SCI Flashcards

1
Q

33 vertebrae, how many in each section

A

7 Cervical
12 Thoracic
5 Lumbar
5 Sacrum (fused)
4 Coccyx (fused)

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2
Q

31 pairs of spinal nerves, how many in each section

A

8 Cervical (C1-C8)
12 Thoracic (T1-T12)
5 Lumbar (L1-L5)
5 Sacral (S1-S5)
1 Coccygeal

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3
Q

what makes up the spinal cord

A

33 vertebrae
31 pairs of spinal nerves
conus medullaris
cauda equina

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4
Q

dorsal horn

A

sensory
ascending neurons

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5
Q

ventral horn

A

motor
synapses with peripheral nerve

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6
Q

lateral horn

A

ANS
specifically fight or flight

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7
Q

is there more white or gray matter as you move caudal to cranial

A

WHITE

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8
Q

is there more white or gray matter as you move cranial to caudal

A

GRAY

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9
Q

dorsal column– medial lemniscus

A

(Conscious) proprioception, vibration, light and discriminative touch
Second order neurons cross in caudal medulla in internal arcuate fibers

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10
Q

anterolateral pathways

A

Pain, temperature, crude touch
Second order neurons cross at level of spinal cord through anterior commissure

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11
Q

spinocerebellar pathways

A

Unconscious proprioception from trunk and limbs
Ascends ipsi and contralaterally
Terminates in ipsilateral cerebellum

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12
Q

lateral corticospinal tract
function and where it crosses

A

Function: Volitional movement of contralateral limbs
Cross at the pyramidal decussation and descend contralaterally

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13
Q

anterior corticospinal tract
function

A

Function: Control of bilateral axial and girdle muscles
Descend ipsilaterally until level of spinal cord, at which point splits into bilateral innervation

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14
Q

rubrospinal tract
originates, crosses, and function

A

Originates in Red Nucleus, crosses in midbrain, and descends contralaterally
Assists LCST with descending drive for movement of contralateral limbs (flexors)

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15
Q

vestibulospinal tracts
medial and lateral

A

Medial VST: Originates in rostral medulla, descending bilaterally to cervical region to coantrol positioning of head and neck
Lateral VST: Originates in pons, descends ipsilaterally down spinal cord to aide in truncal control and balance

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16
Q

reticulospinal tract
originates and function

A

Originates in both pontine and medullar RF and descends ipsilaterally
Aids in posture and gait-related movements

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17
Q

tectospinal tract
originates, crosses, and function

A

Originates in superior colliculus, crosses in midbrain and descends contralaterally to upper cervical cord
Assists with coordination of head and eye movements

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18
Q

sympathetic nervous system

A

Fight or Flight
Pupil dilation
Bronchodilation
Cardiac acceleration
Digestive Inhibition
Piloerection
Systemic vasoconstriction

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19
Q

parasympathetic nervous system

A

Rest and Digest
Pupil constriction
Bronchoconstriction
Cardiac deceleration
Digestion stimulation

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20
Q

traumatic SCI MOI

A

MVA, GSW, jumps and falls, diving

Flexion (likely from a car crash)
Flexion + rotation
Extension + rotation
Vertical compression (landing feet first or diving)
Penetration
Hyperextension (falls; more common in c-spine)

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21
Q

non-traumatic SCI MOI

A

Disc prolapse, vascular insult, infections
Often have a worse prognosis

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22
Q

traumatic cervical spine injury
most common at

A

C4 - C7 most frequently involved areas of injury
C5 and C7 most common

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23
Q

traumatic cervical spine injury
most common MOI and other

A

Flexion + rotation

Vertical loading
Extension + rotation
Lateral flexion
Hyperextension

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24
Q

traumatic thoracic injury
most common site

A

T12-L1 junction

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25
Q

traumatic thoracic injury
most common MOI

A

Flexion or vertical compression

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26
Q

why are you less likely to be injured from traumatic thoracic injuries

A

Rib cage and higher stability as compared to cervical region

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27
Q

traumatic lumbar SCI MOI

A

flexion

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28
Q

traumatic lumbar SCI
most common location

A

L1

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29
Q

tetraplegic

A

Injury to the cervical spinal cord (C1-C8)
Involvement of all 4 extremities and trunk

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30
Q

paraplegic

A

Injury to thoracic or lumbar regions of spinal cord (T1 down)
Involves BLEs and trunk (chest down)

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31
Q

complete SCI

A

Absence of sensory and motor function below lesion level
More severe presentation of SCI – worse prognosis
Can have Zones of Partial Presentation (ZPP)

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32
Q

zones of partial presentation

A

Dermatomes and myotomes caudal to the sensory and motor levels that remain partially innervated
Movement rarely has functional importance
ex: can randomly flex ankle (trickling of ascending/descending capabilities)

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33
Q

incomplete SCI

A

Involves partial preservation of sensory and motor functions below the lesion level
Better prognosis than complete SCI due to preserved axon function
Incomplete SCIs occur more frequently than complete

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34
Q

what determines the degree of SCI

A

ASIA exam

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35
Q

most common sites of SCI injury

A

Cervical (C5 and C7) and thoracolumbar junctures (T12-L1)

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36
Q

most frequent type of SCI

A

incomplete tetraplegia

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37
Q

primary goal of SCI management
any devices?

A

stabilize spine to prevent further damage
Surgery: Closed or open reduction; spinal canal decompression
External support devices
Halo Brace, CTLSO, TLSO, LSO

38
Q

methylprednisone
on complete vs incomplete SCI

A

Incomplete: Enhances return of some function below spinal level
Complete: increases chances of return of function of the last preserved spinal level

39
Q

what is the window of opportunity for methlyprednisone and what does it do

A

3-8 hours post injury

Stabilizes cell membranes
Decreases inflammation
Increases nerve impulse generation
Improves blood flow to damaged area

40
Q

sequelae of SCI

A

ischemia
edema
demyelination and necrosis of axons

41
Q

complications of SCI

A

spinal shock
autonomic dysreflexia
pressure ulcers
postural hypotension
pain
spasticity
contractures
hetertopic ossification
edema
DVT
osteoporosis and renal calculi
respiratory compromise
bladder and bowel dysfunction
sexual dysfunction

42
Q

spinal shock

A

Temporary phenomenon with injuries T6 (ANS) and above

43
Q

initial response to spinal shock

A

↑ ↑ BP → ↓ BP, HR, hypothermia, venous stasis

44
Q

when does spinal shock resolve and what returns first

A

Usually resolves within 24 hours to several days of the injury
1st thing to typically return: sacral/anal reflexes

45
Q

autonomic dysreflexia

A

Over-activity of the autonomic nervous system with damage to T6 or above

46
Q

autonomic dysreflexia cause

A

irritating stimulus introduced to body below level of spinal cord injury
Most common cause: FULL BLADDER

Other causes: full bowel, wounds/pressure sores, burns, ingrown toenails, kinked clothing/catheter, foreign object (rock) pressing against skin

47
Q

symptoms of autonomic dysreflexia

A

Pounding HA (due to ↑ ↑ BP), goosebumps, sweating above level of injury, BRADYcardia, skin blotching

48
Q

interventions for autonomic dysreflexia

A

If the patient is lying down, sit them up immediately
If already in sitting, remain in sitting (DO NOT LIE DOWN), perform pressure relief
Check catheter
Check clothing
Check skin
Initiate emergency response if not resolved within 10 min

49
Q

sequelae of autonomic dysrefelxia

A

Convulsions, LOC, death

50
Q

cause of impaired thermoregulation

A

Due to loss of sympathetic output
Damage to T6 or above

Body’s ability to control blood vessel responses that conserve or dissipate heat is lost
Ability to sweat & shiver are lost
At risk of hypothermia due to peripheral vasodilation.
Later at risk of hyperthermia due to lack of sweat gland control.

Higher level injuries → greater disturbances in temperature control

51
Q

s/sx of hyperthermia

A

skin feels hot and appears flushed, feeling weak, dizziness, HA, visual disturbances, nausea, tachycardia, weak or irregular HR

52
Q

s/sx of hypothermia

A

shivering, exhaustion/drowsiness, confusion, slurred speech,

53
Q

what level lesion is spasticity most common

A

cervical

54
Q

pulmonary dysfunction

A

“C3, C4, C5 – Keeps the patient alive” → diaphragm
Below T10 = normal ventilatory and respiratory function

55
Q

bladder dysfunction
above conus medullaris/sacral segments

A

Spastic/hypereflexic bladder
Voiding is involuntary and incomplete

56
Q

management of bladder dysfunction

A

External collection devices (catheter)
Intermittent catheterizations
Medication
Surgery
Suprapubic catheter
Bladder augmentation

57
Q

what is the the 2nd most common cause of autonomic dysreflexia

A

bowel dysfunction

58
Q

management of bowel dysfunction

A

Reflex Bowel Programs:
Digital Stim Programs
Bowel Suppositories

59
Q

significant health problems related to bowel management

A

Rectal prolapse, hemorrhoids, abdominal pain and bloating

60
Q

Level of SCI determines type of dysfunction
above vs below

A

Above S2: spastic/reflex bowel
Excrement is involuntary and incomplete

S2-S4: flaccid/areflexive bowel
Bowel overfills and over-distend

61
Q

Symptoms of Bladder and Bowel Dysfunction

A

Fever
Chills
Nausea
HA
Increased spasticity
Autonomic dysreflexia
Dark or bloody urine

62
Q

sexual dysfunction
males vs females

A

Males: directly related to level and completeness of injury
Erectile capacity spared with UMN lesions, but fertility can be impacted

Females: menstruation and fertility more likely to be spared
Pregnancy is often considered high risk if SCI present (likely need C-section)

63
Q

strategies for BP instability

A

TED stockings, abdominal binder*, ace wraps, monitoring fluid intake

64
Q

common cardiovascular dysfunction for T6 and up

A

persistent bradycardia, excessive peripheral vascular dilation

65
Q

neuropathic pain

A

Poorly localized c/o numbness, tingling, burning, shooting, and aching pain & visceral discomfort below level of injury
Can be exaggerated by noxious stimuli, UTI, spasticity, bowel impaction, & cigarette smoking

66
Q

orthopedic pain
common sites

A

shoulder overuse injuries, low back

67
Q

common causes of pain post-SCI

A

irritation & damage to neural elements, mechanical trauma, surgical interventions, poor handling & positioning

68
Q

management of osteoporosis and renal calculi

A

Preventative

Early mobilization
Therapeutic standing
Administration of calcium supplements
Good dietary management

69
Q

Decreased weight bearing may lead to

A

demineralization of bones
which can then lead to vertebral compression fractures and other fractures.

70
Q

causes of anterior cord syndrome

A

Damage to cord itself, damage to Anterior Spinal Artery, or both

Common cause: flexion injuries, burst fractures

71
Q

anterior cord syndrome= loss of motor function and _____

A

pain/temp below level of injury bilaterally

72
Q

what tract stays intact with anterior cord syndrome

A

medial lemniscus

73
Q

central cord syndrome results from

A

damage to central aspect of spinal cord
Almost exclusively a cervical injury

74
Q

central cord syndrome common occurs in the elderly due to ______
in youbger population due to ____

A

Typically, due to extension injury
Often results from relatively minor trauma, often without vertebral trauma

Younger population: flexion + compression
+vertebral trauma, herniated disc

75
Q

central cord syndrome extremity involvement

A

UE>LE

Sparing sacral sensation, may have sparing of sacral motor

76
Q

brown sequard syndrome
results from damage to
causes?

A

one side of cord
Hemi-section or incomplete injury

cause: knife wound or GSW

77
Q

brown sequard syndrome
results in

A

IPSILATERAL motor and dorsal column symptoms and CONTRALATERAL anterolateral pathway symptoms

Ipsilateral spasticity common below level of lesion

IPSI– BECAUSE TRACT HAS NOT CROSSED (not until brainstem)
CONTRA– BECAUSE ALS IMMEDIATELY CROSSES OVER in spinal cord (such as reduction in pain, temperature, crude touch)

78
Q

posterior cord syndrome results from

A

compression by disc or tumor, PSA infarct, or vitamin B12 deficiency

extremely rare

79
Q

posterior cord syndrome
what is lost and what is preserved

A

Dorsal column lost bilaterally below level of lesion
Motor and pain/temp preserved

80
Q

anterior cord prognosis

A

extremely poor for:
Bowel and bladder function
Hand function
Ambulation
10-20% chance of motor recovery

81
Q

central cord prognosis

A

Most people will regain some level of ambulatory function
This becomes more disproportionate with older patients (90% versus 41%)
>50% will recover bowel and bladder control
Intrinsic hand function last to return

82
Q

positive prognostic factors for central cord syndrome

A

Good hand function,
Evidence of early motor recovery
Young age
Absence of spasticity,
Pre-injury employment,
Absence of LE neurologic motor impairment at rehab admission

83
Q

Brown-Séquard Syndrome prognosis

A

generally very good
Nearly all patients will attain some level of ambulatory function
80% regain hand function
100% regain bladder control, 80% bowel control

84
Q

conus medullaris syndrome
damage to
cause?

A

Damage to sacral cord and lumbar nerve roots
Common cause: trauma, tumors, infections, stenosis

85
Q

conus medullaris syndrome
symptoms

A

Sudden onset of UMN and LMN symptoms

Symmetrical saddle anesthesia – more localized perianal
Symmetrical weakness/flaccidity
Can see hypertonicity
Distal LE (ankle) areflexia
May see intact sacral reflexes
Sexual dysfunction
Mild low back pain with potential mild radicular symptoms, more pain noted in perianal region
Bowel & bladder dysfunction: typically urinary retention and atonic anal sphincter

86
Q

conus medullaris syndrome tx

A

surgical decompression

87
Q

cauda equina syndrome
where does injury occur

A

below L1 to lumbosacral roots of peripheral nerves → LMN injury
Cord spared

88
Q

cauda equina syndrome causes

A

lumbar burst fx or herniated disc
Can be acute or chronic presentation
Damage to nerve roots is highly variable, incomplete lesions common

89
Q

cauda equina syndrome symptoms

A

(can be gradual onset or acute):
Common triad: Asymmetrical saddle anesthesia, bowel and/or bladder dysfunction, asymmetrical LE weakness
Variable sensory loss: partial vs complete loss
Flaccid paralysis, areflexia (including loss of sacral reflexes)
Flaccid paralysis of bowel and bladder
Severe low back pain, often with severe radicular pain

90
Q

cauda equina tx

A

surgical decompression

91
Q

cauda equina prognosis

A

PNS injury → potential for nerve regeneration!
However, regeneration often incomplete
Tends to plateau after 1 year

Prognosis:
Bladder outcomes worsen the longer the cauda equina is compressed
Prognosis improves when surgery occurs within 48 hours of initial presentation
Due to potential for regeneration, more favorable prognosis for functional recovery compared to UMN SCI Syndromes

92
Q

conus medullaris prognosis

A

Similar prognostic indicators, but since UMN involvement, prognosis less favorable than CES
10% regain function