SCI Flashcards
SCI
SPINAL CORD INJURY:
A lesion or injury of the spinal cord due to bleeding, strain, bruising or total disruption of the spinal cord resulting in partial or complete loss of motor and/or sensory function below the site of the injury.
Causes
Direct injury to the spinal cord (e.g. stab wound to the spinal cord)
Indirect (e.g. fracture dislocations)
• Traumatic causes > non-traumatic
– 50% of traumatic cases are through road traffic accidents
– 26% industrial accidents
– 10% sporting accidents
– 10% accidents at home
– Other causes include falls from a height and tu
Primary traumatic Causes
o 84% of all cases o 25% of the cases = dislocations • Motor vehicle accidents • Pedestrian-vehicle Accidents • Motorbike accidents • Quadbike accidents • Violence/ Assault - Gunshots - Stab injuries • Diving accidents Falls • Agricultural accidents
Secondary traumatic causes
Usually occurs over days or weeks because of • bleeding, • swelling, • inflammation and • fluid accumulation in and around SC
Fragile SC
Lower cervical region (C5 – C7)
o Mid thoracic region (T4 – T7)
o Thoracolumbar junction (T10 – L2).
Non traumatic causes
Non-traumatic causes
• TB spine
• Inflammatory (e.g. poliomyelitis, GBS)
• Neoplasia (benign or malignant)
• Degenerative diseases (e.g. disc prolapse, spinal stenosis)
• Developmental (e.g. Spina Bifida, Scoliosis)
• Demyelinating diseases (e.g. Multiple Sclerosis)
• Infection
• Vascular accidents especially with involvement of the
anterior vertebral artery
• Cysts (e.g. Syringomyelia)
gray matter.
Tetraplegia
Refers to impairment (or loss of) motor and/or sensory function in the cervical segments of the spinal cord due to damage of neural elements within the spinal canal.
• Results in impairment of upper limbs (ULs), trunk and lower limbs (LLs).
NB
It does NOT include brachial plexus injuries or injuries to peripheral nerves outside the neura
Paraplegia
Refers to impairment (or loss of) motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord, due to damage of the neural elements within the spinal cord.
Results in the preservation of UL function, but depending on the level of injury, the trunk and LL’s may be impaired.
Note: This includes cauda equina and conus medullaris injuries, but not lumbo-sacral plexus injuries or injuries to
Haematomyelia
Acute haemorrhage into the central grey matter – is followed by loss of function below level of lesion
• As oedema subsides and the bleed is absorbed -
function returns in the posterior and lateral columns
white columns.
• Patient has segmental flaccid paralysis and muscle
atrophy.
• Gradual increase of spastic paralysis with segmental loss of pain and temperature sensation.
• Preservation of pain and temperature sensation and posterior column function above and below level of bleed
Asia class
ASIA A = Complete: No motor or sensory function is preserved in the sacral segments S4-S5.
• ASIA B = Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.
Asia class cont
ASIA C = Incomplete: Motor function is preserved below the neurological level and the majority of key muscles below the neurological level have a muscle grade of less than 3.
- ASIA D = Incomplete: Motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade greater than or equal to 3.
- ASIA E = Normal: Motor and sensory function are norma
Anterior cord syndrome
Damage of the front two- thirds of spinal cord (& preservation of the posterior columns) -results from compression of anterior spinal artery. • Often caused by: – flexion injuries where anterior segment is directly injured. – Retropulsed disc or bone fragments
• Damages the Corticospinal and Spinothalamic tracts.
SYMPTOMS
Variablelossofmotor function (muscle power), pain & temperature sensation below the lesion.
• Proprioception, light touch and deep pressure is preserved.
Prognosis
• Poorprognosisfor recovery of LL function &
Central cord
Usually due to unbelted MVA’s and falls from the elderly
Common in elderly with pre-existing spondylosis/stenosis
Occurs almost exclusively in the cervical region
(due to hyperextension with simultaneous compression of the spinal cord)
Main symptoms • Motor loss UL’s (including hands)>LL’s • Sensory loss varies, but more severe in the UL • Flaccid paralysis (LMN) of the arms • Relatively strong but spastic (UMN) leg function • Sacral sensation and bowel and bladder function partially spared. Prognosis • Favourable for ambulation and ADLs • Recovery occurs first in legs, then bladder, then UL extremity before intrinsic had fx
Posterior cord
Incidence rate <1%)
• Commonly seen in hyperextension injuries.
• Causes contusion in the
posterior columns.
• Motor function, pain and temperature less affected
• Walking is difficult due to:
– Profound sensory and proprioception loss
– Difficulty with coordination
Brown sequard syndrome
Hemisection of the spinal cord
Mostly due to penetrating (stab) injuries or GSW
– (Due to interruption of posterior column)
• Ipsilateral: Hemiplegia
– loss of vibration
– loss of form perception
– loss of two point discrimination
– loss of proprioception/position sense
– Motor loss below the lesion
• Contralateral: Hemianaesthesia / hemianalgesia
(Due to interruption of the spinothalamic tract)
– Loss of pain, temperature sensation
and light touch below the lesion
