Spinal Cord Injury

Question 1

Defintion

Answer 1

Damage to the spinal cord from trauma, disease or degeneration leading to variable degrees of sensory, motor and autonomic dysfunction below the level of the lesion.

Question 2

Classification

Answer 2

• Complete injury
• Incomplete injury
• Anterior cord syndrome

Question 3

Complete injury

Answer 3

Total loss of sensory and motor function below level of injury

Question 4

Incomplete injury

Answer 4

Preservation of some function below the level of injury. Presentation depends on the part of the spinal cord that is damaged

Question 5

Brown-sequard syndrome

Answer 5

• Hemisection of the spinal cord leading to ipsilatral paralysis and light touch sensory loss + contralateral pain and temp loss below the level of lesion as those nerves dessucate.

Question 6

Anterior cord syndrome

Answer 6

• Damage to the anterior spinal artery affects the anterior 2/3 of the spinal cord
• Motor and spinothalamic pathways affected = loss of pain and temperature sensation
• Dorsal columns typically unaffected = light touch and proprioception preserved
• MC iatrogenic cause = during surgical repair
• Rarer causes = emboli, cardiac arrest, and sickle cell disease

Question 7

Epidemiology

Answer 7

• 16-30
• Males
• Trauma
  = road traffic accidents
  = falls
  = sports injuries

Question 8

Diagnosis

Answer 8

• Neurological assessment using American Spinal Injury Association (ASIA) chart
• Whole body CT
• MRI: assess level of spinal cord injury and vertebral damage
• Urodynamics: evaluate bladder function and guide future management

Question 9

Treatment Acute

Answer 9

• Maintain full in-line spinal immobilisation: High risk of C-spine injury, unable to rotate their neck 45 degrees left and right, dangerous mechanism of injury, or abnormal neurology
• Surgical decompression: for significant or unstable fractures

Question 10

Treatment Chronic

Answer 10

• Tx spasticity: baclofen or pregabalin used to manage muscle spasms
• Rehabilitation: physical and occupational therapy to maximize functional independence

Question 11

Complications

Answer 11

• Neurogenic shock: 2’ to decreased in systemic vascular resistance = profound hypotension
• Pressure sores
• UTI: 2’ to catheter use or neurogenic bladder
• Respiratory complications: such as pneumonia due to reduced lung function