Spinal Cord Injuries Flashcards
What are the mechanisms of spinal injury
Hyperflexion Hyper extension Lateral stress Rotation Compression Distraction
What are common causes of spinal injuries
Trauma: car accidents, contact sports, falls, alcohol
Head injuries: 20% have c spine injury
Where are common sites of spinal injury
C6/7 (50%)
C2 (30%)
C1/2 in children (heavy head + lax ligaments)
What are the types of spinal cord injuries
Complete transection Hemisection Anterior cord injury Central cord injury Posterior cord injury
What are the causes of complete transection
Trauma Infarction Transverse myelitis Abscess Tumour (metastasis)
What are the clinical features of complete transection
Spinal shock
Neurological shock
Bilateral paralysis below level of injury
Bilateral sensory loss of all modalities below level of injury
Priapism
What is spinal shock
Paralysis of bladder and rectum
What is neurological shock
Hypotension and bradycardia due to loss of sympathetics in cervical spine lesions
What is priapism
Prolonged sustained erection due to unopposed parasympathetic activity
What are the causes of spinal cord hemisection
Penetrating trauma Fractured vertebrae Tumour Abscess Multiple sclerosis
What are the features in Brown Sequard Syndrome
Ipsilateral loss of proprioception at+below level of lesion
Ipsilateral loss of motor function at+below level of lesion
Contralateral loss of pain sensation below level of lesion
What are the causes of anterior cord injury
Flexion injury: fracture, dislocation, herniation
Anterior spinal artery injury: atherosclerosis, iatrogenic (clamping, dissection)
What are the clinical features of anterior cord injury
Complete paralysis at+below lesion
Complete loss of pain sensation below lesion
Sparing of proprioception, fine touch, vibration
Autonomic dysfunction: bladder, bowel, sexual
What are the causes of central cord injuries
Trauma: hyperextension (elderly), hyperflexion (young) Disruption to spinal blood flow Cervical spinal stenosis Degenerative spinal disease Syringomyelia Central canal ependymoma
What are the clinical features of central cord injury
Initial Loss of pain + temp in cape like distribution
Followed by paralysis in cape like distribution
Motor>sensory
Upper extremity > Lower extremity
Distal>proximal
Bladder dysfunction
Sparing of proprioception, fine touch, vibration
What are the causes of posterior cord injury
Chronic pathological processes: Spondylosis Spinal stenosis Infection Vitamin B12 deficiency
Posterior spinal arteries occlusion
What are the clinical features of posterior cord injury
Loss of proprioception, fine touch, vibration
Sparing of motor function
Sparing of pain + temp sensation
What are the principles of management of spinal injuries
Intubation + icu admission Early c spine immobilisation C spine restriction for 6 weeks PT/OT long term Surgery - progressive neurological deficit, unstable fractures
What is the initial management of spinal cord injuries
ABCDE assessment Intubation Log-roll and Backboard Rigid C collar Manual stabilisation Treat: hypoxia, shock, hypothermia Catheterise
Why is intubation important
Spinal injuries above C5 loss of diaphragm innervation, intercostal muscle’s will tire out
When do you assume spinal injury
Head injury present
Focal neurological deficit
Altered level of consciousness/GCS
Spinal tenderness
What is log roll
Manoeuvre to transfer patient onto backboard as a team
What is a backboard
Board to transport patients in pre-hospital trauma setting in supine position
What is manual stabilisation
Technique used to minimise movement of head and neck
What are the methods of manual stabilisation
Place hands on patients mastoid processes from above the patient
Place hands on sides of head from patients side with elbows on their chest
In what position do you place patients head in manual stabilisation
ANY position comfortable for patient
You must not apply traction
Why is catheterisation important
Possible bladder dysfunction and retention
How do you “clear” spinal injuries
Communication:
Alert and oriented
No language barrier
Not intoxicated
Examination:
No focal neurological deficits
No posterior midline tenderness
No painful distracting injuries
