SC injuries

Question 1

SCIs

Answer 1

MVAs>falls>violence>unk>sports

Question 2

slide 4

Answer 2

know bolded

also slide 6 low right pic

Question 3

compression fx

Answer 3

vertebral body

Question 4

herniated disc..needs

Answer 4

laminectomy

Question 5

anterior vertebral column should be

Answer 5

nice and smooth

Question 6

complete SCI

Answer 6

The complete absence of sensory and motor function below the level of injury.
This includes loss of function to the level of the lowest sacral segment

Question 7

incomplete SCI

Answer 7

Sensory, motor, or both functions are partially present below the neurologic level of injury.

may consist only of sacral sensation at the anal mucocutaneous junction or voluntary contraction of the external anal sphincter upon digital examination

Anterior Cord Syn, Central Cord Syn, Brown-Sequard

Question 8

spinal shock

Answer 8

The temporary loss or depression of spinal reflex activity that occurs below a complete or incomplete spinal cord injury (unknown duration)

The lower the spinal cord injury, the more likely that all distal reflexes will be absent.

Loss of neurologic function that occurs with spinal shock can cause an incomplete spinal cord injury but mimics a complete cord injury.

Question 9

spinal shock 2

first reflex to return ?
duration ?

Answer 9

Therefore, cord lesions cannot be deemed complete until spinal shock has resolved.

The bulbocavernosus reflex is among the first to return as spinal shock resolves.
The duration of spinal shock is variable; it generally persists for days to weeks

Question 10

SC syndromes

Answer 10

Anterior Cord Syndrome-

Central Cord Syndrome

Brown-Sequard (Hemisection

Question 11

anterior cord syndrome from…

Answer 11

Corticospinal pathway
Spinothalamic pathway
Preservation of posterior column function

Question 12

anterior cord syndrome

Answer 12

It is characterized by

loss of motor function below the level of injury

loss of sensations carried by the anterior columns of the spinal cord (pain and temperature)

preservation of sensations carried by the posterior columns (fine touch and proprioception)

Question 13

anterior cord causes

Answer 13

Contusion of the cord or bony-injury
Flexion of cervical spine
Thrombosis of anterior spinal artery
Leads to ischemic injury
Extrinsic masses

Question 14

anterior cord px

Answer 14

Overall is poor
Functional recovery has been and is still very minimal

Anterior spinal artery syndrome is the most common form of spinal cord infarction

Question 15

central cord from damage to

Answer 15

Corticospinal pathway
Spinothalamic pathway
Preservation of posterior column function

Question 16

Central Cord Syndrome

Answer 16

Decreased: (not loss)
Motor function, pain and
to a lessor extent temperature 
sensation ; greater in upper than
lower extremities (more deficit in uppers)

Question 17

Central Cord Syndrome causes

Answer 17

Usually in older patients with pre-existing cervical spondylosis who sustain a hyperextension injury
Thrombosis of anterior spinal artery
Leads to ischemic injury
Extrinsic masses

Question 18

Central Cord Syndrome ps

Answer 18

Good for recovery of function
However, most do not recover fine motor use of the upper extremities

the most common form of cervical spinal cord injury*

Question 19

Brown-Sequard Syndrome

Answer 19

Results from hemisection of the spinal cord:

Patients will exhibit:
Ipsilateral loss of:
Motor function
Proprioception
Vibratory sensation

Contralateral loss of:
Pain and temperature sensation

Question 20

Brown-Sequard Syndrome causes

Answer 20

Most common cause is penetrating trauma (GSW)
Disk protrusion
Hematomas
Bone injury
Tumors

Question 21

Brown-Sequard Syndrome px

Answer 21

Best prognosis for recovery of all the incomplete cord syndromes

Question 22

radicular pain

Answer 22

Typically more local and follows a dermatome or myotome pattern
i.e. older person with neck pain, not nec. a SC problem directly, spasm when studying-peripheral issue

Question 23

Clinical Approach to Spinal Cord Trauma/Injury : First and foremost –

Answer 23

You must assume there is a spinal cord injury until proven otherwise

A-B-C’s are top priority but with assumption of cervical spine injury
(log roll-as a unit)

Question 24

Clinical Approach to Spinal Cord Trauma/Injury

Answer 24

good detailed hx
increase or decrease your suspicion for a spinal cord injury (SCI)??
reliable history?

Question 25

then focus neurological hx

Answer 25

Mechanism of injury
Loss of consciousness
Neurologic complaints

Question 26

neuro exam

Answer 26

Vital signs
Level of consciousness (AVPU)
Glasgow Coma Scale
Pupil evaluation
Cranial Nerves
Motor assessment
Sensory assessment
Reflexes

Question 27

C6 or higher

Answer 27

quadriplegic

Question 28

T6 or lower

Answer 28

paraplegic

in btw??

Question 29

once suspect injury, confirm w.

Answer 29

Plain Radiographs

CT scans-bony details, more radiation

MRIs

Question 30

Plain Radiographs

Answer 30

Advantages:
Quick and easy to get
Rapid turnaround on viewing/interpretation

Disadvantages:
Limited compared to other modalities
Patient disorders limit utility of studies

Question 31

CT

Answer 31

Advantages:
Give much more information than radiographs
More sensitive than plain films
Great for detecting blood

Disadvantages:
Patient must be stable enough to have study
Much more radiation than plain films
Usually require interpretation by radiologist
Cannot give any info on spinal cord
better for bony detail than soft tissue

Question 32

MRIs

Answer 32

Advantages:
Gives a lot of information about bones, cord, vasculature
More sensitive than CT scans
Great for detecting spinal cord injury, ischemia
No radiation

Disadvantages:
Patient must be stable enough to have study
Studies require a lot more time to complete
Requires interpretation by radiologist
Patients with metal cannot have study

Question 33

dx modality determined by History and Physical Exam

Answer 33

GCS, Mental status, Intoxicants?
Patient status (stable vs unstable)
Capabilities of facility (keep vs transfer)

Question 34

(after H&P) Diagnostic modality used will be determined by:

Answer 34

Balance need for information with Do No Harm!

If a patient disposition can be made with a plain film or no imaging than that is the route to go.