Spinal Cord Injury Flashcards
primary spinal cord injury
actual physical disruption of axons
results in disruption of neurologic tissue or vascular supply
immediate trauma on the spinal cord
types of primary spinal cord injury
vertical compression
axial loading
hyperflexion
hyperextension
rotation
stretch
laceration
contusion
secondary spinal cord injury
progressive injury that can occur minutes to hours after injury
24 hr period following SCI
manifested by neurological deterioration over first 8-12 hrs
results in spinal cord edema, and then eventually central hemorrhagic necrosis
vertical compression, axial loading
vertical force along the spinal cord
fall from heights, landing on feet
diving
compression injuries cause burst fractures of vertebral body that often and bony fragments into spinal canal/cord
hyperextension
injuries involve backward & downward motion of head/neck
seen in rear-end collisions
spinal cord is stretched, distorted
neuro deficits caused by contusion & ischemia of cord without significant bony involvement
hyperflexion
seen in head on collisions
sudden deceleration of the motion of the head
dislocates anterior vertebrae, posterior ligaments of cervical spine torn and cord is compressed
flexion-rotation
severe rotation of neck or body results in tearing of posterior ligaments and displacement (rotation) of the spinal column
t-bone MVA
most unstable
causes of secondary SCI
ischemia
hypoxia
inflammation
edema
exctitotixicity
disturbances on ion homeostasis
apoptosis
effect of edema in secondary SCI
compression of cord and extension of edema above and below injury
causes ischemic damage
functional injury
degree of disruption of normal spinal cord function
depends on what motor structures and nerve tracts are damaged
cannot be classified for several days until spinal shock resolves
effects of a injury at C1-C4
requires electric WC with breath, head, or should controls
needs ventilatory support
effects of a injury at C5
electric WC with hand controls
may require adaptive devices for ADLs
effects of a injury at C6
independent, manual WC, hand controls, adaptive devices for ADLs
effects of a injury at C7
manual WC
effects of a injury at C8-T1
may need adaptive devices for ADLs
spinal shock
occurs shortly after injury, can last weeks, but resolve spontaneously
physiologic transection of spinal cord that results in temporary loss or depression of all or most spinal reflex activity below level of injury
spinal shock manifestation
decreased reflexes
loss of sensation
absent thermoregulation
flaccid paralysis
all below level of injury
spinal shock treatment
symptomatic treatment
neurogenic shock
loss of SNS innervation from the brainstem
unopposed vagal stimulation
massive peripheral vasodilation
venous pooling
decreased venous return to heart
decreased cardiac output
manifestations of neurogenic shock
unopposed parasympathetic stimulation
hypotension
bradycardia
decreased CO
hypothermia
treatment for neurogenic shock
fluids
pacer
vasopressors
warmer
atropine
complete SCI
possible inability to sustain spontaneous ventilation
total loss of sensory and motor function below the level of injury
results in quadriplegia (from C1-T1) or paraplegia (from T2-L1)
incomplete SCI
mixed loss of voluntary motor and sensory function below level of lesion
if ANY function remains below the level of injury
central cord syndrome
motor and sensory deficit more pronounced in UE than LE, often spastic (can move LE better)
mostly in cervical spine and caused from hyperextension
