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Neuromuscular System Evaluation and Management > Lecture SCI - Mechanisms of Injury and Acute Management > Flashcards

Lecture SCI - Mechanisms of Injury and Acute Management Flashcards

1
Q

What are the 3 mechanisms of Injury for SCI

A

Compression

Shearing

Distraction

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2
Q

How could a compression injury happen

A

Can occur with a diving or football tackling injury

  • Axial blow to the skull
  • Often coupled with a flexion injury
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3
Q

What does a compression injury do to the bones

A

Leads to a concave (burst) fx of the bony end plate

-Bony fragments enter the cord and rupture intervertebral disc

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4
Q

How do compression fractures cause SC injuries

A

The bony fragments break off and travel into the spinal cord

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5
Q

What are shearing forces

A

They move side to side.

Occur when a horizontal force is applied to the spine relative to an adjacent segment, and flexion/extension is blocked

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6
Q

What part of the spine are more prone to damage from shearing force

A

Most common in the thoracic spine

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7
Q

What type of damage is the result of a shearing force

A

Results in ligamentous damage and often results in abnormal axonal transmission

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8
Q

Is distraction a common injury

A

not really, this is the least common type of SCI, it occurs with whiplash and that is a hyperextension injury.

hyperextension injuries are not common because of the spinous processes

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9
Q

What does distraction do to the axons

A

Can result in longitudinal axonal shearing

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10
Q

Is it important to reduce secondary cord damage

SCI

A

YES! Damage to the cord is rarely the result of the initial trauma, and is more commonly due to secondary effects of the injury

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11
Q

Name 5 types of secondary effects from a SCI

A

Ischemia – damaged spinal arteries & vasospasms

Inflammation

Physical disruption of axons - stretching of the axon

Hemorrhage or edema

Ion derangement – altered membrane permeability leads to abnormal concentrations of K+ & Na+ (and you would want to prevent the neuron cascade)

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12
Q

When there is traumatic injury to the SC this causes what type of responses in the body and what is this called

A

Spinal shock - happens when you have a traumatic injury to the spinal cord, the body responds by sending inflammation to that area.

That inflammation causes depression of a lot of he reflexes in that area and the loss of our sensory motor function below it (it kind of creates a wall so it can protect the area)

Now that this area is protected there will be ionic disruption, axon disruption, and flaccid paralysis (loss of all sensorimotor functions) below the level of injury

You also have vasodilation which leads to hypotension and bradycardia. This results in a decrease in CO.

You also have venous pooling because the muscle pump is not effective

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13
Q

What is spinal shock - definition

A

A state of transient physiological reflex depression of cord function below the level of injury with associated loss of all sensorimotor functions.

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14
Q

What are some signs and symptoms of spinal shock

A 
Flaccid paralysis
Areflexia
Vasodilatations 🡪 
Hypotension
Bradycardia
↓ in cardiac output
Venous pooling
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15
Q

How long does spinal shock last and what might this tell you about a patient’s prognosis

A

Can last for hours or for weeks - but the sooner it resolves the better the prognosis

typically resolves in 24 hours

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16
Q

What does spinal shock do to the cardiovascular system

A

It causes vasodilation which leads to hypotension and bradycardia. This results in a decrease in CO.

You also have venous pooling because the muscle pump is not effective

17
Q

How would you test for Spinal Shock

A

An early sign of resolution is the presence of the bulbocavernosus reflex

(+) reflex indicates the end of spinal shock, and may precede the presence of DTRs or spasticity for several weeks

If the reflex is (+) without later sensory or motor return, a complete lesion is indicated

18
Q

What is the bulbocavernosus reflex

A

During digital rectal exam, pressure is applied to the glans penis or the glans clitoris by pulling on the catheter tube
Contraction around the examining digit = (+) reflex

(+) reflex indicates the end of spinal shock, and may precede the presence of DTRs or spasticity for several weeks

If the reflex is (+) without later sensory or motor return, a complete lesion is indicated

-a positive reflex is a good sign

19
Q

What are the first 3 steps of Acute Management of SCI

A
  1. Pharmacologic management
  2. Surgical realignment and stabilization
  3. Prevention of secondary complications
20
Q

Pharmacologic management of SCI, What are the two main and there are 3 others

A

2 Main:

  • Methylprednisolone
  • GM1 Ganglioside

Others

  • Interleukin-10
  • Glutamate (AMPA) Receptor Blockers
  • 4-Aminopyridine
21
Q

What is the standard of care for SCI

A

Methylprednisolone

22
Q

Methylprednisolone is, does and when should it be administered

A

“Standard of care”

Anti-inflammatory steroid – prevents swelling & damage at injury site

↓ the secondary effects

Administered in high doses & must be given within 8 hours of the onset of injury

23
Q

What does GM1 Ganglioside do

A

Evidence suggests that it may augment nerve growth & induce regeneration & sprouting

LEs appeared to be more affected by the drug than the UEs

Recovery appeared to be primarily due to restoration of muscle function in initially paralyzed muscles as opposed to muscles gaining greater strength

24
Q

What does Interleukin-10 do

A

potent anti-inflammatory; unclear about correct amount/combo needed?

25
Q

What does Glutamate (AMPA) Receptor Blockers do

A

neurotransmitter; decreases cell from firing in excess.

Because of active role that glutamate plays in secondary effects

26
Q

What does 4-Aminopyridine do

A

improves function in surviving spinal cord nerve cells long after the injury.

(supports the existing cells in the spinal cord)

27
Q

Surgical management of SCI

A

Surgical stabilization

Decompression

28
Q

What is surgical stabilization in regards to SCI

A

Injured spinal column is stabilized to prevent further damage to the cord and/or nerve roots

29
Q

How does decompression help SCI

A

Decompression has been shown to ↑ neurologic recovery

Research has shown that recovery ↓’s with ↑’ing time of compression & with ↑ compressive forces

30
Q

When people to have surgery for a SCI (2 Types)

A
  • Traction: Gardner-Wells Tongs

- Internal Fixation

31
Q

Traction: Gardner-Wells Tongs is used for

A

Used acutely to provide traction

Inserted into the skull, with weights attached to provide traction

↓ dislocation and maintain alignment

32
Q

Surgical Management of SCI:

Internal Fixation is used for

A

(stabilizes the region)

Fusion of unstable joint(s) with hardware and/or bone autografts

Harrington rods are the most common for thoracic/lumbar injuries

Recent advances in transpedicular screws improve fixation
Pedicle is the strongest site posteriorly for fixation

33
Q

What are some types of non-surgical managements for a SCI (name 2)

A
  • Halo Traction

- Orthoses (worn for 6-12 weeks)

34
Q

What are some advantages to halo traction

A

Advantages

  • Early mobility
  • Avoidance or delay of surgery
35
Q

What are some disadvantages to halo traction

A

Disadvantage

  • Skin breakdown
  • Dysphagia
  • TMJ problems
  • Limited UE movement
36
Q

Ambulation: Realistic goals and setting expectations for AIS Grade A

A
  1. 7% negative predictive probability for independent ambulatory ability
  2. 1% of patients with a complete injury improved to incomplete by 5 years
37
Q

Ambulation: Realistic goals and setting expectations for AIS Grade B and C

A

inconsistent but postinjury somatosensory evoked potentials in the tibial nerve strongly related to ambulatory outcomes

38
Q

Ambulation: Realistic goals and setting expectations for AIS Grade D

A

97.3% positive predictive probability of regaining independent ambulation at 1 year

Neuromuscular System Evaluation and Management (21 decks)

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