Session 12 - Spinal Cord Injuries Flashcards
At which spinal levels do spinal injuries most commonly occur?
C6 or C7 (50%)
C2 (30%)
In children, C1-C2 more likely to be injured in view of having heavier heads with lax ligaments.
What are the mechanisms of spinal cord injury?
Hyperflexion (forward movement)
Hyperextension (backward movement)
Lateral stress (sideways movement)
Rotation (twisting of the head)
Compression (force along the axis of the spine downward from the head or upward from the pelvis)
Distraction (pulling apart of the vertebrae)
Give examples of flexion injuries.
Fractures - anterior wedge, flexion teardrop, Clay-shoveller’s
Dislocations - anterior subluxation, bilateral interfacet dislocation, antlanto-occipital dislocation, anterior Atlanta-axial dislocation)
Often leads to neurological injury
Give examples of extension injuries.
Fractures - hangman’s, teardrop
Dislocation - anterior atlanto-axial dislocation
What are the possible causes of complete cord transaction syndrome?
Trauma Infection Transverse myelitis Abscess Tumour
How will complete cord transaction syndrome present?
Loss of all sensory modalities bilaterally below the lesion
Complete paralysis below the lesion
Spinal shock and autonomic dysfunction occurs with higher lesions
Hypotension
Priapism
What is Brown-Sequard syndrome?
Complete hemisection of the cord.
Leading to unilateral compression/injury.
What are the possible causes of Brown-Sequard syndrome?
True complete hemisection is rare, but may be caused by:
- penetrating trauma
- fractured vertebrae
- tumour
- abscess
- multiple sclerosis
What are the clinical features of brown-Sequard syndrome?
Ipsilateral to side of injury:
- loss of motor function (corticospinal tract)
- loss of proprioception, vibration, fine touch and two point discrimination (dorsal column)
Contralateral to side of injury:
- loss of pain, temperature and crude touch sensation (spinothalamic tract)
What are the causes of anterior cord syndrome?
Often occur as a result of flexion injury
- leading to fractures or dislocations of vertebrae or herniated discs
Can also be due to injury to the anterior spinal artery
- vascular or atherosclerotic disease in the elderly
- iatrogenic secondary to cross-clamping of the aorta intraoperatively
What are the clinical features of anterior cord syndrome?
Flaccid paralysis below level of lesion (corticospinal tract)
Loss of pain/temperature/crude touch below lesion (spinothalamic)
Autonomic dysfunction (bowel, bladder, sexual function)
Preservation of modalities carried by the dorsal column.
What are the causes of central cord syndrome?
Trauma - hyperextension injury of cervical spine in elderly - hyperflexion injury of cervical spine in younger patients Disruption of blood flow to spinal cord Cervical spinal stenosis Degenerative spinal disease Syringomyelia Central canal ependymoma
What is syringomyelia?
Development of syrinx (cyst) in the central canal.
Unknown aetiology
What are the symptoms of syringomyelia?
Initial symptoms arise from the obliteration of spinothalamic fibres decussating in the white commissure. Loss of sensitivity to painful and thermal stimuli in a ‘cape-like’ distribution. Dorsal column pathways intact.
What are the clinical features of central cord syndrome?
More extensive motor weakness found in the upper extremities than lower extremities.
More extensive motor weakness found distally compared to proximally in the limbs.
Motor dysfunction more extensive than sensory dysfunction.
Bladder dysfunction and urinary retention.