Spinal Cord Flashcards
introduction to spinal injury
-Annually 15,000 permanent spinal cord injuries
-Commonly men 16-30 years old
-Mechanism of Injury
– Vehicle crashes: 48%
– Falls: 21%
– Penetrating trauma: 15%
– Sports injury: 14%
-Lifelong care for spinal cord injury victim exceeds $1 million.
-Best form of care is public safety and prevention programs.
vertebral column
-33 bones comprise the spine.
-Function:
– Skeletal support structure
– Major portion of axial skeleton
– Protective container for spinal cord
-Vertebral Body:
– Major weight-bearing component
– Anterior to other vertebrae components
components of vertebrae
- spinal canal
- pedicles
- laminae
- transverse process
- spinous process
- intervertebral disk
size of vertebrae
-C-1 and C-2:
-No vertebral body
-Support head
-Allow for turning of head
-Vertebral body size increases the more inferior they
become.
-Lumbar spine strongest and largest-> Bear weight of the body
-Sacral and coccyx vertebrae are fused -> No vertebral body
spinal canal
Opening in the vertebrae that the spinal cord passes through
pedicles
Thick, bony structures that connect the vertebral body to the
spinous and transverse processes
laminae
Posterior bones of vertebrae that make up foramen
transverse process
- Bilateral projections from vertebrae
- Muscle attachment and articulation location with ribs
compo
spinous process
Posterior prominence on vertebrae
intervertebral disk
- Cartilaginous pad between vertebrae
- Serves as shock absorber
Vertebral Ligaments: Anterior Longitudinal
- Anterior surface of vertebral bodies
- Provides major stability of the spinal column
- Resists hyperextension
vertebral ligaments: Posterior Longitudinal
- Posterior surface of vertebral bodies in spinal canal
* Prevents hyperflexion
cervical spine
-7 vertebrae
-Sole support for head
-Head weighs 16–22 pounds
-C-1 (Atlas)
• Supports head
• Securely affixed to the occiput
• Permits nodding
-C-2 (Axis)
• Odontoid process (dens) -> Projects upward and Provides pivot point so head can rotate
-C-7
• Prominent spinous process (vertebra prominens)
thoracic spine
-12 vertebrae
-1st rib articulates with T-1
-Attaches to transverse process and vertebral body
-Next nine ribs attach to the inferior and superior portion of
adjacent vertebral bodies
-Limits rib movement and provides increased rigidity
-Larger and stronger than cervical spine
-Larger muscles help to ensure that the body stays erect
-Supports movement of the thoracic cage during respirations
lumbar spine
– 5 vertebrae
– Bear forces of bending and lifting above the pelvis
– Largest and thickest vertebral bodies and
intervertebral disks
sacral spine
- 5 fused vertebrae
– Form posterior plate of pelvis
– Help protect urinary and reproductive organs
– Attach pelvis and lower extremities to axial
skeleton
coccygeal spine
-3–5 fused vertebrae
– Residual elements of a tail
layers of spinal meninges
– Dura mater
– Arachnoid
– Pia mater
-Cover entire spinal cord and peripheral nerve roots
that exit
-Cerebrospinal fluid bathes spinal cord by filling the
subarachnoid space
–CSF Exchange of nutrients and waste products
–CSF Absorbs shocks of sudden movement
spinal cord function
-Transmits sensory input from body to the brain
-Conducts motor impulses from brain to muscles and
organs
-Reflex center- Intercepts sensory signals and initiates a reflex signal
growth of spinal cord
-Fetus- Entire cord fills entire spinal foramen
-Adult- Base of brain to L-1 or L-2 level
-adult Peripheral nerve roots pulled into spinal foramen at the distal end
(cauda equina)
axons
-Transmit signals upward to the brain and down to the
body
-Ascending tracts
– Axons that transmit signals to the brain
– Sensory tracts
-Descending tracts
– Axons that transmit signals to the body
– Motor tracts
» Voluntary and fine muscle movement
dermatomes
-Topographical region of the body surface innervated by one nerve root -Key locations • Collar region: C-3 • Little finger: C-7 • Nipple line: T-4 • Umbilicus: T-10 • Small toe: S-1
myotomes
-Muscle and tissue of the body innervated by spinal nerve roots -Key myotomes • Arm extension: C-5 • Elbow extension: C-7 • Small finger abduction: T-1 • Knee extension: L-3 • Ankle flexion: S-1
reflex pathways
-Function • Speed body’s response to stressors • Reduce seriousness of injury • Body stabilization -Occur in special neurons • Interneurons • Examples: -Touch hot stove. -Severe pain sends intense impulse to brain. -strong signal triggers interneuron in the spinal cord to direct a signal to the flexor muscle. -Limb withdraws without waiting for a signal from the brain.
ANS: Parasympathetic, “Feed and Breed”
• Controls rest and regeneration • Peripheral nerve roots from the sacral and cranial nerves • Major Functions -Slows heart rate -Increases digestive system activity -Plays a role in sexual stimulation
ANS: Sympathetic, “Fight or Flight”
• Increases metabolic rate
• Branches from nerves in the thoracic and lumbar regions
• Major Functions
– Decreases organ and digestive system activity
» Vasoconstriction
– Release of epinephrine and norepinephrine
– Systemic vascular resistance
» Reduces venous blood volume
» Increases peripheral vascular resistance
– Increases heart rate
– Increases cardiac output
mechanism of spinal injury
- extremes of motion
- hyperextension- head flings backward
- hyperflexion- kiss the chest
- excessive rotation
- lateral bleeding
axial stress
-Axial loading
-Compression common between T-12 and L-2
• Distraction
• Combination
-Distraction/rotation or compression/flexion
-pressure to the length of the spine
-you land feet first (or head) -> squish the spine
other MOI spinal injuries
- direct, blunt, or penetrating trauma
- electrocution
flexion injury
-lumbar spine
compression injury
- axial loading injury
- landing on the feet or the head
column injury
- movement of vertebrae from normal position
- subluxation or dislocation
- fractures:
- spinous process and transverse process
- pedicle and laminae
- vertebral body
- ruptured intervertebral disks
- common sites of injury:
- C-1/C-2: delicate vertebrae
- C-7: transition from flexible cervical spine to thorax
- T-12/L-1: different flexibility between thoracic and lumbar regions
cord injury: concussion
- similar to cerebral concussion
- temporary and transient disruption of cord function
cord injury: contusion
- bruising of the cord
- tissue damage, vascular leakage, swelling
cord injury: compression
-Secondary to: – Displacement of the vertebrae – Herniation of intervertebral disk – Displacement of vertebral bone fragment – Swelling from adjacent tissue
cord injury: laceration
- causes:
- bony fragments driven into the vertebral foramen
- cord may be stretched to the point of tearing
- hemorrhage into cord tissue, swelling, and disruption of impulses
cord injury: hemorrhage
Associated with contusion, laceration, or stretching
transection cord injury
-Injury that partially or completely severs the spinal cord -can be incomplete or complete -Complete: -Cervical Spine damage: -Quadriplegia -Incontinence -Respiratory paralysis – Below T-1: » Incontinence » Paraplegia
incomplete transection cord injury: anterior cord syndrome
-Anterior vascular disruption
-Loss of motor function and sensation of pain, light touch, and
temperature below injury site
-Retain motor, positional, and vibration sensation
incomplete transection cord injury: central cord syndrome
- Hyperextension of cervical spine
- Motor weakness affecting upper extremities
- Bladder dysfunction
incomplete transection cord injury: brown-sequard’s syndrome
- Penetrating injury that affects one side of the cord
- Ipsilateral (same side) sensory and motor loss
- Contralateral pain and temperature sensation loss
general signs and symptoms of spinal injury
– Extremity paralysis – Pain with and without movement – Tenderness along spine – Impaired breathing – Spinal deformity – Priapism – Posturing – Loss of bowel or bladder control – Nerve impairment to extremities
spinal shock
-Temporary insult to the cord
-Affects body below the level of injury
-Affected area:
• Flaccid
• Without feeling
• Loss of movement (flaccid paralysis)
• Frequent loss of bowel and bladder control
• Priapism
• Hypotension secondary to vasodilation
neurogenic shock
- Spinal-Vascular Shock
- Occurs when injury to the spinal cord disrupts the brain’s ability to control the body
- Loss of sympathetic tone:
- Dilation of arteries and veins -> Expands vascular space and results in relative hypotension
- Reduced cardiac preload
- Reduction of the strength of contraction -> Frank-Starling reflex
- ANS loses sympathetic control over adrenal medulla
- Unable to control release of epinephrine and norepinephrine -> Loss of positive inotropic and chronotropic effects
signs and symptoms of neurogenic shock
- Bradycardia
- Hypotension
- Cool, moist, and pale skin above the injury
- Warm, dry, and flushed skin below the injury
- Male: priapism
Autonomic Hyperreflexia Syndrome
-Associated with the body’s resolution of the effects of
spinal shock
-Commonly associated with injuries at or above T-6
-Presentation
• Sudden hypertension
• Bradycardia
• Pounding headache
• Blurred vision
• Sweating and flushing of skin above the point of injury
other causes of neurologic dysfunction
-Any injury that affects the nerve impulse’s path of travel: • Swelling • Dislocation • Fracture • Compartment syndrome
scene size up of spinal injury pt
– Evaluate MOI.
– Consider spinal clearance protocol.
– Determine type of spinal trauma.
– Maintain suspicion with sports injuries.
– If unclear about MOI, take spinal precautions.
initial assessment of spinal injury
-Consider spinal clearance protocol.
-Consider spinal precautions.
• Head injury
• Intoxicated patients
• Injuries above the shoulders
• Distracting injuries
-Maintain manual stabilization.
• Vest style versus rapid extrication
• Maintain neutral alignment
• Increase of pain or resistance, restrict movement in position found
– ABCs.
– Suction.
– Consider oral or digital intubation if required -> Maintain in-line manual c-spine control.
rapid trauma assessment of spinal injury
- Focused versus rapid assessment
- Rapid Assessment
- Suspected or likely spinal cord/column injury
- Multi-system trauma patient
- Evaluate for:
- Neck deformity, pain, crepitus, warmth, tenderness
- Bilateral extremities -> Finger abduction/adduction, push, pull, grips
- Motor and sensory function:
- > Dermatome and myotome evaluation
- > Babinski’s sign test
- > Hold-up position
secondary assessment of spinal injury: vital signs
-Body temperature
-Above and below site of injury
– Pulse
– Blood pressure
– Respirations
ongoing assessment of spinal injury
-Recheck elements of initial assessment.
– Recheck vital signs.
– Recheck interventions.
– Recheck any neurological deviations
spinal alignment
-Move patient to a neutral, in-line position.
-Position of function.
-Hips and knees should be slightly flexed for maximum comfort and
minimum stress on muscles, joints, and spine.
-Place a rolled blanket under the knees
-ALWAYS support the head and neck.
-Contraindications to neutral position:
• Movement causes a noticeable increase in pain.
• Noticeable resistance met during procedure.
• Increase in neurological deficits occurs during movement.
• Gross deformity of spine.
– LESS MOVEMENT IS BEST.
padding in order to keep body aligned with spinal injury
- padding under shoulders for infant
- child no padding necessary
- padding under the head
- elderly- look for lordosis, kyphosis
movement of spinal injury patient
-Any movement MUST be coordinated.
-Move patient as a unit.
-NO LATERAL PUSHING.
-Move patient up and down to prevent lateral bending.
-Rescuer at the head “CALLS” all moves.
-ALL MOVES MUST be slowly executed and well coordinated.
-Consider the final positioning of the patient prior to
beginning move.
emergency medical care of spinal injuries
-Follow standard precautions.
-Maintain the patient’s airway while keeping
the spine in the proper position.
-Assess respirations and give supplemental
oxygen.
-Managing the airway -> Perform the jaw-thrust maneuver.
-After you open the airway, consider inserting an oropharyngeal airway.
-Have a suctioning unit available.
-Provide high-flow oxygen.
-Stabilization of the cervical spine -> Restrict motion of the head and trunk so that bone fragments do not cause further damage.
long backboards
- Provide full body spinal motion restriction to the head, neck, torso, pelvis, and extremities
- Used to move patients to a stretcher, then removed, while maintaining spinal motion restriction
