Spinal Cord Injuries Flashcards
Roughly how many spinal cord injuries occur each year (new)?
12,000 per year
Who is more at risk for Spinal Cord Injury?
Young patients (males) 16-30 years
Second peat at age 60+ (associated with OA)
What level of the spinal cord is most commonly injured?
Cervical SCI (C5 most common)
Who should you assume a spinal cord injury?
All patients with a significant trauma should be assumed to have a spine injury until proven otherwise
What branch of the nervous system is impacted when C5 or lumbarthoracic is severed?
Sympathetic nervous system
When is dysregulation worse in a spinal cord injury?
The higher up in the spinal cord
What is the acute phase of a spinal cord injury?
First 48 hours, cytotoxic inflammatory response nerve depolarization
What is the subacute phase of a spinal cord injury?
48 hours to 14 days; macrophage infiltration and scar initiation
What is a critical thing to manage during the acute phase?
BP; due to vascular changes occuring in the acute phase it is critical to well control BP (avoid hypotension)
What is the intermediate phase of a spinal cord injury?
14 days to 6 months; continued scar formation
What is the chronic phase of a spinal cord injury?
6+ months; degeneration of spared components
What should be your initial treatment in the trauma bed?
Immobilization
What is the first line imaging modality (text book answer)?
AP and lateral x-ray (+ odontoid for c-spine)
What is the first line imaging modality in clinical practice?
CT, usually of entire spine
Does the degree of SCI correlate with the degree of stability of fractures?
No, it does not correlate
What does initial treatment depend on?
Stability of fractures
What does disruption to the sympathetic nervous system risk in neurogenic shock?
Inability to maintain vascular tone
What do you see in neurogenic shock (vascular symptoms)?
Hypotension with bradycardia and without vasoconstriction (doesn’t make any sense is how to remember it) - not compensating properly
What is the treatment for neurogenic shock?
Fluid resuscitation and vasopressors
When does neurogenic shock resolve?
24-48 hours; body reaches equilibrium during acute phase
What are the classifications of SCI?
Complete, incomplete, and transient
What does a Grade A mean on the ASIA scale?
Complete injury, bad news!
What does a Grade E mean on the ASIA scale?
Normal, no injury
What occurs during transient spinal shock?
Acute areflexia and flaccid paralysis, “spinal cord stinger”
Can you complete an ASIA during a transient spinal shock?
No, need to complete once resolved or after 72 hours
When does transient shock resolve?
24-72 hours
What is the minimum intact function that has to be present to be considered an incomplete SCI?
‘Sacral Sparing’; voluntary anal sphincter tone, perineal sensation, great toe flexion
When do you transfer to specialized rehab?
Earlier the better to improve morbidity and mortality
What is the benefit of spinal rehab?
Lower morbidity and mortality
Extensive PT, assistive technologies/devices
What are some drawbacks of a specialized spinal rehab?
Expensive, often far away, limited beds
What are some common complications from SCI?
Gastritis/ileus
Urinary dysfunction
Breathing difficulty
Skin breakdown
Vascular complication
What levels of the spine keep the diaphragm alive?
C3, C4, C5
What is the most common complication that results in poor morbidity or mortality?
Vascular complications, worse with higher level injuries
What is autonomic dysreflexia?
Rapid increase in BP (imbalanced sympathetic NS stimulation)
Stimulates stimuli below level of injury (bowel or bladder dysfunction)
