Spinal Cord Injury Flashcards
How many spinal nerves are there?
31 pairs
What are some symptoms of secondary spinal cord injuries?
- Spinal swelling and
secondary ischaemia
Loss of spinal autoregulation
Hypotension and hypoxia
are very significant
Release of excitatory amino
acids (Glutamate),
activation of NMDA
receptors, and other
cytotoxic substances
resulting in cellular
hypoxia and apoptosis
What are the 4 spinal injury levels?
C4 Injury = tetraplegia
C6 Injury = tetraplegia
T6 Injury = paraplegia
L1 Injury = paraplegia
What is the level of disability for a C3/4 lesion?
Fully dependent
Needs full assistance in all cares
What is the level of disability for a C4/5 lesion?
Can use wheelchair with hand control.
Needs total assistance
What is the level of disability for a C5/6 lesion?
Can use wheelchair with hand control/manual wheelchair.
Can transfer from chair to chair but not floor to chair.
Can live with moderate support.
What is the level of disability for a C6/7 lesion?
Can drive a car
Feeds independently
Mostly independent only requiring minimum support.
What is the distribution for spinal cord injuries (where they are)?
40% Cervical
10% Thoracic
35% Thoracolumbar
5% Lumbar
What are some of the mechanisms of injuries for spinal cord injuries?
Hyperextension
Hyperflexion
Rotation
Vertical compression
Penetrating trauma
What is the early management for a spinal cord injury?
Immobilisation
Cervical collar
No air mattress or pillows
Ensure pt is in straight alignment at all times
Spinal assessment
What does a spinal cord injury do to the cardiovascular system?
- Contractility of the heart and vascular resistance
is controlled by the autonomic system - Sympathetic and parasympathetic systems work together to maintain stable BP and heart rate
- A spinal injury disrupts the descending spinal
pathway - This results in an underactive sympathetic
nervous system, which in turn means the
parasympathetic system is unopposed
What is neurogenic shock?
Loss of sympathetic nervous stimulation
-Bradycardia
-Bronchial constriction
-No stress response
What is spinal shock?
- Associated with
autonomic
dysfunction,
bradycardia,
hypothermia, and
peripheral
vasodilatation - Usually does not
occur with lesions
below T6 - If no neurological
deficit exists,
hypotension is not due to spinal
shock
What is central cord syndrome?
-Most common of the incomplete SCI
-Common cause in pts over 50yrs is hyperextension
-Common cause in pts under 40yrs is high velocity trauma
-Sensory loss
-Motor loss
-Autonomic regulation
What is Brown-Sequard Syndrome (BSS)?
-Rare type of incomplete SCI
-Usually seen in penetrating trauma
-Presents with ipsilateral loss of motor function, sensation and contralateral loss of pain and temperature
What is anterior cord syndrome?
-Rare incomplete SCI that has the worst prognosis
What is anterior cord syndrome caused by?
Decreased vascular perfusion to the anterior spinal artery.
Can be caused by increased direct pressure of the spinal cord.
What are some signs of anterior cord syndrome?
Bilateral loss of motor function, pain, and temperature sensation.
Severe back pain, loss of bladder and bowel function.
What is posterior cord syndrome?
-Very rare (1%)
-Affects the posterior aspect of the spinal cord containing dorsal column fibres
What are the symptoms of posterior cord syndrome?
-Loss of proprioception
-Sensation of electric shocks running down their spine
What are the causes of posterior cord syndrome?
-Vascular compromise to the posterior spinal artery
-Trauma
-Multiple Sclerosis (MS)
-Vitamin B12 deficiency
-Syphilis
What is autonomic dysreflexia?
-Defined as a sudden uncontrolled rise
in BP with a pathological response to sympathetic stimuli
-Causes include constipation and urine retention
-Symptoms includes headache, sweating/shivering, chest tightness
-SBP can reach 250-300mmhg
When should carry out spinal cord immobilisation?
If they are pain free, and able to rotate their neck 45 degrees.
