Spinal cord injuries Flashcards
Spinal cord
Direct continuation of the brainstem specificaly the medulla
conus medullaris
at L1 level where spinal cord becomes cone shaped
cauda equina
mass of spinal nerve roots formed with spinal cord
filum terminale
extends from the caudal end of the spinal cord and attaches to the coccyx.
Gray matter
refers to areas that contain large numbers of nerve cell bodies and dendrites.
it surrounds the white matter.
White matter
composed of axon and associated glia
how many pairs of spinal nerves does human have
31 pairs corresponding to segment of spinal cord
C1-C8
T1-T12
L1-L5
S1-S5
Coccygeal 1 pair
A spinal cord injury
A spinal cord injury is damage to the spinal cord that causes temporary or permanent changes in its function.
Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
causes of spinal cord injury
*Trauma
*Infection
*Benign/malignant tumor
*Vascular disorders
Primary Injury
The initial mechanical forces delivered to the spinal cord at the time of injury is known as primary injury where “displaced bone fragments, disc materials, and/or ligaments bruise or tear into the spinal cord tissue.”
Secondary injury
In the 15th minute, microhemorrhage occurs in the gray matter and spreads, the spinal cord swells, fills the canal, ischemia begins when venous pressure is exceeded.
Spinal Shock
- Spinal shock is manifested by the absence of the
bulbocavernous reflex, hypotension, bradycardia, and complete
loss of motor, sensation and reflexes.
Upper Motor Neuron Lesion
– Refers to the lesion of the spinal cord.
– Cortical control is lost below the lesion level.
Lower Motor neuron lesion
– It is the lesion of the cauda equina and peripheral nerve
roots.
Tetraplegia (Quadriplegia)
– They are the lesions above T1
– It is dysfunction of the arms, trunk, legs and pelvic organs.
– The term incomplete tetraplegia is used instead of the previously used term tetraparesis.
Lesions below T1
– Depending on the lesion level, the trunk, lower extremities, and pelvic
organs may be affected.
– Includes lesions of cauda equina and conus medullaris.
paraplegia
types of spinal injury
complete
incomlete
incomplete injuries
there is partial preservation of some motor or sensory function
central cord syndrome
prognosis is good
bleeding into central gray matter causes damage to the spinal cord
anterior cord syndrome
prognosis is bad
result from flexion injury to cervical spine in which dislocation/fracture of cervical spine occurs
posterior cord syndrome
rare incomplete syndrome that results from damage to posterior spinal artery by tumor or vascular infarct
Brown-Séquard Syndrome
best prognosis
injury involve half of the spinal cord
Damage to the sacral aspect of the spinal
cord and the lumbar nerve roots
– Blow to the back such as gunshot and spinal tumor.
conus medullaris syndrome
injury usually occurs after the patient sustains a direct trauma from a fracture-dislocation below the L1 vertebrae
Cauda Equina Syndrome
Complete injuries
If an injury is complete, sensory and motor function will be absent below the level of the injury and in the lowest sacral segments of S4 and S5.
Factors affecting functional expectation
*Return of sacral sensation
*Neurological level
*Complete-incomplete injury
*Other medical problems
*Age
*Motivation
Complications in spinal cord injury
Autonomic Dysfunction
Cardiovascular Dysfunction
Respiratory Dysfunction
Gastrointestinal Dysfunction
Urological Dysfunction
Sexual Dysfunction
Bone Metabolism Dysfunction
Pain
Psychological
Spinal shock
temporary loss of all neurological activity including motor, sensory and reflex activity
Neurogenic shock
result from damage to the spinal cord above level of T6
Autonomic Dysreflexia
Autonomic dysreflexia, also referred to as autonomic hyperreflexia, is a potentially life-threatening condition that can affect people who have had a spinal cord injury at the level of T6 or above, and occurs more frequently in those with a complete injury over those with an incomplete injury, presenting more commonly during the chronic phase of spinal cord injury, around 3 - 6 months.
thermoregulatory problems
Thermoregulatory center in the hypothalamus regulates thermogenesis by activating or inhibiting the sympathetic nervous system to maintain core body temperature.
Orthostatic hypotension
Orthostatic Hypotension is defined as a decrease in
systolic blood pressure of 20 mmHg or more, or
diastolic blood pressure of 10 mmHg or more,
Upper motor neuron bladder
occurring in a suprasacral lesion results in a reflex bladder, characterized by loss of cortical inhibition of sacral reflex arcs due to disturbance of descending spinal tracts, leading to detrusor
hyperactivity often in combination with detrusor sphincter dyssynergia.
lower motor neuron bladder
occurring in a Sacral Lesion at S2 - S4 results in an areflexic bladder characterized by diminished motor stimulation of the bladder and reduced or absent contractility of the detrusor, meaning the bladder will not contract no matter how much it fills up.
other complications of spinal injury
*Erectile dysfunction
*Infertility
*Heterotrophic ossification
*Osteoporosis
*Spasticity
*Nociceptive pain and
*Neuropathic pain
*Psychological pain
