Spinal Cord Injury Flashcards
Spinal Cord Injury Epidemiology
% Cervical, thoracic, and lumbar
50% Cervical (C5 most common)
35% Thoracic
11% Lumbar
4% Unknown
Patients with SCI are ___ - ___ times more likely to die prematurely.
2-5
What age/gender groups are most likely to sustain a SCI?
Males, m/c individuals ages 16-30 (Trauma) and also age 60+ (OA)
What is the most common classification of SCI?
Incomplete paraplegia
What are the most common causes of SCI?
- MVA
- Falls
- Violence
- Sports
- Medical/surgical
Sympathetic nervous system responsibilities and location
Fight or flight
Ganglia in the spinal cord
Parasympathetic Nervous System responsibilities and location
Rest and digest
Brainstem and sacral spinal cord
Parasympathetic nerves are responsible for what?
Sympathetic Nerves are responsible for what?
Primary injury
Initial mechanical force directly damaging the cord
Secondary injury
Persistant physiologic insult
Phases of spinal cord injury
- Acute: Cytotoxic, inflammatory, hemorrhage, edema, necrosis, nerve depol
- Subacute: Macrophage infiltration, excitotoxicity, and scar initiation
- Intermediate: Continued scar formation
- Chronic: Wallerian degeneration, myelomalacia, cystic caviations
Pathophys spinal cord
Impaired auto regulation, loss of sympathetic tone, pooling of venous blood due to atonia results in Hypotension, bradycardia, neurogenic shock
If someone is in neurogenic shock they will appear ____ and ____.
Warm and dry
Neurogenic shock will most often occur at what injury level
Thoracic level injury above T6
Treatment for neurogenic shock
Fluid resusitation then vasopressors (norepinephrine preferred)
When handling a patient with spine trauma how should they be handled initially?
- Immobilization with c-collar, full length backboard, side supports/straps, head of bed flat/log roll only.
What does the exam involve for a spine trauma?
- ABC’s
- Initial neurological survey: gross motor/sensory, tenderness, STEP OFFS, palpable fluid collections/hematoma, bruising or abrasions/wounds
- Later complete neuro exam with additional repeat.
What is the first line imaging for spine trauma (textbook)?
X-ray (AP and Lat + odontoid for c-spine)
What is the first line imaging for spine trauma (in practice)?
CT
How would you treat a stable spine fracture?
Conservative, typically with brace for immobilization
How would you treat an unstable spine fracture?
ORIF, usually a fusion
What are the grades of spinal cord injury?
A (worst)-E (normal)
Transient SCI
comes and goes, spinal shock
* Acute areflexia
* Flaccid paralysis
* Absence of bulbocavernosus reflex
* Resolves in 24-72 hours
Complete
Absence of sensory and motor function distal to injury
* Poor prognosis
* Quadriplegia vs. paraplegia
Incomplete
Some degree of neurological function present distal to injury
* May have sacral sparing-voluntary anal sphinctor tone, perineal sensation, great toe flexion
* Greater function initially = better prognosis
Ascending tracts carry sensory or motor information?
sensory
Decending tracts carry sensory or motor information?
Motor
Dorsal columns are responsible for what?
- Proprioception
- Vibratory sense
- Fine touch
Lateral and ventral corticospinal tracts are responsible for what?
Motor
Lateral spinothalamic tract is responsible for what?
- Pain
- Temperature
Ventral spinothalamic
- Light touch
Central cord syndrome
- m/c incomplete pattern
- m/c involves the cervical spine
- Extension injuries in setting of OA
- Disruption of corticospinal and spinothalamic tract.
Central cord syndrome presentation
- Flaccid paralysis of UE (more common)
- Spastic paralysis of LE
- Sacral sparing
Anterior cord syndrome
- m/c from ischemic injury (compression anterior spinal injury)
- Injury to the corticospinal and spinothalamic tracts
- Equal injury to UE, LE, and sacral area
- Dorsal columns preserved
Anterior cord syndrome symptoms
- Loss of motor, pain, temp, and light touch below level or injury.
- Worst prognosis of incomplete SCIs
What sensations will remain intact in anterior cord syndrome?
Proprioception, position sense, vibratory sense, and discrimination preserved.
Brown-Sequard Syndrome
- Rare, often due to penetrating injury.
- 1/2 of the spinal cord is damaged
Brown-Sequard Syndrome presentation
- Ipsilateral loss of motor, proprioeption, light touch, vibration, position sense, discrimination
- Contralateral loss of pain and temperature
- Good prognosis
Posterior cord syndrome
- Rare, seen with tumors, vascular disorders, demyelinating disorders.
- Injury to dorsal columns
Posterior cord syndrome presentation
Loss of proprioception, position sense, vibration, and discrimination.
Common complications from SCI’s
- Gastritis/ileus-NG tube and H2 blockers
- Urinary dysfunction-foley or intermittent caths (risk UTI)
- Breathing difficulty (C3-5 injury)
- Skin breakdown, reposition every two hours
- Vascular complications
