SCI Flashcards
Etiology of SCI
tramuatic- cutting of the cord
non traumatic- autoimmune destruction of the cord
non traumatic- vascular compromise of the cord
Incidence of SCI
15-30 yo male
MVA, Falls
Non traumatic SCI: Vascular malformation
aneurym, hemorrhaging, embolism, thrombosis, a-v malformation
Non traumatic SCI: Vertebral degeneration
OA, RA, Paget’s disease, kyphosis, kyphoscoliosis, stenosis, AA issue
Non traumatic SCI: Primary or Secondary neoplasm
multiple myeloma, metastasis from lung/breast
Non traumatic SCI: Infection
syphillis, myelitis, guillian-burree
Non traumatic SCI: Abscess
necrosis of tissue
Other Non traumatic SCI
spina bifida
radiation, ALS, mutliple sclerosis
Mechanism of SCI in general depends on
magnitude and direction of force
point of contact
head position
Mechanism of SCI for Cervical hyperflexion
falling and hitting back of head
MVA head hitting wheel
compression anteriorly, distraction posteriorly
most commonly affects C5-C6
Mechanism of SCI for Cervical axial loading
high speed vertical load to top of head burst fx fx segments may traverse posteriorly into cord disc rupture affects most commonly C4-C5
Mechanism of SCI for Cervical hyperextension
rear ended in MVA, chin hitting during fall
anterior structures disctracted, posterior structures compressed
C4-C5 most commonly affected
disc rupture
Mechanism of SCI for Cervical flexion with rotation
occurs with some degree of SB, stable situation
locking of facet joints
lamina/pedicle fx
Brown sequard/nerve root damage
Mechanism of SCI for Thoracic
T1-T10 with rib cage= more stable
T12-L1, MVA, Falls, GSW most commonly affected
Flexion- posterior elements distracted, wedge fracture
Vertical compression may = burst fx into SC
Extension with SB- uncommonly injured
Mechanism of SCI for Lumbar flexion
flexion injury due to lap belt without shoulder
distraction posteriorly in a horizontal oriented manner
thoracolumbar injury with internal injury
Mechanism of SCI for lumbar flexion with rotation
highly unstable
P-A force direction
posterior structures distracted with bony fx
Penetrating wounds
low velocity- ice pick, bullet, physical SC cutting
high velocity- rifle, explosion, concussive
Diagnosing SCI
C-spine: lateral x-rays = 85% accuracy, with open mouth and A-P x-rays= 100%
CT scan- examine the nervous impingement
Myelography- may be used in conjunction with CT
MRI- appropriate but may not be preferred acutely
Patho of SCI
concussive, contusion, laceration
ascending tract of sensory
descending tract, motor neurons, nerve roots
sexual, CV, respiratory, integumentary, multi system involvement
Functional classification of SCI
quadriplegia- all limbs and visceral involved
paraplegia- LE, trunk, and visceral involved
paresis- incomplete
plegia- complete lesion
Extent of injury classification of SCI
Complete- no motor or sensory below the neurological level of lesion
incomplete- some motor and sensory below the neurological level of lesion ie. anterior/posterior/central cord syndrome, brown sequard, sacral sparing, and cauda equina, zoneof injury
Level of injury classification of SCI
lowest level of neurological motor and sensory function intact
ie. C5 complete delt and bi motor intact, C5 delt and bi dermatomal intact
C5 incomplete some functional below delt and bi, sensation below level
American Spinal Injury Scale
A- complete lesion of motor and sensory
B- incomplete sensory lesion & no motor 3 neuro levels bellow
C- incomplete motor lesion & > half of the key muscle groups below are a MMT of < 3/5
D- incomplete motor lesion & at least half of the key muscle groups below are a MMT of > 3/5
E- normal motor and sensory
Emergency care of SCI assessment
assess MOI ABC assessment CPR as needed assess motor and sensory function assume SCI if unsure
Emergency care of SCI immobilization
immobilize in the position found OR a neutral positon
use of a Philadelphia collar for neck
use of a long or short back board
Emergency care of SCI Extrication/Transport
use of force to free them of difficult situation
move the person without jarring excessive movements
Acute care of SCI: reduction with traction
spinal traction
crutchfield or Gardner Well cervical instrumentation
Acute care of SCI: reduction with orthosis
HALO, SOMI, Philedelphia collar, TLSO body jacket
Acute care of SCI: reduction with surgery indications
fracture is not reduced fracture is unstable impinging on the spinal cord malaligned cord decreased neuro status
Acute care of SCI: reduciton with surgery method
vertebral bone graft
spinous/transverse process wiring
compression/distraction with rods/springs
Prognosis of SCI
if made it to ED = better prognosis
90% of SCI discharged home
highest mortality first 4wks
decreased life expectancy due to respiratory, infeciton, cardiac pathologies
Other medical managment/research
fetal cell transplant
RAGs role of axonal regeneration
growth factors
