Spinal Cord Injury Flashcards
Two most common causes of non-traumatic spinal cord injury?
Tumor, inflammatory/autoimmune
What is the most common level of injury for children and adolescents suffering SCI?
Cervical
What percentage of pediatric SCIs are incomplete?
90%
What is the most common cause of traumatic SCI in children?
MVC’s
At what age is the ASIA exam thought to be reliable
6 years old
What type of injury typically causes central cord syndrome?
Hyperextension
What type of bladder impairment is typically seen in central cord syndrome?
Urinary retention
How is pain/temp affected in Brown-Sequard syndrome?
Contralateral loss starting two levels below the lesion.
What is the typical mechanism of injury for anterior cord syndrome?
Hyperflexion injury
At what level does the spinal cord terminate?
L1/L2
What are four anatomic vulnerabilities that increase children’s susceptibility to SCIWORA?
Underdeveloped neck muscles, ligament laxity, horizontal facet joints, large head to trunk ratio
What age group has a higher incidence of SCIWORA?
9 and under
In what age group are cervical SCIWORA injuries more common?
3 and under
Most common cause of SCIWORA in the 11 to 17 age group?
Sports
What is the standard treatment for SCIWORA with MRI findings?
Hard collar bracing for 12 weeks
What is the treatment for self-resolving SCI symptoms with normal MRI?
Hard collar brace for 1-2 weeks with close follow-up
What are the three criteria for a spinal cord concussion?
- Spinal trauma with immediate neurological deficit
- Deficit corresponds to level of spinal injury
- Complete recovery within 72 hours
What spinal abnormality are patients who suffer a spinal cord concussion at risk for developing?
Syringomyelia (up to 15% at 2 year follow-up)
At what age do cervical vertebrae reach adult size?
10
A Minerva body jacket is as effective as a halo in stabilizing what level cervical injuries?
Mid to lower portion of cervical spine
When do most VTE’s after SCI occur?
Within in 90 days
What is the greatest independent risk factor for VTE in the setting of pediatric trauma?
Central venous catheter (CVC)
Under what age does risk of a VTE significantly decrease?
14
Recommended length for chemoprophylaxis in an adult with SCI without additional risk factors?
At least 8 weeks
What risk factors argue for VTE chemprophylaxis longer than 8 weeks in an adult with SCI? (6)
Older, obesity, cancer, complete injury, lower extremity fracture, history of VTE
Length of anticoagulation treatment for first provoked VTE?
3 months
ASIA examination at what time after injury allows for best prognostication?
72 hours
Recovery of pinprick or light touch associated with more motor recovery?
Pinprick
When does most recovery from SCI occur?
first 6 months, plateau reached around one year
What percentage of ASIA A level SCI patients will be functional ambulators at one year?
Up to 5 percent
What percentage of patients with ASIA B will be functionally ambulating at 1 year?
33%
What physical exam finding significantly increases the odds of an ASIA B SCI patient being able to ambulate at 1 year post-injury?
Intact sacral pin prick sensation
What are the odds of ASIA C and D SCI patients being able to functionally ambulate at one-year post injury?
About 80%
What level injury is able to use their extremities for feeding/upper body dressing and complete lower body dressing with an assistive device?
C6
What level ASIA injury can drive and self-catheterize?
C5
What level can self-feed and complete upper body dressing with assistive devices?
C5
What level ASIA injury can be fully independent needing only an assistive device for lower body dressing?
C7
What medication has the best evidence to treat orthostasis in SCI patients?
Midodrine
How can FES help treat orthostasis?
It can increase venous return to the heart
What age are typical children normally independent with a majority of self-care activities with supervision?
5 years old
When teaching self-care to a child with an SCI injury, which activity is usually first?
Self-feeding
At what age should a child with an SCI injury be introduced to self-catheterization?
3 years old
What is the goal age range for self-catheterization in a child with an SCI injury?
5 to 7 years old
What is the usually timing for urodynamic testing after an SCI? Why?
3 months to allow for resolution of spinal shock
Are antibiotics typically recommended for UTI prophylaxis in SCI patients?
No
What is the Mitrofanoff procedure?
Using the appendix to create a conduit from the bladder to abdominal wall with formation of a stoma in order to allow for easier self-catheterization.
What are the benefits of bladder augmentation surgery in an SCI patient?
Increases the volume of the bladder, reduces frequency of catheterization, and reduces the risk of renal damage
What can patients with bladder augmentation be at increased risk for?
Urolithiasis
Where is the electrode typical implanted with sacral neuromodulation to treat overactive bladder?
S3 foramen
What is the Malone Antegrade Continence Enema (MACE) procedure?
The appendix is used to create a induct from the cecum to the abdominal wall with creation of a stoma to allow for antegrade enema
When monitoring pulmonary status in SCI patients, what are signs and symptoms to watch for? (5)
snoring, secretions,, headache, cough, change in mental status
How long does senna and bisacodyl typically take to work?
6 - 12 hours
What are two side effects of metoclopramide?
Cardiac arrhythmia, extrapyramidal effects
How do most bowl medications work (magnesium, lactulose, PEG)?
By drawing water into the gut to stimulate colonic motility
How does mechanical ventilation in an SCI patient differ from a patient with ARDS?
Ventilation in an SCI patient requires HIGH tidal volumes (12-20ml/kg of ideal body weight)
In an SCI patient on mechanical ventilation, how are high tidal volumes of benefit?
They facilitate early weaning
When should parenteral feeds be considered in an SCI patient?
If nutrition needs are not otherwise met in 5 days
What presents with nausea, vomiting, abdominal pain, bloating, AD, and increased spasticity in an SCI patient?
Superior mesenteric artery syndrome (SMA)
How is superior mesenteric artery syndrome diagnosed?
CT of abdomen with contrast
What is the treatment for superior mesenteric artery syndrome?
Left side-lying, abdominal decompression with an NG, high-calorie feeding with a NJ or TPN
What grade pressure injury is consistent with full-thickness skin loss?
III
What is a grade one pressure injury?
Non-blanchable erythema
What is the standard for repositioning a SCI patient in bed?
Every 2 hours
How often and for how long should a patient in a wheelchair preform a weight shift (independent and dependent)?
Independent: every 15 minutes for at least 15 seconds
Dependent: every 30 minutes for at least 30 seconds
How does autonomic dysreflexia typically present?
With hypertension, bradycardia and vasodilation above the level of the injury.
When after an SCI injury does AD typically present?
Majority of cases do not occur until 3 to 6 months post injury
What are the two most common causes for AD in a child with SCI?
Urologic (75%) followed by bowel impaction (18%)
How often should blood pressure be monitored when treating AD?
Every 2-5 minutes
What class of medications can be helpful for prophylactic treatment of AD in SCI patients?
Alpha-1 blockers (prazosin, terazosin)
When after injury is hypercalcemia typically seen?
1 to 4 months after injury
What are two treatments for hypercalcemia?
Fluids, diuretics (furosemide)
What is the most common site for HO in SCI patients?
Hip
How does timing of development of HO differ in the pediatric SCI population?
It is more delayed (4 months on average and up to about 12 months) than in adults (2 months on average and up to about 6 months)
What are 3 risk factors for HO in the SCI population (among others)?
ASIA A or B, pelvic trauma, spasticity
What is the prophylactic treatment for HO in ASIA A and B patients?
NSAIDs (indomethacin) for at least 15 days
Besides NSAIDs, what is another prophylactic treatment for HO?
Low-dose radiation
Do you have to wait for HO to mature before surgical removal?
No
What level pediatric SCI patients are at risk for difficulty with temperature regulation?
T8 and above
What are three classes of medications that can reduce heat dissipation?
Anticholinergics, antihistamines, and serotoninergic drugs
What are two types of medications that can reduce ability to conserve heat?
Opioids, sedatives
What are two risk factors for development of a latex allergy in a pediatric SCI patient?
Younger age at time of exposure, repeated exposures
When does spinal shock typically resolve?
Within weeks
When does spasticity typically develop after SCI?
In weeks to months
Can SDR be done in children with SCI?
Yes
What is the most common orthopedic complication in children with SCI?
Neuromuscular scoliosis
What age children with SCI are at higher risk of needing surgery for scoliosis?
Those under 12
What is the benefit of using a TLSO bracing in children with neuromuscular scoliosis after SCI?
It can delay rate of curve progression and delay need for surgery
At what angle is surgery for neuromuscular scoliosis in a child with SCI typically recommended?
Over 40 degrees
At what age of SCI are children at a significantly higher risk of hip subluxation?
Children who sustain SCI before age 10 are at much higher risk (about 90% vs 10%)
What type of SCI injury is most at risk for a pathologic fracture?
Complete paraplegic
What is the timing of decrease in bone mineral density after SCI?
Between 6 months to 2 years
At what level injury is the parasympathetic reflexogenic erection maintained?
Below L2
How is sperm affected in an SCI patient?
Low motility and viability
At what level injury can penile vibratory stimulation (PVS) be expected to be effective?
At or below T10
What spinal levels mediate a psychogenic erection?
T11-L2
When does fertility typically normalize in women with a SCI?
After 6 months to one year
When do nerve transfer surgeries for peripheral nerve injuries need to take place? Why?
Within 6 to 12 months before development of muscle fibrosis
How long might a patient with an UMN injury wait before pursing nerve transfer?
Up to 2 years to allow for natural recovery
What age group in children is most at risk for SCI?
Adolescents (6 times more likely than in children)
When does HO show up on XR?
About 3 - 6 weeks after symptom onset
Other than medication, what can halt progression of HO?
low-dose radiation
Can a patient with C5 injury roll in bed?
no, requires mod to max assist
What activity does a C6 patient need assistance with?
bathing
What are two activities that a C6 patient may be independent with but it is not expected?
level surface transfers, rolling
What activity may a C7 patient be independent with but it is not expected?
bathing
What is the one activity besides bathing that a C7 patient may need assistive devices to complete?
lower body dressing
Besides lower body dressing, what are two ADLs a C6 can complete independent with assistive devices?
bladder and bowel care
Can a C5 preform bowel care?
no
Can a C5 preform bladder care?
yes, with assistive devices but not expected
