SCI Flashcards
4 types of compression fractures
- tear drop, chip breaks off
- entire upper 1/2 of vertebrae crushed
- fx of both superior and inferior plates
- burst fx, crushes and destroys entire vertebral body
pathological changes after SCI (3)
- ischemia
- inflammation/ ion derrangement** causes the most damage
due to ion concentration shifts - apoptosis in oligodendrocytes (cells that make myelin)
flexion cervical injury (3)
- very unstable due to dislocation of posterior ligaments
- anterior dislocation of C-spine => shearing of cord
- likely complete
hyperextension injury
- most common C4-C5
- acceleration/decceleration injury
- can be elderly/ DJD
- cord involvement likely, not mandatory
flexion/rotation cervical injury
- most common C5-C6
- unilateral facet joint dislocation => narrowing of canal
- often non neuro involvement above C5 because vertebral foramen large enough
complete transection def
actual space between 2 segments of cord
complete lesions usually due to… (3)
- bilateral facet joint dislocation
- thoracolumbar flex/rotation injury (because so much force needed)
- transcanal projectile (GSW)
incomplete lesions due to… (3)
- unilateral facet jt dislocation
- cervical spondylosis (1 vertebra slips forward)
- projectile injuries w/o canal penetration
dorsal column medial leminiscal tracts where they cross what they are responsible for general location
fasiculus gracilis & cuneatus
cross in medulla
fine touch, 2 point descrimination, proprioception
posterior cord
anterolateral tracts where they cross what they are responsible for general location
tracts: anterior & lateral spinothalamic
cross immediately
gross touch, pain & temp
close together, anterior
motor pathways
tracts
general location & organization
lateral & medial corticospinal
lateral is more posterior & arranged with tracts CTLS (medial -> lateral)
so central cord syndrome leads to loss of UE > LE
cauda equina location/ what it is special thing to know syndrome: causes (5) symptoms (3) (compared to conus medularis syndrome)
nerve roots at L1-L2
junction of CNS &PNS so symptoms are PNS = LMN
syndrome is caused by:
- tumor
- trauma
- spinal stenosis
- bleeding
- inflammation
symptoms:
- gradual presentation
- asymmetrical saddle anasthesia
- asymmetrical flaccid paralysis
conus medullaris
location/ what it is
syndrome:
causes (3)
symptoms (3) (compared to cauda equina syndrome)
distal bulbous end of SC
causes of syndrome:
- damage from compression (most common)
- stenosis
- trauma
symptoms:
- bilateral
- sudden onset
- flaccid paralysis
quick and dirty ASIA motor assessment
C5-T1
C5- biceps C6- wrist extensors C7- elbow extensors C8- finger flexion T1- finger adduction (intrinsics)
quick and dirty ASIA motor assessment
L2-S1
L2- hip flexors L3- knee extensors L4- ankle DF L5- toe extensors S1- ankle PF
ASIA motor scoring
higest level possible
LEMS (2) and what they mean for potential ambulation
highest motor score is 100; 25 points/ extremity
LEMS 30 = likelihood of being a community ambulator
ASIA scoring if pt has contracture/ spasticity (3)
- if ROM is limited by less than 25-50% of range, grade throughout available range
- if limited >50% graded as NT
- if spasticity or clonus prohibits testing, graded as NT
ASIA sensory testing
scores (3)
complete vs. incomplete
0- absent or cannot reliably distinguish btwn sharp/dull
1- impaired (diminished sensation) but can reliably distinguish btwn sharp/dull
2- normal and reliable
if pt has 0 throughout, do deep anal sensation to test S4-5 to determine if complete or incomplete
