SCI Flashcards
What age group do SCI’s occur in most frequently? What is average age of SCI?
16-to-30 year olds; average age is 43 yoa
Most common level of SCI? Most common level for paraplegia? Most common type of injury?
C5;
T12;
incomplete tetraplegia, followed by incomp para, comp para, comp tetra
What type of marriage survives better with SCI, post-injury or pre-injury?
Post-injury
Most likely causes of death for someone with SCI?
- Respiratory disorders (pneumonia most common)
- Heart disease
- Septicemia
- Cancer
What vessel provides major blood supply to lumbar and sacral cord?
Artery of Adamkiewicz
Describe the 4 types of C-spine flexion/hyperextension injuries and common levels
- Flexion/axial loading (Burst/compression fx): C5
- Flexion/rotation injury (Unilateral facet): C5-6
- Flexion (Bilateral facet): C5-6
- Hyperextension (central cord): C4-5
Causes of non-traumatic SCI
Spinal stenosis, transverse myelitis, NMO, epidural abscess, radiation myelopathy, sub-acute combined degen, spinal cord tumors
NMO: What does it affect in CNS? M or F predominance? Lesions are more ______ on MRI compared to MS. Treatment?
Optic nerves and spinal cord;
F;
longitudinal (more than 3 spinal segments);
IV glucocorticoids, plasmapharesis
Extradural tumors are largely comprised of
spinal metastases and primary bone tumors
Inpatient rehab lengths of stay are ______ for persons with NT injury 2/2 tumors vs. traumatic SCI
shorter
List cervical orthoses from least to most restrictive
- Soft collar
- Head cervical orthosis (Philadelphia, Aspen, Miami J)
- SOMI brace
- Four poster
- Minerva
Halo most restrictive and not removable
When are you likely to see complete lesions vs. incomplete lesions?
Complete:
- B/l cervical facet dislocations
- Thoracolumbar flexion-rotation injuries
- Trans-canal gunshot wounds
Incomplete:
- Cervical spondylosis (falls)
- Unilateral facet joint dislocations
- Non-penetrating gunshot/stab injuries
Treatment for C1 and C2 fractures typically?
Halo vest if stable; surgery if unstable
Most common type of odontoid fx?
Type 2 (through base of odontoid); type 1 is through tip of dens, type 3 goes into C2 body
What does zone of partial preservation mean?
Refers to dermatomes and myotomes caudal to neurological level of injury remaining partially innervated for historically complete injuries
Define spinal shock
temporary loss or depression of all spinal reflex activity below level of lesion;
see loss of motor function and sensation accompanied by atonic paralysis of bladder and bowel
What does a low cauda equina lesion cause with regards to B/B?
Areflexic bowel and bladder
Highest complete SCI level when one can live independently without aid of attendant is what? What’s the usual level for achieving independence?
C6;
C7
Pathophys of autonomic dysreflexia?
Brainstem unable to send messages through injured spinal cord to decrease symp outflow and allow vasodilation of splanchnic bed to decrease BP
What innervates internal and external urethral sphincters?
T11-L2 hypogastric nerve (sympathetic);
S2-4 pudendal nerve (somatic efferent)
What bladder receptors respond to sympathetic efferents?
Alpha-1 and beta-2
LMN bladder is failure to _______, while UMN bladder is failure to _________
empty; store;
LMN bladder with increased tension at internal sphincter;
UMN with no suppression of sacral micturition center
What is physiology behind detrusor sphincter dyssynergia?
Neuro injury b/w sacral (S2-4) and pontine micturition centers causes lack of coordinated regulation of bladder function
Poor semen quality 2/2
- Stasis of prostatic fluid
- Testicular hyperthermia
- Recurrent UTI’s
- Abnormal testicular histology
- Changes in hypothalamic-pituitary-testicular axis
- Possible sperm Ab’s
- type of bladder management
- Long-term use of various meds
Decreased libido after SCI likely due to combo of
psychological and physical changes after injury, including change in self-image and altered sensation in genital region
What may be the only clinical manifestation of labor?
AD
What happens to likelihood of pregnancy after SCI?
Unchanged, as fertility is unimpaired
What is treatment of choice for AD in pregnant patient?
Epidural anesthesia extending to T10
With UMN lesion from SCI, what happens with GI system?
Lose symp and parasymp input at transverse and descending colon, with decreased fecal movement
What are two different reflexes that help with bowel program for SCI patients?
Gastrocolic and rectocolic reflex; latter can be manipulated by digital stimulation of rectum
What occurs with SMA syndrome? What can cause it?
Third portion of duodenum compressed by overlying SMA resulting in GI obstruction;
rapid weight loss, supine, spinal orthosis like Halo, flaccid abdo wall
When does hypercalcemia manifest usually for SCI? How to manage?
4-8 weeks post-SCI;
may need IV fluids with NS
How to manage fx in patients with chronic SCI?
Non-op with soft padded splints;
distal femur and prox tibia most common
Most freq respiratory complications in SCI?
Pneumonia, atelectasis, ventilatory failure
What is leading cause of death among chronic SCI patients?
Pneumonia
What lung pattern do tetraplegics develop?
Restrictive (all volumes except residual volume decrease)
When to mechanically ventilate?
VC < 1 L
ABG with increasing PCO2 or decreasing PO2 levels;
PO2 less than 50 or PCO2 greater than 50
Severe atelectasis
When can HO manifest in SCI? Which joint is most common?
1-3 months after injury;
Hip
Gold standard to diagnose DVT? What complication of DVT is leading cause of death in acute SCI?
LE venogram;
PE
Gold standard to diagnose pulmonary embolism
Pulmonary arteriogram
What are 2 uses of e-stim for SCI?
- Exercise to avoid complications of muscle inactivity
- Producing extremity motion for functional activities (FES can be used to provide a cardiovascular conditioning program)
For pain in SCI patient, what is most commonly affected joint?
Shoulder; tendonitis/bursitis; rotator cuff tear sub-acromial bursitis capsulitis
Why is carpal tunnel prevalent in SCI population?
Stress from transfers, WC propulsion, and pressure relief
For post-traumatic syringomyelia, most common presenting symptom? Earliest sign? How to diagnose?
Pain;
ascending loss of DTR’s;
MRI with gadolinium is gold standard
What psychological co-morbidity can co-exist with SCI?
Depression;
suicide rate is higher among SCI patients, and is leading cause of death in youngest age groups
Most common location of pressure ulcer injuries
Sacrum, ischium, heels, trochanter;
occiput in kids
Most important risk factors for developing pressure injuries
pressure and shear forces