includes the lowest sacral segments S4-5 sensory and motor innervation to the anus (sacral sparing)
Can be due to contusion, swelling in the spinal canal, or partial transection of the cord
Name 6 incomplete spinal cord syndromes
Anterior cord Central cord Posterior cord Brown-sequard (hemi cord) Conus Medullaris Cauda Equina
What is the most common incomplete syndrome
Anterior cord syndrome
How does anterior cord syndrome usually happen
Usually due to hyperflexion injury
Head-on collision in MVA
Blow to the back of the head
Common associated fx
Wedge fx of ant. vertebral body
Fx of posterior elements (SP, laminae and pedicles)
How would someone with anterior cord syndrome present
Loss of voluntary motor function
Damage to corticospinal
Loss of pain and temperature sensation
Damage to spinothalamic
Sparing of LT, proprioception & kinesthesia
Dorsal column is generally intact
What is spared with anterior cord syndrome
Dorsal column
- Proprioception
- Kinesthesia
- light touch
What tracts are affected with a Anterior cord syndrome
Damage to the corticospinal tract and the spinothalamic tract
Corticospinal Tract
-Voluntary muscle function
Spinothalamic Tract
-Pain and temp
How does Central Cord Syndrome
usually happen and what region is commonly affected
Common with hyperextension injuries to the C/S
Associated with congenital or degenerative narrowing of the vertebral canal
Seen often in the elderly 2o spinal stenosis
Occurs most commonly in the cervical region
Frequently caused by
Rear-end MVA
Elderly fallers when the chin contacts a stationary object
Are hyperextension injuries common
No, bc of spinal processes
What does the central cord syndrome result in
Results in edema and/or bleeding into the central gray matter
Results in loss of UE function with relative sparing of LE function
AKA “Walking Quad”
How is ambulation affected?
↑ risk of falls & subsequent injuries
Do people with central cord syndrome have problems with ADLs
Yes, uppers more affected than lowers
and
they have difficulty utilizing assistive devices
Why does central cord syndrome affect uppers more than lowers
Because of the location of the tracts
If you have a posterior cord syndrome what is most affected
Damage to dorsal column
Loss of somatosensation below the level of injury, often results in a wide based gait and distal signs of ataxia
Fine touch, Proprioception, kinesthesia
If you have a posterior cord syndrome what is least affected
Motor spared
How would someone with posterior cord syndrome present
Risk of falls
Might walk wide base of support - looks like ataxia
Etiology of posterior cord syndrome and what type of disease can cause this
compression or compromise of the posterior spinal artery, tumors, disease
long term consequence of Tabes Dorsalis (from advanced syphilis)
What is Tabes Dorsalis
demyelination of the spinal tracts of the dorsal column due to advanced syphilis
Brown-Sequard Syndrome aka
Hemi-cord Syndrome
- half the SC affected
What are possible causes of brown-sequard syndrome
Often caused by a penetrating wound to the cord – GSW or stabbing
What is the prognosis for Brown-Sequard Syndrome
Prognosis is generally good for regaining ambulation, hand and B&B function
What 3 primary tracts are we concerned about with Brown-Sequard Syndrome
Dorsal column
Corticospinal tract
Spinothalamic tract
With Brown-Sequard Syndrome what would be the ipsilateral damage and which tracts
Lateral corticospinal tract & dorsal column
Ipsilateral motor function & position sense (proprioception), 2-point discrimination, fine touch, stereognosis below the level of the lesion
With Brown-Sequard Syndrome what would be the contralateral damage and which tracts
Lateral spinothalamic tract, which ascends ipsilaterally for a few segments before crossing
Contralateral pain and temperature sensation beginning a few levels below the lesion
What is stereognosis
The mental perception of depth or three-dimensionality by the senses, usually in reference to the ability to perceive the form of solid objects by touch.
Is the conus medullaris an UMN or LMN injury
Both! It is considered a transition area so you might see a blend of UMN and LMN impairments
Possible impairments from conus medullaris syndrome
Erectile dysfn
Possibly areflexic bowel/bladder
Variable sensory loss
Anesthesia in sacral dermatomes
Possible spasticity in sacrally innervated ms – hams, toe flexors, plantarflexors
Possible diminished reflexes if lumbar n. roots affected
occurs with CE syndrome
What is the conus medullaris and where is it
Transition between CNS and PNS it is around L1/2
Causes of Conus Medullaris Syndrome
Central disc herniations, lumbar/sacral burst fractures
Is Conus Medullaris Syndrome bilateral or ipsilateral and what other syndrome would be present
Likely to be bilateral involvement & occurs w/ CE syndrome
What is Cauda Equina Syndrome
and at what level
Below level of L1
Considered a LMN injury
Cauda Equina Syndrome dysfunctions
Flaccid paralysis, absent spinal reflexes, lack of automatic bowel & bladder (areflexic) function
Sacral reflexes (anal wink) may or may not be present
Are LMN injuries good or bad for recovery
better compared to the SC because of the possibility for regeneration
The PNS nerves are surrounded by a neural tube
Regeneration of PNS nerves are limited by
Distance between the lesion & the point of innervation
Axonal regeneration may not occur along the original nerve distribution
May be blocked by collagen scarring (if you have a scar in between it is hard for the nerves to regenerate )
End organ may no longer be functioning once regeneration is complete
Rate of regeneration slows & stops after 1 year
