MIDTERMS: SCI Flashcards
Epidemiology of SCI
Young men with a ratio of 4:1
Average age at injury is 30 years old
Traumatic SCI secondary to:
Vehicular accidents 37 %
Violence 28 %
Falls 21 %
Sports injuries 6 %
Anatomy: Spinal cord segments
Cervical 8, Thoracic 12, Lumbar 5, Sacral 5, Coccygeal 1
Injury: Cord hemisection
Characteristics:
Ipsilateral: Weakness, proprioceptive deficits
Contralateral: Loss of pain and thermal sensation caudal to 1-2 segments below the lesion
Brown-Sequard Syndrome
Blood supply: Anterior 2/3 of spinal cord
A) Posterior spinal arteries
B) Vertebral arteries
C) Anterior spinal arteries
D) Radicular arteries
C) Anterior spinal arteries
Blood supply: Posterior ⅓ of spinal cord
A) Posterior spinal arteries
B) Vertebral arteries
C) Anterior spinal arteries
D) Radicular arteries
A) Posterior spinal arteries
Spinal Tract: Proprioception and tactile discrimination
A) DCML
B) Spinothalamic
C) Spinocerebellar
D) Spinoreticular
A) DCML
Function of the spinal column: Anterior
A) Weight-bearing
B) Postural stability
C) Muscle attachments
D) Reflexes
A) Weight-bearing
Spinal Tract: Pain and temperature sensation
Spinothalamic
ASIA Impairment Scale: Complete, no motor or sensory function below S4-S5
A) A
B) B
C) C
D) D
E) E
A (Complete)
Spinal Tract: Proprioception to the cerebellum
Spinocerebellar
Injury: Hyperextension injuries with spondylosis
Characteristics: Weakness more severe in the arms, cruciate paralysis involving upper cervical spine
Central Cord Syndrome
ASIA Impairment Scale: Motor function is preserved below the neurological level with muscle grade > 3
A) A
B) B
C) C
D) D
E) E
D (Incomplete, muscle grade > 3)
Definition: Preservation or return of function of nerve roots near the level of the lesion
Potential: Recovery of some function
Root Escape
A Jefferson Fracture is a burst fracture involving the ___________ vertebra, typically caused by axial compression.
C1 (Atlas)
Injury: Flexion injury, anterior spinal artery damage
Characteristics: Pain sensation and motor weakness below injury level, preservation of proprioception, light touch, and deep pressure
Anterior Cord Syndrome
Injury: Damage to the conus medullaris
Characteristics: Bowel and bladder dysfunction, symmetrical sensory deficits in the saddle area, minor lower extremity deficit
Conus Medullaris Syndrome
Injury: LMN lesion, damage to the lumbosacral nerve roots
Characteristics: Asymmetrical deficits, areflexia, muscle atrophy, and atonia
Cauda Equina Syndrome
Common Locations: C5-C7, T12-L2
Injuries: Wedge fractures, burst fractures, teardrop fractures
Flexion
Common Locations: Fractures of posterior elements, avulsion fracture
Example: Hangman’s fracture from chin hitting the dashboard
Hyperextension
Injuries: Fractures of pedicles, articular facets, laminae
Example: Unstable if posterior longitudinal ligament (PLL) is affected
Flexion-Rotation
Injury: Horizontal force causing ligament disruption
Example: Fracture dislocations of thoracolumbar (TL) spine, Chance/lap belt fractures
Shearing
Injury: Least common mechanism
Cause: Whiplash, tensile force
Distraction
Injury: Fracture of C3-C7, axial compression
Stability: Stable, requires CT for evaluation
Burst Fracture
Injury: Burst fracture of atlas (C1), axial compression
Displacement: Lateral masses of C1 beyond the margins of C2
Jefferson Fracture
Injury: Anterior displacement of occipital condyles over C1
C1 - C2 Subluxation
Which of the following describes a Clay Shoveler’s Fracture?
A) Avulsion fracture of the spinous process (C6-T1)
B) Burst fracture of C1
C) Spondylolisthesis of C2
D) Flexion teardrop fracture of C3-C7
A) Avulsion fracture of the spinous process (C6-T1)
Injury: Bilateral C2 pars interarticularis fractures, hyperextension, and distraction
Stability: Unstable
Hangman’s Fracture
Type I: Tip of odontoid, rare, potentially unstable
Type II: Most common, base of odontoid, unstable
Type III: Base of odontoid into the body of axis, best prognosis
Odontoid Fractures
Name the fracture associated with hyperextension and distraction, commonly caused by hitting the dashboard during a motor vehicle accident.
Hangman’s Fracture
T or F
A Chance Fracture typically occurs due to flexion-distraction and is associated with high intra-abdominal injury risk.
True
Which of the following spinal cord syndromes is characterized by bowel and bladder dysfunction, with symmetrical sensory deficits in the saddle area?
A) Cauda Equina Syndrome
B) Anterior Cord Syndrome
C) Central Cord Syndrome
D) Conus Medullaris Syndrome
D) Conus Medullaris Syndrome
The most common mechanism of injury for a Burst Fracture is ___________.
Axial compression
Name the fracture that is characterized by a fracture of the odontoid process at its base and is the most common type of odontoid fracture.
Type II Odontoid Fracture
What mechanism of injury is most commonly associated with a Flexion Teardrop Fracture?
A) Hyperflexion and compression
B) Hyperextension
C) Distraction
D) Shearing
A) Hyperflexion and compression
In the ASIA Impairment Scale, Grade A represents _____________ injury, while Grade E represents _____________ motor and sensory function.
complete; normal
The Motor Index Score (MIS) in the ASIA classification has a maximum score of _____________.
100
The Beevor’s Sign indicates a lesion at which spinal level?
A) C2-C4
B) T10
C) L2
D) S4-S5
B) T10
Which type of spinal cord injury (SCI) syndrome results in ipsilateral weakness and proprioceptive deficits with contralateral pain and temperature loss?
A) Brown-Sequard Syndrome
B) Central Cord Syndrome
C) Anterior Cord Syndrome
D) Conus Medullaris Syndrome
A) Brown-Sequard Syndrome
T of F
A Clay Shoveler’s Fracture is a stable injury caused by hyperextension of the neck.
False (It is caused by hyperflexion)
Which of the following is NOT a descending spinal tract?
A) Corticospinal Tract
B) Rubrospinal Tract
C) Spinothalamic Tract
D) Vestibulospinal Tract
C) Spinothalamic Tract
T or F
The spinocerebellar tract conveys proprioceptive information to the ipsilateral cerebellum.
true
Which type of injury results from horizontal force causing ligament disruption and is often associated with fracture dislocations of the thoracolumbar spine?
Shearing injury
Which medication is not effective in penetrating SCI wounds?
A) Methylprednisolone
B) Gacyclidine
C) Naloxone
D) Neuro Ganglioside GM-1
A) Methylprednisolone
T or F
A Chance Fracture occurs primarily in the cervical spine.
FASLE (It occurs in the upper lumbar spine)
In a Burst Fracture, the empty vertebral body sign can be seen on a(n) _____________ radiograph.
AP (Anteroposterior)
What is the clinical significance of preserved pin-prick sensation in SCI prognosis?
Better prognosis for ambulation recovery compared to preserved light touch sensation.
True/False: Central Cord Syndrome has a better prognosis than Anterior Cord Syndrome.
True
The majority of Brown-Sequard patients ambulate within _______ months of injury.
6 months
What pharmacologic treatment is used for Venous Thromboembolism (VTE) in SCI patients?
Low Molecular Weight Heparin (e.g., Enoxaparin).
Name a common respiratory complication in patients with C1-C4 SCI.
Pneumonia
What is the recommended catheterization interval in an Intermittent Catheterization Program (ICP)?
4-6 hourss
What is the key treatment for autonomic dysreflexia (AD)?
Sit the patient upright, identify and remove the noxious stimulus, treat hypertension with rapid-onset, short-duration antihypertensives like nifedipine.
Name a common acute GI complication in SCI.
Ileus or fecal impaction.
Which scoring system is used to evaluate motor and sensory functions in SCI patients?
ASIA motor/sensory scale.
What are common associated fractures in SCI?
Chest, lower extremities (LE), upper extremities (UE), head, and pelvis.
Which type of SCI leads to mechanical ventilatory support being necessary for patients?
Injuries at C4 or higher.
What percentage of Brown-Sequard patients ambulate within 6 months post-injury?
90%.
What medication is used within 8 hours of SCI for neuroprotection and its associated risks?
Methylprednisolone (MP); risks include increased infections, sepsis, respiratory complications, and GI hemorrhage.
What is the first stage of spinal shock, and what are its features?
Stage 1 (0-24 hrs): Motor neuron hyperpolarization, hyporeflexia.
What type of spinal cord injury (SCI) has the best prognosis for recovery?
Central cord syndrome and Brown-Sequard syndrome.
