SCI

Question 1

Etiology of SCI

Answer 1

tramuatic- cutting of the cord
non traumatic- autoimmune destruction of the cord
non traumatic- vascular compromise of the cord

Question 2

Incidence of SCI

Answer 2

15-30 yo male

MVA, Falls

Question 3

Non traumatic SCI: Vascular malformation

Answer 3

aneurym, hemorrhaging, embolism, thrombosis, a-v malformation

Question 4

Non traumatic SCI: Vertebral degeneration

Answer 4

OA, RA, Paget’s disease, kyphosis, kyphoscoliosis, stenosis, AA issue

Question 5

Non traumatic SCI: Primary or Secondary neoplasm

Answer 5

multiple myeloma, metastasis from lung/breast

Question 6

Non traumatic SCI: Infection

Answer 6

syphillis, myelitis, guillian-burree

Question 7

Non traumatic SCI: Abscess

Answer 7

necrosis of tissue

Question 8

Other Non traumatic SCI

Answer 8

spina bifida

radiation, ALS, mutliple sclerosis

Question 9

Mechanism of SCI in general depends on

Answer 9

magnitude and direction of force
point of contact
head position

Question 10

Mechanism of SCI for Cervical hyperflexion

Answer 10

falling and hitting back of head
MVA head hitting wheel
compression anteriorly, distraction posteriorly
most commonly affects C5-C6

Question 11

Mechanism of SCI for Cervical axial loading

Answer 11

high speed vertical load to top of head
burst fx
fx segments may traverse posteriorly into cord
disc rupture
affects most commonly C4-C5

Question 12

Mechanism of SCI for Cervical hyperextension

Answer 12

rear ended in MVA, chin hitting during fall
anterior structures disctracted, posterior structures compressed
C4-C5 most commonly affected
disc rupture

Question 13

Mechanism of SCI for Cervical flexion with rotation

Answer 13

occurs with some degree of SB, stable situation
locking of facet joints
lamina/pedicle fx
Brown sequard/nerve root damage

Question 14

Mechanism of SCI for Thoracic

Answer 14

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

Question 15

Mechanism of SCI for Lumbar flexion

Answer 15

flexion injury due to lap belt without shoulder
distraction posteriorly in a horizontal oriented manner
thoracolumbar injury with internal injury

Question 16

Mechanism of SCI for lumbar flexion with rotation

Answer 16

highly unstable
P-A force direction
posterior structures distracted with bony fx

Question 17

Penetrating wounds

Answer 17

low velocity- ice pick, bullet, physical SC cutting

high velocity- rifle, explosion, concussive

Question 18

Diagnosing SCI

Answer 18

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

Question 19

Patho of SCI

Answer 19

concussive, contusion, laceration

ascending tract of sensory
descending tract, motor neurons, nerve roots
sexual, CV, respiratory, integumentary, multi system involvement

Question 20

Functional classification of SCI

Answer 20

quadriplegia- all limbs and visceral involved

paraplegia- LE, trunk, and visceral involved

paresis- incomplete
plegia- complete lesion

Question 21

Extent of injury classification of SCI

Answer 21

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

Question 22

Level of injury classification of SCI

Answer 22

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

Question 23

American Spinal Injury Scale

Answer 23

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

Question 24

Emergency care of SCI assessment

Answer 24

assess MOI
ABC assessment
CPR as needed
assess motor and sensory function
assume SCI if unsure

Question 25

Emergency care of SCI immobilization

Answer 25

immobilize in the position found OR a neutral positon

use of a Philadelphia collar for neck
use of a long or short back board

Question 26

Emergency care of SCI Extrication/Transport

Answer 26

use of force to free them of difficult situation

move the person without jarring excessive movements

Question 27

Acute care of SCI: reduction with traction

Answer 27

spinal traction

crutchfield or Gardner Well cervical instrumentation

Question 28

Acute care of SCI: reduction with orthosis

Answer 28

HALO, SOMI, Philedelphia collar, TLSO body jacket

Question 29

Acute care of SCI: reduction with surgery indications

Answer 29

fracture is not reduced
fracture is unstable
impinging on the spinal cord
malaligned cord
decreased neuro status

Question 30

Acute care of SCI: reduciton with surgery method

Answer 30

vertebral bone graft
spinous/transverse process wiring
compression/distraction with rods/springs

Question 31

Prognosis of SCI

Answer 31

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

Question 32

Other medical managment/research

Answer 32

fetal cell transplant
RAGs role of axonal regeneration
growth factors