Spinal Cord Injuries Flashcards
What is the most common cause of spinal injuries?
Physical trauma
Are spinal injuries more common in males or females?
Males
What spinal levels do spinal injuries most commonly occur at?
Half occur at C6 or C7
30% occur at C2
What spinal levels do injuries most commonly occur at in children? Why?
C1, C2
Heavier head, lax ligaments
What are the different mechanisms of spinal injury? What do they each mean?
Hyperflexion, forward movement of the head
Hyperextension, backward movement of the head
Lateral stress, sideways movement of the head
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
What are some examples of flexion injuries?
Atlanto-occipital dislocation
Atlanto-axial dislocation
What are some examples of extension injuries?
Hangman’s fracture
Atlanto-axial dislocation
What are the different types of cord injuries?
Complete cord transection syndrome
Brown-Sequard syndrome
Anterior cord syndrome
Central cord syndrome
Posterior cord syndrome
What is complete cord transection syndrome?
Injury to a whole section of the spinal cord
What are the causes of complete cord transection syndrome?
Trauma
Infarction
Transverse myelitis
Abscess
Tumour
What is transverse myelitis?
Inflammation of both sides of one section of the spinal cord
What spinal tracts are injured in complete cord transection syndrome?
All of them
- dorsal-column medial-lemniscus pathway
- spinothalamic tract
- corticospinal tract
What are the signs and symptoms of complete cord transection syndrome?
Complete loss of all sensory modalities below the lesion
Flaccid paralysis followed by UMN lesion signs below the lesion
Autonomic dysfunction
- hypotension
- priapism
What is priapism?
Prolonged sustained erection
What are the types of complete cord transection syndromes?
Paraplegia
Tetraplegia/quadriplegia
What is paraplegia?
Complete cord transection syndrome in the thoracic, lumbar or sacral regions affecting the lower limbs
What are the causes of Brown Sequard syndrome?
Penetrating trauma
Fractured vertebrae
Tumour
Abscess
Multiple sclerosis
-all giving unilateral cord injury
What is tetraplegia/quadriplegia?
Complete cord transection syndrome in the cervical region affecting both upper limbs and lower limbs
What are the causes of anterior cord syndrome?
Flexion injury
Injury to anterior spinal artery
What is anterior cord syndrome?
Injury to the anterior half of a section of the spinal cord
How does flexion injury lead to anterior cord syndrome?
Fracture
Dislocation
Herniated discs
What can cause injury to the anterior spinal artery?
Vascular disease
-atherosclerotic disease
Cross-clamping of aorta during surgery, gives reduced blood flow through anterior spinal artery
What spinal tracts are injured in anterior cord syndrome?
Spinothalamic tract
Corticospinal tract
What are the signs and symptoms of anterior cord syndrome?
Loss of temperature, pain, pressure modalities below the lesion
Flaccid paralysis followed by UMN lesion signs below the lesion
Autonomic dysfunction
- bowel problems
- bladder problems
- sexual problems
What is central cord syndrome?
Injury to the middle of a section of the spinal cord
What are the causes of central cord syndrome?
Trauma
Ischaemia of spinal cord
Cervical spinal stenosis
Degenerative spinal disease
Syringomelia
How does trauma cause spinal cord syndrome?
Hyperextension injury of cervical spine in elderly
Hyperflexion injury of cervical spine in younger people
What is syringomelia?
Development of cyst in central canal
What causes syringomelia?
Unknown cause
What spinal tracts are injured in syringomelia?
Spinothalamic fibres decussating in white commissure
What are the signs and symptoms of syringomelia?
Loss of temperature, pain and pressure modalities
In the neck, shoulders and arms as cervical fibres are more medial
What are the causes of posterior cord syndrome?
Spondylosis
Spinal stenosis
Infections
Vitamin B12 deficiency
Injury of paired posterior spinal arteries
What are the signs and symptoms of central cord syndrome?
More motor symptoms than sensory symptoms
Upper half of body affected more than lower half of body, due to nerve fibres of upper half of body being more medial in corticospinal tract
Distal extremities affected more than proximal
Autonomic dysfunction
-urinary retention
What spinal tracts are injured in posterior cord syndrome?
Dorsal-column medial-lemniscus pathway
What are the signs and symptoms of dorsal-column medial lemniscus pathway?
Loss of light touch, proprioception, vibration modalities below the lesion
What signs and symptoms suggest the patient has a spinal cord injury?
Head injury
Unconscious, confused
Spinal tenderness
Loss of sensation
Extremity weakness
How are spinal cord injuries immediately managed?
ABCDE approach
Manual inline stabilisation for short-term
Log-roll, backboard, rigid C-collar for long-term
Assess bladder volume, insert urinary catheter
What parts of the ABCDE approach are particularly important with a spinal cord injury?
Monitor vital signs e.g. heart rate, blood pressure, respiratory rate, % saturation, temperature
If patient is hypotensive, give fluid challenge and vasoconstrictors e.g. adrenaline
If patient is not breathing, if injury is C5 or above meaning loss of innervation to diaphragm, intubate patient
If patient is hypoxic, give oxygen
If patient has hypothermia, give blankets
Why do patients with spinal cord injuries become hypotensive?
Loss of sympathetic output
Vasodilation, decreased systemic vascular resistance and hence blood pressure
Why do patients with spinal cord injuries become hypothermic?
Loss of sympathetic output
Vasodilation of arterioles in skin, loss of heat by radiation
Loss of piloerection reflex, can’t conserve heat
Loss of voluntary motor output, can’t shiver to generate heat
Why do patients with spinal cord injury get urinary retention?
Flaccid paralysis of bladder detrusor muscle
What is manual inline stabilisation?
Crouching above the patient, hands placed on mastoid process or cradle their occipital
Or standing beside patient, hands placed on sides of heads, forearms resting on patient’s chest
How are spinal cord injuries managed after the patient is stable?
C-spine restriction for approx. 6 weeks
Physiotherapy, occupational therapy
Surgery if neurological deficits are progressing, or to correct unstable spinal fractures
What is meant by clearing the spine?
Removing the C-collar
What are the criteria for clearing the spine?
Alert and oriented
Not intoxicated
No midline posterior tenderness
No focal neurological deficit
No language barrier
