SCI Flashcards
relative and absolute stenosis
12 mm, 10 mm
anterior spinal artery provides blood to
anterior 2/3 of spinal cord, posterior spinal arteries arise from vertebral arteries and give to posterior 1/3.
artery of adamkiewicz
major blood supply to lumbar and sacral cord, T9-L3, major supply to the lower 2/3 of spinal cord
watershed area of spine
lower thoracic region, T4-6, clamping of aorta can affect this area
most common level of SCI
C5
Most common level of jumped facets
C5-6, surgery
Jefferson fx
C1 bust fx, usually stable fx, usually no SCI, fragmentation of all 4 bone areas, cervical bracing Halo
C2 fracture, odontoid fx, MOA of the fx and then the types of fx and their tx
Rapid decelration injury of neck, Type II most unstable req surgery, Type I tip of the dens, stable, type 3 base fx extending into C2 vert itself, Type 2 is fx at BASE of odontoid req surg
C2 fracture, odontoid fx, hangman fracture, MOA of the fx and then the types of fx and their tx
Rapid decelration injury of neck, Type II most unstable req surgery, Type I tip of the dens, stable, type 3 base fx extending into C2 vert itself, Type 2 is fx at BASE of odontoid req surg and is most common type of the three
Chance fx
extends from spinour process all the way through the bones and into the VB , due to trauma/falls
Chance fx “seatbelt fracture”
Thoraco lumbar fx usually T12, L1, L2; extends from spinous process all the way through the bones and into the VB , due to trauma/falls…..avoid flexionHighest
Particularly in the pediatric population, intra-abdominal injuries occur 50% of the time. (Chance fractures are associated with motor vehicle collisions. Intra-abdominal injuries are associated with lap belt use).
lateral CS tract
arms/legs
central cord pattern of weakness
UE>LE, distal > proximal weakness…cervical is center most, as we proceed more lateral its thoracic and lumbar and finally sacral…so first to return is lower ext function, then bladder function, then proximal uppper ext and distal upper ext.
Pudendal nerve
S2-4, voluntary contraction of external urethral sphincter (storage
Parasympathetic nerve, pelvic nerve
S2-3, parasymp, pee pelvic, activate Muscarinic ACh receptors in bladder wall which cause detrusor contraction (emptying (using ACh)
Hypogastric nerve
T11-L2, sympathetic, makes your bladder big as hippo, activates alpha 1 and beta 2 receptors to allow bladder storage (Norepinephrine) , alpha 1 in internal urethral sphincter causes contraction (storage), B2 in bladder wall causes relaxation of detrusor (storage)
cp,,pm area fpr fx in SCI osteoporotic patient
distal femur , usually no surgery just splint and let heal with ROM and WB after several weeks
Common area fpr fx in SCI osteoporotic patient
distal femur , usually no surgery just splint and let heal with ROM and WB after several weeks
anterior cord syndrome
impaired pinprick/temperature sensation, strength, coordination
anterior cord syndrome
impaired pinprick/temperature sensation, strength, coordination…light touch is preserved as well as proprioception and vibratory sense..often associated with flexion injuries and vascular insufficiency from occlusion of anterior spinal artery
fist and second most common causes of SCI
Motor vehicle accidents remain the most common cause of SCI. Falls are the next most common cause.
fist and second most common causes of SCI
Motor vehicle accidents remain the most common cause of SCI. Falls are the next most common cause. FOllowed by Violence/GSW and fourth leading cause is sports related
Highest level of SCI for ind bowel care
Tetraplegics at the C7 level can potentially be independent with all components of bowel care with the use of bathroom equipment
what happens to skin collagen below level of injury in SCI
Decreased type I collagen and increased type III collagen below the level of injury
Studies have shown there is a decrease in amino acid content in the activity of enzymes of collagen synthesis, and in the proportion of type 1 to type 3 collagen fibers. These changes may lead to diminished tensile strength of the skin, increased risk of mechanical injury, and impaired healing of pressure ulcers in the spinal cord injured population.
anticoag ppx in complicated vs uncomplicated complete SCI
8 weeks uncomplicated, 12 weeks complicated (lower limb fractures, a history of thrombosis, cancer, heart failure, obesity or age over 70). Patients with AIS C SCI should receive chemoprohylaxis for up to 8 weeks, and those with ASI D injuries should receive chemoprohylaxis while remaining in the hospital.
C6 tetra dressing abilities
mod I upper ext dressing , some assist to total assist for lower ext dressing
HO onset
1-4 months
Positions for MMT upper ext and hip flexors
At C7 shoulder is neutral rotation, abducted and in 90 degrees of forward flexion with elbow in 45 degrees of flexion. L2: hip is flexed to 90 degrees. C5: elbow flexed at 90 degrees, arm at the patient’s side and forearm supinated. C6: wrist is full extension.
Halo, four poster brace, SOMI and philidelphia collar in order of. restriction of movement
Halo, 4 poster brace, SOMI, Phili collar
Halo, four poster brace, SOMI and philidelphia collar, minerva, in order of. restriction of movement
Halo is most restrictive of all and is non removable;; in terms of removable Minerva most restrictive followed by 4 poster brace, SOMI, Phili collar
Autonomic dysreflexia systolic and diastolic BP changes
autonomic dysreflexia, which is defined as an increase of 40 mmHg systolic or 20 mmHg diastolic blood pressures.
Autonomic dysreflexia (AD) occurs in spinal cord injury (SCI) levels at or above T6, above the innervation for the major splanchnic outflow. It causes relative hypertension as a result of vasoconstriction due to relatively unopposed sympathetic outflow, associated with the release of norepinephrine, dopamine, and dopamine beta-hydroxylase. Systolic blood pressure elevations of 20-40 mmHg above the baseline may be a sign of AD. The body’s initial compensatory mechanism is to increase parasympathetic stimulation to the heart via the vagus nerve, which may cause bradycardia. The secondary compensatory reflex is an increase in sympathetic inhibitory outflow from the vasomotor centers above the SCI, resulting in flushing and vasodilatation above the level of injury.
Bilateral pars interarticularis fx of C2 (axis)
hangmans fx
SMA tx (obstruction in distal duodenum)
Treatment includes sitting the patient in upright or positioning them in left side-lying after meals, nourishment to restore weight, and applying a lumbosacral corset to push the abdominal contents upward. Surgery is rarely indicated.
Factors predictive of better prognosis in MS
Factors predictive of better prognosis in multiple sclerosis include female sex, younger age at onset, > 5 years between attacks, < 2 relapses in the first 5 years, and initial attack of optic neuritis, and complete recovery after the first attack.
Chronic SCI cause of death
1) PNA 2) Heart disease 3)sepsis
Watershed area of spine
The cervical segments of the spinal cord are supplied by branches of the vertebral and ascending cervical arteries. Because of the dual source of blood supply, these segments are usually less vulnerable to ischemia. The upper thoracic segments depend on radicular branches from the intercostal arteries. The midthoracic region is particularly vulnerable to ischemia, as its vascular supply is in the watershed region between the primary rostral inflow from the vertebral arteries and the caudal supply from the artery of Adamkiewicz.
areas t1-4 and t12-L2 are vulnerable to infarct due to blood supply anatomy
Level for independence at WC level
The C7 level is considered the key level for becoming independent in most activities at a wheelchair level. Persons with a C7 motor level who are in good health are usually independent for weight shifts, transfers between level surfaces, feeding, and upper body dressing. Some assistance may be required for wheelchair propulsion on uneven terrain. Bathing and grooming can be performed independently with the appropriate adaptive equipment.
flexion injury causes
facet joint disloc (c spine) and burst/compression fx Jefferson fx, c5-6 most common
extension injury
C4-5 most common
Most common cause of myelopathy and myelopathy presentation
c spine spondylosis…stiffness and then hypermobility in adjacent segments…gait disturbance, UE parasthesias, decr fine motor, arm/hand weakness…CS tract involved ffirst with resultant leg weakness, followed by posterior column involvement with ataxic wide based gait!!
Transverse myselitis
inflammation of SC, thoracic spine usually, leg parasthesias usually first, pain at involved cord segments, MRI shows hyperintense T2 signal intramedullary, CSF lymphocytic pleocytosis and protein elevation, but can be normal..1/3 get better, 1/3 dont, and 1/3 get better but with deficits. TM can be presenting sx of MS…incomplete lesions higher progression to convert to MS
NMO/Devic’s disease
Mostly female, affects optic nerves and SC, causing a combo of optic neuritis and transverse myelitis..IV glucocorticoids, plasmapheresis, IVIG, long term immunosuppression rituximab, mycophenylate, mofetil, azathioprine
Potts disease at
thoracolumbar junction
Subacute combined degeneration
degeneration of posterior and lateral columns of SC, mostly at C and T levels..B12 deficiency, Vit E and copper def…Vit b12 def from malabsorption, lack of Intrinsic factor or inhibition of attachment of intrinstic factor, gastritis….Nitrous oxide administration enhances the oxidation of B12 and makes it ineffective. Vit E def from CF or Bassen Kornzweig deficiency….CBC shows megaloblastic anemia, decr B23, elevated MMA and HC levels . Tx B12 injetion 1,000 mcg daily x1 week, 1,000 mcg weekly 1 month, then monthly injections
Because serum methylmalonic acid level is as sensitive as, but more specific than, serum homocysteine level for vitamin B12 deficiency, it is the confirmatory test of choice.
Radiation myelopathy
whitematter more affected with axon loss and demyelination….develops months or years after tx 9-15months.
Intradural SC tumors
usually primary tumors, divided into extramedullary and intramedullary
Intramedullary: arise from the cord, glial tumors such as astrocytoma, ependymoma (astrocytes in peds and ependymomas in adults), mostly involve C spine
Metastatic tumors to the spine
start extradural and secondarily compromise the spinal cord…more common than primary neoplasm of SC
Intradural extramedullary spinal cord tumor
schwannomas and neurofibromas both from nerve sheath cells, or arachnoid cap cells AKA meningiomas.
Extradural SC tumor
spinal mets and primary bony tumors, usually involve T spine then L spine…Lung breast and prostate as well as lymphoma metastasize to the spine
Most common primary malignant tumor of spine
MM and plasmacytoma, AA , F>M, followed by hemangiomas and osteoid osteomas
Non traumatic SCI
lower incidence of secondary complications such as spasticity, orthostasis, DVT, pressure injuries, AD, wound infections…shorter rehab stays but FIM scores are comparable to traumatic SCI, favorable dc to home if incomplete injury and ok bowel/bladder, intact skin, male, cog intact.
Highest level of complete SCI that can live ind without the help of an attendant
C6 complete tetra…extremely motivated; C7 is usual level for achieving independence
Mod I for driving independently
C5 tetra
Mod I for bowel/bladder
C6
fully ind in manuel WC
C6….C5 is mod I in power and Mod I on level surfaces
Mod I upper ext dressing/Lower ext dressing
C6, lower ext is C7
Feeding Mod I
C6, c5 requires set up
Orthostatic hypotension midodrine MOA, mineralocorticoid
alpha 1 adrenergic agonist, 2.5 to 10 mg TID, 0.05 to 0.1 mg daily increasing sodium reabsorption by the kidney, thus increasing cardiac output and standing blood pressure
Orthostatic hypotension midodrine MOA, mineralocorticoid
alpha 1 adrenergic agonist, 2.5 to 10 mg TID, 0.05 to 0.1 mg daily increasing sodium reabsorption by the kidney, thus increasing cardiac output and standing blood pressure
Meds approved for AD
nitropaste, clonidine 0.3 to 0.4, procardia 10 mg chew, hydralazine, labetolol
Spinal shock
spinal shock” whereby hypotension, bradycardia, and hypothermia occur.
The hypotension occurs as a result of systemic loss of vascular resistance, accumulation of blood within the venous system, reduced venous return to the heart, and decreased cardiac output. Over the course of time, the sympathetic reflex activity returns, with normalization of blood pressure.
Non key muscle groups in asia exam used to distinguish between which two levels?
y definition in the AIS grading, non-key muscle groups were added in 2012 to distinguish between AIS B and C.
ZPP
The ZPP refers to the most caudal dermatomes and myotomes below the sensory and motor levels that remain partially innervated.
If DAP present, you CANNOT record sensory level ZPP (in complte injury)…it’s N/A
If VAC not present you can record …vise versa so look if there is a a muscle grade of 1 at L2, then ZPP on that specific side is L2
Vena cava placement in what type of patient
Vena cava placement is indicated in those who have failed prophylaxis, have a contraindication to anticoagulation, or have high cervical cord injury lesions with poor cardiopulmonary reserve
Braden scale for pressure injuries
Measures the risk of pressure injury. It measures six components: activity, mobility, sensory perception, nutrition, friction and shear, and moisture. Each component carries a minimum of 1 point and maximum of 4 points except for friction and shear which carry a minimum of 1 point and maximum of 3 points. The greater the level of impairment (decreased sensation, activity, mobility, or nutrition, and the increased moisture and level of friction and shear forces), the lower the score in each category. The overall grading is from 6 to 23 points, with a
**score of 18 or less indicating increased risk, as stratified below:
19 to 23: no risk 15 to 18: mild risk 13 to 14: moderate risk 10 to 12: high risk 9 or less: very high risk
most common level of SCI
C5 (incomplete tetra), for para the most common level is T12
bladder receptors
Beta located on body and neck, so NE causes relaxation for filling… alpha 1 adrenergic receptors respond to NE by contracted, hwoever sine they are located at the base of the bladder, contraction helps prevent leading so help swith storage….when bladder is ready to empty Ach binds to M receptors located throughout the bladder and causes contraction , B2 at the neck cause relaxation there to aid in emptying.
Why avoid etidronate in peds?
rickets (vit D deficiency)… so do ROM and stretching for HO.
anterior vs lateral corticospinal tracts
The lateral corticospinal tract controls voluntary motor activity in the distal muscles (fine motor movements of the hands).
The anterior corticospinal tract controls voluntary motor activity in the proximal muscles.
most common fx in sci
supracondylar femur fx
intubation should be considered when FVC is
<1L
When the FVC is greater than 15-20 cc/kg, a patient may be ready to be removed from the ventilator. Others also say when the FVC is >1L.
