Spinal cord injury

Question 1

Definition: Spinal cord injury

Answer 1

an insult to the spinal cord resulting in a change in motor, sensory, or autonomic function below the site of the injury, which can be either “incomplete” or “complete”.

Question 2

Tetraplegia (Quadriplegia)

Answer 2

SCI in the cervical region affecting all four limbs and trunk (depending on the level that is affected, can affect trunk, diaphragm, shoulder and arms and hands)

Question 3

Paraplegia

Answer 3

SCI in the thoracic, lumbar and sacral region afecting the lower limbs (with or without trunk involvement)

Question 4

Pathophysiology: SCI

Answer 4

The primary process of spinal cord lesion formation is ischaemic necrosis, which can result from both mechanical and ischemic events. Following trauma, the injured spinal cord swells up and it compresses against the surrounding bone, which leads to disruption of blood and oxygen circulation within the spinal cord, resulting in ischaemic tissue necrosis. Consequently, conduction across spinal cord neurons stops

Question 5

Cental cord syndrome:
is characterized by greater motor impairment in _____ compared to____extremities, and variable degree of sensory loss below the level of injury in combination with bladder dysfunction and urinary retention (_______ arrangement of the white matter).

Answer 5

upper, lower, somatotopic

Question 6

Cause of “Central cord syndrome”

Answer 6

-Hyper extension (backwards fall)
-Common in old adults due to cervical spondylosis
[degenerative OA ; narrowing of vertebral canal]

Question 7

Anterior cord syndrome:
is the most common and severe incomplete syndrome. It is characterized by loss of ___________ below the level of injury, loss of _______ carried by the anterior columns of the spinal cord: _________ tract, __________ tract, and preservation of sensations carried by the __________.

Answer 7

motor function, sensations

• lateral spinothalamic tract … pain, temperature
• anterior spinothalamic tract …crude/light touch
• DCML … fine localised touch, vibration sense, two-point discrimination and proprioception

Question 8

Dorsal Column Medial Lemniscus: __________ sensation

What does it sense?

Answer 8

-Discriminative sensation

fine localised touch, vibration sense, two-point discrimination and proprioception

Question 9

Cause of “Anterior cord syndrome”

Answer 9

• Hyperflexion injury
• The most common causes are insufficiencies within the aorta.(These include aortic aneurysms, dissections, direct trauma to the aorta, surgeries and atherosclerosis)

Question 10

Brown-Séquard syndrome:
is characterized by loss of _____ function (X ______ tract), loss of _______ and _________, loss of _________, loss of ________ on the ipsilateral of the spinal injury (X _________ tract). On the contralateral of the lesion, there will be a loss of ______&______ sensation and _______touch 1 or 2 segments below the level of the lesion (X ________ Tract).

Answer 10

motor = Corticospinal tract
vibration sense, fine localised touch, proprioception, two-point discrimination =DCML
pain & temperature, crude/light =Spinothalamic tract

Question 11

Posterior cord syndrome:
is characterised by a good __________ (________ tract), ____ & _____ and ______ touch sensation (________tract), however they may experience difficulty in ________movement of their limbs (X _________ … proprioception, vibration sense, fine localised touch, two-point discrimination).

Answer 11

muscle power = Corticospinal tract
pain, temperature, crude/light = Spinothalamic tract
coordinating =DCML

Question 12

Cauda equina syndrome:
is a serious neurological condition; lower motor neuron lesion (LMNL), which indicates damage to the nerve roots of the spinal canal below the____________ (L1/L2 intervertebral space) of the spinal cord.

Answer 12

conus medullaris
causing LBP and problems with bowel and bladder function, numbness in the saddle area, which is around the back passage (anus), and weakness/paralysis in one or both legs with no spinal reflex (= areflexia)

Question 13

ASIA A

Answer 13

Complete: No sensory or motor function is
preserved in the sacral segments S4-S5
(Many regain one neurological level )

Question 14

ASIA B

Answer 14

Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.
(50 % may improve one AIS level (i.e. go to C))

Question 15

ASIA D

Answer 15

Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade greater than or equal to 3.
(Less common for these to return to ‘normal’ but still highly functional)

Question 16

ASIA E

Answer 16

Normal: Sensory and motor function is normal