SC injuries Flashcards
SCIs
MVAs>falls>violence>unk>sports
slide 4
know bolded
also slide 6 low right pic
compression fx
vertebral body
herniated disc..needs
laminectomy
anterior vertebral column should be
nice and smooth
complete SCI
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
incomplete SCI
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
spinal shock
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.
spinal shock 2
first reflex to return ?
duration ?
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
SC syndromes
Anterior Cord Syndrome-
Central Cord Syndrome
Brown-Sequard (Hemisection
anterior cord syndrome from…
Corticospinal pathway
Spinothalamic pathway
Preservation of posterior column function
anterior cord syndrome
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)
anterior cord causes
Contusion of the cord or bony-injury Flexion of cervical spine Thrombosis of anterior spinal artery Leads to ischemic injury Extrinsic masses
anterior cord px
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
central cord from damage to
Corticospinal pathway
Spinothalamic pathway
Preservation of posterior column function
Central Cord Syndrome
Decreased: (not loss) Motor function, pain and to a lessor extent temperature sensation ; greater in upper than lower extremities (more deficit in uppers)
Central Cord Syndrome causes
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
Central Cord Syndrome ps
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*
Brown-Sequard Syndrome
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
Brown-Sequard Syndrome causes
Most common cause is penetrating trauma (GSW) Disk protrusion Hematomas Bone injury Tumors
Brown-Sequard Syndrome px
Best prognosis for recovery of all the incomplete cord syndromes
radicular pain
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
Clinical Approach to Spinal Cord Trauma/Injury : First and foremost –
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)
Clinical Approach to Spinal Cord Trauma/Injury
good detailed hx
increase or decrease your suspicion for a spinal cord injury (SCI)??
reliable history?
then focus neurological hx
Mechanism of injury
Loss of consciousness
Neurologic complaints
neuro exam
Vital signs Level of consciousness (AVPU) Glasgow Coma Scale Pupil evaluation Cranial Nerves Motor assessment Sensory assessment Reflexes
C6 or higher
quadriplegic
T6 or lower
paraplegic
in btw??
once suspect injury, confirm w.
Plain Radiographs
CT scans-bony details, more radiation
MRIs
Plain Radiographs
Advantages:
Quick and easy to get
Rapid turnaround on viewing/interpretation
Disadvantages:
Limited compared to other modalities
Patient disorders limit utility of studies
CT
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
MRIs
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
dx modality determined by History and Physical Exam
GCS, Mental status, Intoxicants?
Patient status (stable vs unstable)
Capabilities of facility (keep vs transfer)
(after H&P) Diagnostic modality used will be determined by:
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.
