Spinal Cord Injuries

Question 1

Roughly how many spinal cord injuries occur each year (new)?

Answer 1

12,000 per year

Question 2

Who is more at risk for Spinal Cord Injury?

Answer 2

Young patients (males) 16-30 years

Second peat at age 60+ (associated with OA)

Question 3

What level of the spinal cord is most commonly injured?

Answer 3

Cervical SCI (C5 most common)

Question 4

Who should you assume a spinal cord injury?

Answer 4

All patients with a significant trauma should be assumed to have a spine injury until proven otherwise

Question 5

What branch of the nervous system is impacted when C5 or lumbarthoracic is severed?

Answer 5

Sympathetic nervous system

Question 6

When is dysregulation worse in a spinal cord injury?

Answer 6

The higher up in the spinal cord

Question 7

What is the acute phase of a spinal cord injury?

Answer 7

First 48 hours, cytotoxic inflammatory response nerve depolarization

Question 8

What is the subacute phase of a spinal cord injury?

Answer 8

48 hours to 14 days; macrophage infiltration and scar initiation

Question 9

What is a critical thing to manage during the acute phase?

Answer 9

BP; due to vascular changes occuring in the acute phase it is critical to well control BP (avoid hypotension)

Question 10

What is the intermediate phase of a spinal cord injury?

Answer 10

14 days to 6 months; continued scar formation

Question 11

What is the chronic phase of a spinal cord injury?

Answer 11

6+ months; degeneration of spared components

Question 12

What should be your initial treatment in the trauma bed?

Answer 12

Immobilization

Question 13

What is the first line imaging modality (text book answer)?

Answer 13

AP and lateral x-ray (+ odontoid for c-spine)

Question 14

What is the first line imaging modality in clinical practice?

Answer 14

CT, usually of entire spine

Question 15

Does the degree of SCI correlate with the degree of stability of fractures?

Answer 15

No, it does not correlate

Question 16

What does initial treatment depend on?

Answer 16

Stability of fractures

Question 17

What does disruption to the sympathetic nervous system risk in neurogenic shock?

Answer 17

Inability to maintain vascular tone

Question 18

What do you see in neurogenic shock (vascular symptoms)?

Answer 18

Hypotension with bradycardia and without vasoconstriction (doesn’t make any sense is how to remember it) - not compensating properly

Question 19

What is the treatment for neurogenic shock?

Answer 19

Fluid resuscitation and vasopressors

Question 20

When does neurogenic shock resolve?

Answer 20

24-48 hours; body reaches equilibrium during acute phase

Question 21

What are the classifications of SCI?

Answer 21

Complete, incomplete, and transient

Question 22

What does a Grade A mean on the ASIA scale?

Answer 22

Complete injury, bad news!

Question 23

What does a Grade E mean on the ASIA scale?

Answer 23

Normal, no injury

Question 24

What occurs during transient spinal shock?

Answer 24

Acute areflexia and flaccid paralysis, “spinal cord stinger”

Question 25

Can you complete an ASIA during a transient spinal shock?

Answer 25

No, need to complete once resolved or after 72 hours

Question 26

When does transient shock resolve?

Answer 26

24-72 hours

Question 27

What is the minimum intact function that has to be present to be considered an incomplete SCI?

Answer 27

‘Sacral Sparing’; voluntary anal sphincter tone, perineal sensation, great toe flexion

Question 28

When do you transfer to specialized rehab?

Answer 28

Earlier the better to improve morbidity and mortality

Question 29

What is the benefit of spinal rehab?

Answer 29

Lower morbidity and mortality
Extensive PT, assistive technologies/devices

Question 30

What are some drawbacks of a specialized spinal rehab?

Answer 30

Expensive, often far away, limited beds

Question 31

What are some common complications from SCI?

Answer 31

Gastritis/ileus
Urinary dysfunction
Breathing difficulty
Skin breakdown
Vascular complication

Question 32

What levels of the spine keep the diaphragm alive?

Answer 32

C3, C4, C5

Question 33

What is the most common complication that results in poor morbidity or mortality?

Answer 33

Vascular complications, worse with higher level injuries

Question 34

What is autonomic dysreflexia?

Answer 34

Rapid increase in BP (imbalanced sympathetic NS stimulation)

Stimulates stimuli below level of injury (bowel or bladder dysfunction)