MDT spinal cord injury and radiculopathy Flashcards
Injury to the spinal cord results in characteristic ______ . Related to the pattern of tracts that are present in spinal cord anatomy
neurologic symptoms.
Largest demographic for spinal chord injury
young male (drunk)
Most traumatic spinal cord injuries occur with injury to vertebral column which
leads to _______ of the spinal cord. Which can lead to _________ and ______
mechanical compression,
can lead to ischemia and inflammation
\_\_\_\_\_\_\_after injury there may be complete physiologic loss of all spinal cord function below level of injury (a) Flaccid paralysis (b) Anesthesia (c) Absent bowel or bladder control (d) Loss of reflex activity
Immediately
Delayed symptom onset can occur due to ________
spinal cord swelling
When dealing with a spinal chord injury what should you focus on first?
ABCS
you want to immobilize the C-spine with _______ ASAP
Cervical Collar
Insert a ______ if bladder paralysis is suspected
Foley catheter
Patient with high cervical injury may have poor respiratory function and may require
______ if necessary
intubation
Steroid use is ______, consult with _______ prior to administration
controversial
Medical Officer
Steroid use for spinal injuries can theoretically____________________
decrease swelling and inflammation after cord injury
What imaging would be your go to for a spine injury if you have the resources
CT
NEXUS Criteria for C-Spine XR
NSAID
1) N: Focal Neurological deficit
2) S: Midline Spinal tenderness
3) A: Altered mental status
4) I: Intoxicated
5) D: Distracting injuries
Lumbar disk herniation is usually due to ______ or ______ with the back in flexion, causing _______ of disk contents into the spinal cord area.
bending or heavy loading
herniation or extrusion
Disk herniations often occur from degenerative disk disease (desiccation of the annulus fibrosis) in patients between ____ and ___ years old.
30 and 50
The _____ disk is affected in 90% of cases.
L5-S1
Compression of neural structures, such as the sciatic nerve, causes ______
radicular pain
Severe compression of the spinal cord can cause the _____ , a surgical emergency.
cauda equina syndrome
Clinical Presentation of these suggest….
(a) Pain with back flexion or prolonged sitting
(b) shooting or radiating pain into the leg due to compression of neural structures
(c) Lower extremity numbness and weakness
(d) discogenic pain
(e) sciatica
Radiculopathy
_______ pain typically is localized in the low back at the level of the affected disk and is worse with activity.
Discogenic pain
_______ causes electric shock- like pain radiating down the posterior aspect of the leg often to below the knee.
sciatica
Level of herniation, Clinical presentation
-Pain, paresthesia(pins and needles) and sensory loss in the inguinal region
L1
Level of herniation, Clinical presentation
-Acute back pain that radiates around anterior aspect of thigh to knee and may have weakness of hip flexion, knee extension and hip adduction
L2, L3, L4
Level of herniation, Clinical presentation
-Most common radiculopathy; back pain radiating down lteral aspect of
the leg into the foot and decreased strength in foot dorsiflexion, toe extension,
foot inversion, foot eversion
L5
Level of herniation, Clinical presentation
-Pain radiating down posterior aspect of leg into the foot. Weakness in
plantar flexion due to gastrocnemius(calf muscle).
S1
What should be ruled out should be ruled out if the patient complains of perianal numbness or bowel or bladder incontinence.
The cauda equina syndrome
presence or worsening of radicular pain with straight leg maneuver
Lasegue’s sign
Straight leg testing
Lay patient supine and ____ patients extended leg on the _____ side with foot dorsiflexed
raise
symptomatic
Imaging
_________ are helpful to assess spinal alignment (scoliosis, lordosis), disk
space narrowing, and OA changes.
Plain radiographs
Imaging
_____ is the best method to assess the level and morphology of the herniation and is recommended if surgery is planned.
MRI
What is first line treatment for spine injury?
modified activities; NSAIDs and other analgesics
What type of med can also be used to help with acute symptomatic relief
Muscle relaxants
Cyclobenzaprine (Flexeril) 5mg PO Q8Hr and can increase dose to 7.5 – 10mg
Treatment
Reevaluation of the patient at about _____ weeks should occur
4-6
Treatment
If pain is persistent at reevaluation then ___________________________
further adjunctive treatments should be considered (physical therapy)
Treatment
If physical therapy is unsuccessful then ____________ or _____________ should be considered depending on severity of symptoms
consult to pain management or surgery
Spine injury red flags
Urinary or bowel disfunction
saddle anesthesia
loss of feeling in an extremity or loss of movement
