Spinal Cord Disorders Flashcards by Abbie Barkley

The mobility of the cervical spine makes it vulnerable to injury, especially _____ injury.
A. hyperflexion
B. hyperextension

B - hyperextension

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How does acute spinal cord initially present?

A state of spinal shock that has flaccid muscle paralysis with loss of sensation below the level of injury

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What is the difference between spinal shock and neurogenic shock?

Spinal shock - loss of neurogenic function
Neurogenic shock - reduction in BP

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What is initial treatment for cervical fracture or dislocation?

Immediate immobilization to limit neck motion

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Hard neck collars limit neck flexion and extension by ____%.

only 25%

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What is the most effective in preventing cervical spine movement?

Immobilization and traction provided by halothoracic devices

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What is manual in-line stabilization?

An assistant’s hands are placed on each side of the patient’s face, the head is grasped with fingertips resting on the mastoid process, and downward pressure is applied against a firm table surface to hold the head immobile in neutral position

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For acute spinal cord injury, during DL what is recommended to minimize cervical spine flexion and extension?

Manual in-line stabilization

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Cervical spine movement during DL is likely to be concentrated in what area?

the occipito-atlanto-axial area

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What makes patients with cervical or high thoracic spinal cord injury vulnerable to dramatic decreases in BP following changes in body position, blood loss, or positive pressure ventilation?

The absence of compensatory SNS responses

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What is poikilothermic?

Inability to maintain body temperature

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Patients with acute spinal cord injury tend to become poikilothermic in dermatomes _____ the level of spinal cord lesion.

BELOW

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T/F: Succinylcholine does not provoke excessive release of Potassium during the first few hours after spinal cord injury.

True

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How long do you have to give Succinylcholine after spinal cord injury before it provokes the excessive release of Potassium?

24 hours

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Injuries that occur more _____ along the spinal cord tend to have more significant systemic effects.

Rostrally (toward the top of the spinal cord/front of the brain)

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With chronic spinal cord injury, where is nerve root pain located?

It is localized at or near the level of injury

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How is visceral pain produced in chronic spinal cord injury?

By distention of the bladder or bowel

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What medication is useful for treating spasticity in chronic spinal cord injury?

Baclofen

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How does Baclofen work?

It potentiates the inhibitory effects of GABA

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What can occur with abrupt cessation of Baclofen?

Withdrawal reactions including seizures

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Spinal cord injury at or above the ___ cervical vertebra may result in apnea. Why?

5th; b/c of denervation of the diaphragm

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The diaphragm’s innervation is from ___ – ____.

C3-C5

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What is the main focus for anesthetic management in patients with chronic spinal cord injury?

Preventing autonomic hyperreflexia

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For chronic spinal cord injury, succinylcholine may provoke ______, most commonly during the ______ after spinal cord injury.

hyperkalemia; initial 6 months

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When does autonomic hyperreflexia appear?

Following spinal shock and in association w/ return of spinal cord reflexes

Autonomic hyperreflexia reflex response can be initiated by ____ or ____ stimulation above or below the spinal cord injury??

cutaneous or visceral stimulation BELOW the level

What are common stimuli for autonomic hyperreflexia?

surgery and distention of a hollow viscus (such as bladder or rectum)

Autonomic hyperreflexia: stimulation ____ the level of spinal cord injury initiates ____ impulses that enter the spinal cord.

below; afferent

Autonomic hyperreflexia, in the presence of a spinal cord lesion, splanchnic outflow is isolated from inhibitory impulses from above, so generalized _____ occurs below the level of spinal cord injury.

vasoconstriction

What are the hallmarks of autonomic hyperreflexia?

HTN and reflex bradycardia

During autonomic reflexia, reflex cutaneous vasodilation occurs where?

Above the level of the spinal cord injury

Approximately 85% of patients with spinal cord lesion injuries above ____ exhibit autonomic hyperreflexia reflex.

What should be readily available for patients with spinal cord injury in case autonomic hyperreflexia occurs intra-op?

Vasodilator drugs with a short half-life (Ex: sodium nitroprusside)

What are the 2 categories of spinal cord tumors?

Intramedullary tumors and extramedullary tumors

Where are intramedullary tumors located?

Within the spinal cord (Gliomas and ependymomas)

Where do extramedullary tumors occur?

Either intradural (neurofibromas and meningiomas) or extradural

Spinal cord tumors typically present with what symptoms?

Symptoms of cord compression

Pain related to spinal cord tumors is aggravated by ___ or ____.

coughing or straining

What is the technique of choice for spinal cord tumor diagnosis?

MRI

What is a consideration with airway management of spinal cord tumors?

Significant motion of the cervical spine could lead to further cord compromise via compression and decrease cord perfusion

What medication should be used in caution in spinal cord tumors?

Succinylcholine

What is one of the most common causes of back pain?

Intervertebral disc disease

What is a compression of a single nerve root called?

Radiculopathy

What do patients usually complain of with compression of a single nerve root?

Pain in a single dermatomal distribution or localized muscle weakness

In cervical spine procedures performed via an anterior approach, retraction of the airway structures to attain access to the cervical spine may result in injury to what?

Ipsilateral RLN

What may injury to ipsilateral RLN cause?

Hoarseness, stridor, or airway compromise

What are the 2 most common sites for lumbar disc protrusion?

L4-L5 and L5-S1

What does lumbar disc protrusion at both L4-L5 and L5-S1 cause?

Low back pain that radiates down the posterior and lateral aspect of the thighs and calves (sciatica)

What is spina bifida occulta?

Incomplete formation of a single lamina in the lumbosacral spine w/o other abnormalities; it is a congenital defect

T/F: Spina bifida usually produces no symptoms and is often discovered as an incidental finding.

True

During fetal development, closure of the ____ is required for normal formation of the brain, spinal cord, and their enclosing structures, the cranium and vertebral canal.

neural tube

What causes neural tube defects?

Failure of the neural tube to appropriately close in the caudal segments

What is herniation of contents of the spinal canal called?

Meningocele and myelomeningocele (only contains meninges and CSF)

What is the most common severe congenital anomaly of the spine?

myelomeningocele

What are increased risk factors for myelomeningocele?

Maternal folate deficiency, trisomy 13, trisomy 18, and type II chiari malformations

Myelomeningocele results in ____ and ____ deficits.

motor and sensory

What kind of allergy do patients with myelomeingocele often have?

Latex (d/t to frequent exposure since young age)

What medication should be avoided for myelomeningocele?

Succinylcholine

______ is a common acquired degenerative disorder that leads to osteophyte formation and degenerative disc disease.

Spondylosis

Sponylosis is also known as what?

spinal stenosis

When do symptoms of spondylosis typically develop?

After age 50

What symptoms accompany cervical spondylosis?

neck pain and radicular pain in the arms and shoulders + sensory loss + muscle atrophy

What is spondylolisthesis?

Anterior subluxation of one vertebral body on another

Where does spondylolisthesis most commonly occur?

At the lumbosacral junction

Amyotrophic lateral sclerosis (ALS) is a degenerative disease involves: 1. _____________ 2. _____________

1. the lower motor neurons in the anterior horn gray matter of the spinal cord 2. the corticospinal tracts (i.e., the primary descending upper motor neurons)

What gender is most commonly affected by ALS? What age?

Male; 40-60

When ALS is degenerative process is limited to the motor cortex of the brain, the disease is called _____ lateral sclerosis.

primary

What is pseudobulbar palsy?

Limitation to the brainstem nuclei

What are the initial manifestations of ALS?

skeletal muscle atrophy, weakness, and fasciculations (

Fasciculations of ALS frequently begin in the intrinsic muscles of the _____

hands

GA in patients with ALS may be associated with what?

Exaggerated respiratory depression

What medication should be avoided in ALS?

Succinylcholine

What is the effect of ND NMBD on patients with ALS?

They may show prolonged responses