Spinal Cord Injuries Flashcards by Ellen Stewart

Which movement does C5 cause

Shoulder abduction (deltoid)

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Which movement does C6 cause

Elbow flexion / wrist extension (biceps)

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Which movement does C7 cause

Elbow extensors (triceps)

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Which movement does C8 cause

Long finger flexors (FDS/FDP)

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Which movement does T1 cause

Finger abduction (interossei)

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Which movement does L2 cause

Hip flexion (iliopsoas)

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Which movement does L3/L4 cause

Knee extension (quadriceps)

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Which movement does L4 cause

Ankle dorsiflexion (tib. anterior) - walking on heels

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Which movement does L5 cause

Big toe extension (EHL)

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Which movement does S1 cause

Ankle plantar flexion (gastrocnemius) - walking on tip toes

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What is the reflexes rhyme

1,2 buckle my shoe - ankle
3,4 kick the door - knee
5,6 pick up sticks - biceps
7,8 shut the gate - triceps

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What is the common gender and age range to get a spinal cord injury

M>F

20-29 years

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What are the most common causes of a SCI

Trauma - Falls, RTA, sports 
Degenerative Orthopaedic causes
Tumours 
Spinal cord stroke - infarct
Transverse myelitis - infection
Thoracoabdominal aortic aneurysm

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Features of a complete SCI

No motor or sensory function distal to lesion 
No anal squeeze
No sacral sensation 
No change of recovery 
ASIA Grade A

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Features of an incomplete SCI

Some function is present below site of injury

More favourable prognosis

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ASIA Grade A

Complete SCI - no sensory or motor function preserved in sacral segments S4-S5

ASIA Grade B

Incomplete - sensory but no motor function preserved below neurologic level and extending through S4-5

ASIA Grade C

Incomplete - motor function preserved below neurologic level but most key muscles grade <3

ASIA Grade D

Incomplete - motor function preserved below neurological level but most key muscles grade >3

ASIA Grade E

Normal motor and sensory function

Features of Tetraplegia / Quadriplegia

Partial / total loss in all 4 limbs and trunk
Loss of function (M&S) in cervical CS
Usually due to cervical #
Resp failure due to loss of diaphragm innervation
UMN - Spasticity (increased tone)

Features of Paraplegia

Partial or total loss of use of the lower limbs, arms spared, possible trunk impairment
Impairment or loss of motor / sensory function in T,L or S SC
Usually due to T / L #
Assoc. chest/abdo injuries
Spasticity if SCI above L1
Bladder and bowel function affected

Features of Central Cord Syndrome

Elderly w arthritic neck
Hyperextension injury during low velocity fall
Centrally cervical tracts involved
WEAKNESS in arms > legs
Perianal sensation and lower extremity power preserved

Features of Anterior Cord Syndrome

Hyperflexion injury in anterior compression #
Ant. spinal artery damaged
Profound weakness
Fine touch and proprioception preserved
Infarcted cord - all power distal to infarction lost, loss of pain and temperature, sensation usually fine

Features of Brown-Sequard Syndrome

Hemi-section of cord due to penetrating injuries Paralysis on affected side (corticospinal) Loss of proprioception and fine discrimination (dorsal column) Loss of pain and temperature on opposite side below lesion (spinothalamic)

Management of SCI

A - c-spine control - collar and board to prevent 2o injury B - ventilation & O2, assess concomitant chest injuries C - IV fluids, ?neurogenic shock, Reduced BP/HR, loss of sympathetic tone, vasopressors D - neuro function assess (incl. PR and perianal sensation)

Investigations for suspected SCI

X-ray CT MRI - if child or neuro deficit

Management of unstable fracture

Surgical fixation with pedicle screws

Long term management of SCI

SCI unit Physio and OT Counselling - incl. for urological and sexual

What is spinal shock

``` Transient depression of cord function below the level of injury Flaccid paralysis Arreflexia Can last hours-days after injury Neuro phenomenon ```

What is neurogenic shock

``` Shock due to secondary disruption of sympathetic (ANS) outflow Usually due to SCI above T6 Hypotension Hypothermia Bradycardia ```

56 year old lady presenting with neck pain and 6 months of worsening numbness in the hand i.e. she has difficulty doing buttons. She also has a wide based gait. On History and Exam of cervical spine, not much sensation in LL and reflexes increased, no wasting - UMN. Can feel C5 and 6 but C7 onwards not working. C7 means elbow extension may be weak but is fine. LL reflexes should be brisk and Babinski present. What would you do? What could be the diagnosis

MRI needed | Cervical myelopathy - compression of SC at C7

A 70 year old man presents with a “tired feeling” in both thighs which is precipitated by walking and relieved by rest. He has a long history of backache. What are the main differentials? What are the differences between them Management

Peripheral vascular disease Spinal stenosis History: distribution, risk factors: is it worst when bending over walking up hill etc., smoking, diabetic, CABG, stroke Examination: Pulses history Decompression - laminectomy

A 70 year old lady presents with severe, worsening thoracic and lumbar back pain over several months. No history of trauma, pain worse on standing but still present when lying in bed at night. History of weight loss What are the important diagnosis to include?

Infection: discitis Metastatic malignancy to the spine – lung, breast, prostate, renal, thyroid T1 good for metastatic disease Has tumour in SC as well as mets in vertebra Little surgeon can do – refer to oncology