Session 13: Pathophysiology and Management of Spinal Cord Injuries Flashcards
What are the causes of spinal injuries?
- Most often caused by physical trauma such as cars, contact sports, assault, falls and alcohol
- Male 4X more likely to have injuries of spinal cord
Which parts of the spine are more likely to be injured?
- 10-20% of head injury have a concurrent C-spine injury. Approximately 30% have other spinal injuries. Neurological deficit seen in roughly 30%
- Half occur at C6 or C7 whilst 30% at C2
- In children C1-C2 more likely to be injured due to having heavier heads with lax ligaments
What is the mechanism of injury in spinal cord injuries?
Hyperflexion - forward movement of head
Hyperextension – backward movement of head
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)
What are some flexion injures?
Fractures – anterior wedge, flexion teardrop, Clay-Shoveller’s
Dislocations – anterior subluxation, bilateral interfacet dislocation, antlanto-occipital dislocation, anterior atlanto-axial dislocation)
Injuries often lead to neurological impairment
What are some extension injuries?
Fracture – Hangman’s, Teardrop
Dislocation – anterior atlanto-axial dislocation
What are some causes of Complete Cord Transection Syndrome?
- Trauma
- Infarction
- Transverse myelitis
- Abscess
- Tumour
What are clinical features of Complete Cord Transection Syndrome?
- Spinal shock and autonomic dysfunction with higher lesions
- Hypotension due to sudden loss of sympathetic input. Increase parasympathetic so vasodilation and venous pooling
- Priapism (Prolonged sustained erection) due to increased parasympathetic results in increased blood flow to the penile tissue
- Complete loss of sensation below the lesion
- Complete paralysis below the lesion
What are causes of Brown-Sequard Syndrome?
- True hemisection rare
- Penetrating trauma
- Fractured vertebrae
- Tumour
- Abscess
- Multiple sclerosis
What are clinical features of Brown-Sequard Syndrome?
Ipsilateral Side injury
- Loss of motor function (corticospinal tract)
- Loss of conscious proprioception, vibration and touch sensations (dorsal column)
Contralateral side of injury
-Loss of pain and temperature sensation (spinothalmic tract)
What are 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 clinical features of anterior cord syndrome?
- Flaccid paralysis below the level of lesion as it affects the corticospinal tract. Loss of motor functions below the lesion. (At the level flaccid paralysis remain after initial. Below the lesion UPM sign after the initial symptoms as spinal shock syndrome ends)
- Loss of pain/temperature sensation below the lesion due to loss of the spinothalamic
- Autonomic dysfunction so bowel, bladder and sexual dysfunction
- Preservation of modalities carried by dorsal columns so vibration, conscious proprioception and 2-point discrimination
What are 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 the spinal cord
- Cervical spinal stenosis
- Degenerative spinal disease (Ligamentum flavum compresses the cord as the spine degenerates. This causes contusion of the central portion of the spinal cord)
- Syringomyelia
- Central canal ependymoma
What is a Syringomyelia?
- Development of cyst in or within the central canal. Grow in a 3D plane so upward and down wards as well as side to side.
- Initial symptoms arise from obliteration of spinothalamic fibres decussating in the ventral white commissure
- Loss of sensitivity to pain and temperature first. Cape like distribution. Affect the upper limb before lower limb
- Sensitivity to light touch and proprioception is preserved (dorsal column and medial lemniscus pathway)
What is a central cord ependymoma?
Tumours arising form the ependymal tissue in the CNS. Formation and growth lead to central cord syndrome
What are the clinical features of central cord syndrome?
- Motor loss if greater than sensory loss
- Upper extremity is more affected than lower extremity
- Distal issues are more pronounced than proximal issues
- Bladder dysfunction and urinary retention
