Medical Dx, Acute Mgmt, and Stabilization

Question 1

Pathophysiology

Answer 1

SCI level determined by cause of injury and age

Non-traumatic- often in thoracic area, result in incomplete injury

Vertebral dysplasias- upper cervical

Birth trauma- CT junction

8-10 y/o- cervical spine has greater mobility d/t lig laxity, shallow facets, incomplete ossification, and underdevelopment of neck mm for size of head (i.e upper cervical injury more common in children vs adults

SCIWORA- SCI without radiographic abnormality– no signs of bone damage, 6-38% of SCI

55% tetraplegia, 45% paraplegia

Question 2

Emergent Stabilization (in the field)

Answer 2

stabilize spine to prevent further damage
immobilization during transport and throughout all assessments and procedures
use spine board appropriate to pediatric pt
D/t increased head to torso ration in children- must modify board with occipital cutout, elevation of torso to allow for neutral spinal alignment—normal board may result in increased cervical flexion = increased injury

Question 3

Diagnostic Studies

Answer 3

Neuro exam- determines motor and sensory level of SCI and completeness of injury
Spinal shock usually present

X-rays performed to identify any fractures/dislocations/subluxations, completed on entire spine– obtain AP and lateral views

CT and MRI- dx root impingement, cord compression, bone fragments in spinal canal, and hemorrhage

D/t high incidence of SCIWORA in children– MRI is indicated in all children (SCIWORA specifically common in children less than 10 y/o)

Question 4

Surgical Stabilization

Answer 4

Main goal = prevent later deformity, pain , or loss of neuro function

Surgery may not be needed if can achieve alignment with traction and orthosis

Halo traction preferred and safer than tonged cervical traction– if Halo cannot be applied may need to use CTLSO or external halo orthoses

Surgery indicated if there is a penetrating injury, if traction has failed to reduce dislocation, if nerve root impingement exists, if the spine is highly unstable, or if bone fragments are compressing cauda equina

Use of orthosis following surgery

Question 5

Central Cord Syndrome

Answer 5

Hemorrhage in central part of cervical SC = flaccid weakness in arms and strong but spastic legs, preserved BB control

Ambulation is potential goal for this pop, but hand function may be impaired depending on level of injury

Question 6

Anterior Cord Syndrome

Answer 6

Incomplete SCI d/t damage of anterior spinal artery causing infarction to SC

Variable motor paralysis, reduced sensation of pn and temp with preserved dorsal column function

Poor prognosis for return to function

Question 7

Posterior Cord Lesion

Answer 7

Rare
Produce selective loss of proprioception with preserved motor function
Ambulation unlikely due to loss of proprioception

Question 8

Brown-Sequard Lesion

Answer 8

ipsilateral paralysis and proprioceptive loss
contralateral loss of pn and temp

Cause: penetrating trauma to one side of SC, stab wound

Prognosis Good for ambulation and BB control

Question 9

Cauda Equina

Answer 9

injury at lumbosacral roots
le weakness and areflexia of legs and bladder

lesion of peripheral nerve or LMN–> may show recovery over several years d/t resolution of neurapraxia

Question 10

Spinal Shock

Answer 10

mm are flaccid below SCI and all cutaneous and DTR are absent

State persists for hours to weeks

Over when sacral reflexes (bulbocavernous and anal reflexes) are present

Question 11

Underlying Injuries and Comorbidities

Answer 11

TBI commonly associated with SCI ~38% of cases

Injury to brachial plexus- should be considered if MOI included any type of traction to shoulder or impingement/fracture of clavicle in presence of asymmetrical weakness in ues