Spinal Cord Injuries Flashcards
Which movement does C5 cause
Shoulder abduction (deltoid)
Which movement does C6 cause
Elbow flexion / wrist extension (biceps)
Which movement does C7 cause
Elbow extensors (triceps)
Which movement does C8 cause
Long finger flexors (FDS/FDP)
Which movement does T1 cause
Finger abduction (interossei)
Which movement does L2 cause
Hip flexion (iliopsoas)
Which movement does L3/L4 cause
Knee extension (quadriceps)
Which movement does L4 cause
Ankle dorsiflexion (tib. anterior) - walking on heels
Which movement does L5 cause
Big toe extension (EHL)
Which movement does S1 cause
Ankle plantar flexion (gastrocnemius) - walking on tip toes
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
What is the common gender and age range to get a spinal cord injury
M>F
20-29 years
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
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
Features of an incomplete SCI
Some function is present below site of injury
More favourable prognosis
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
