Spinal Cord Injury

Question 1

How many spinal nerves are there?

Answer 1

31 pairs

Question 2

What are some symptoms of secondary spinal cord injuries?

Answer 2

• 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

Question 3

What are the 4 spinal injury levels?

Answer 3

C4 Injury = tetraplegia
C6 Injury = tetraplegia
T6 Injury = paraplegia
L1 Injury = paraplegia

Question 4

What is the level of disability for a C3/4 lesion?

Answer 4

Fully dependent
Needs full assistance in all cares

Question 5

What is the level of disability for a C4/5 lesion?

Answer 5

Can use wheelchair with hand control.

Needs total assistance

Question 6

What is the level of disability for a C5/6 lesion?

Answer 6

Can use wheelchair with hand control/manual wheelchair.

Can transfer from chair to chair but not floor to chair.

Can live with moderate support.

Question 7

What is the level of disability for a C6/7 lesion?

Answer 7

Can drive a car
Feeds independently
Mostly independent only requiring minimum support.

Question 8

What is the distribution for spinal cord injuries (where they are)?

Answer 8

40% Cervical
10% Thoracic
35% Thoracolumbar
5% Lumbar

Question 9

What are some of the mechanisms of injuries for spinal cord injuries?

Answer 9

Hyperextension
Hyperflexion
Rotation
Vertical compression
Penetrating trauma

Question 10

What is the early management for a spinal cord injury?

Answer 10

Immobilisation
Cervical collar
No air mattress or pillows
Ensure pt is in straight alignment at all times
Spinal assessment

Question 11

What does a spinal cord injury do to the cardiovascular system?

Answer 11

• 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

Question 12

What is neurogenic shock?

Answer 12

Loss of sympathetic nervous stimulation
-Bradycardia
-Bronchial constriction
-No stress response

Question 13

What is spinal shock?

Answer 13

• 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

Question 14

What is central cord syndrome?

Answer 14

-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

Question 15

What is Brown-Sequard Syndrome (BSS)?

Answer 15

-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

Question 16

What is anterior cord syndrome?

Answer 16

-Rare incomplete SCI that has the worst prognosis

Question 17

What is anterior cord syndrome caused by?

Answer 17

Decreased vascular perfusion to the anterior spinal artery.

Can be caused by increased direct pressure of the spinal cord.

Question 18

What are some signs of anterior cord syndrome?

Answer 18

Bilateral loss of motor function, pain, and temperature sensation.

Severe back pain, loss of bladder and bowel function.

Question 19

What is posterior cord syndrome?

Answer 19

-Very rare (1%)
-Affects the posterior aspect of the spinal cord containing dorsal column fibres

Question 20

What are the symptoms of posterior cord syndrome?

Answer 20

-Loss of proprioception
-Sensation of electric shocks running down their spine

Question 21

What are the causes of posterior cord syndrome?

Answer 21

-Vascular compromise to the posterior spinal artery
-Trauma
-Multiple Sclerosis (MS)
-Vitamin B12 deficiency
-Syphilis

Question 22

What is autonomic dysreflexia?

Answer 22

-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

Question 23

When should carry out spinal cord immobilisation?

Answer 23

If they are pain free, and able to rotate their neck 45 degrees.