Spinal Cord Injuries Flashcards
What are the features of the dorsal column?
IPSILATERAL
Vibration, conscious, proprioception, 2-point discrimination, light touch
What are the features of the spinothalamic tract?
CONTRALATERAL
Pain, Temperature
What are the features of the corticospinal tract?
IPSILATERAL
Motor
What can cause a spinal injury?
Physical trauma
Head injury = 10-20% of head injury have a concurrent C-Spine injury
children, C1-C2 more likely to be injured in view of having a heavier heads with lax ligaments
What are the possible cord injuries?
Complete cord transection
Brown-sequard syndrome
Anterior cord syndrome
Central cord syndrome
Posterior cord syndrome
What forces could be involved in a spinal injury?
Hyperflexion (forward movement of the head)
Hyperextension (backward movement)
Lateral stress (sideways movement)
Rotation (twisting of the head)
Compression (force along the axis of the spine downward from the head or upward from the pelvis)
Distraction (pulling apart of the vertebrae)
Outline a complete cord transection
Causes = trauma, infarction, transverse myelitis, abscess, tumour
Complete loss of sensation below the lesion
Complete paralysis below the lesion
Priapism = prolonged sustained erection – loss of sympathetic innervation
Spinal shock and autonomic dysfunction with higher lesions
Outline Brown-sequard syndrome (hemisection)
Causes = penetrating trauma, fractured vertebrae, tumour, abscess, MS
Side of injury = loss of CST, loss of dorsal column
Contralateral side = loss of spinothalamic tract
Discuss anterior cord syndromes
Causes = flexion injury, injury to anterior spinal artery
Flaccid paralysis below level of lesion – CST loss of LMN
Loss of pain/temp – spinothalamic
Autonomic dysfunction – bowel, bladder, sexual
Preservation of Vibration, proprioception, 2-point discrimination, light touch – dorsal column
Central cord syndrome
Causes = hyperextension in elderly, hyperflexion in children, disruption of blood supply, cervical spinal disease, syringomyelia
Starts from the middle, grows out, doesn’t have to be symmetrical
Initial symptoms = obliteration of spinothalamic fibres
In relevant dermatomes
Outline posterior cord syndromes
RARE
Causes = spondylosis, spinal stenosis, infection, vit B12 def, occluded posterior spinal A
Loss of dorsal column - vibration, conscious, proprioception, 2-point discrimination, light touch
Motor spared
Temp/pain spared
What should be the initial management when a spinal injury is suspected?
ABCDE
Early immobilisation of the C-spine
Consider intubation for injuries at C5 or above
Use log-roll, backboard and rigid C-collar
Describe the ABCDE approach
A = airway, patent
B = breathing, RR, resp effort, sats, accessory muscles, trachea central, equal air entry
C = circulation, HR, BP, capillary refill, IV access, fluid challenge (shock)
D = disability, GCS, AVPU (alert, voice, pain, unresponsive)
E = expose the pt
When should a spinal injury be suspected?
Head injury present
Unconscious or confused
Spinal tenderness
Extremity weakness
Loss of sensation
What is manual inline stabilisation?
Crouching above the patient with hands placed on the patient’s mastoid processes or cradling their occiput
Standing beside the patient with hands placed on the sides of the patient’s head and forearms resting on the patient’s chest.
