Spinal Cord Injury

Question 1

Cervical Spine Injury per SCI

Answer 1

most often C5 and C7 flexion, vertical loading and extension accompanied by rot or lat flexion

Question 2

Thoracic Spine Injury per SCI

Answer 2

T12-L1 junction most often flexion motion or vertical compression can cause wedge compression or burst fractures

Question 3

Lumbar Spine Injury per SCI

Answer 3

L1 or L2 levels most often, below these levels caudal equina is most likely to sustain a complete injury * neurological damage is often incomplete due to the large vertebral bodies of the lumbar spine

Question 4

Incomplete SCI - Brown Sequard Syndrom

Answer 4

hemisection of the cord (stab or gsw) w/ ipsilateral loss of dorsal column and corticospinal tracts and contralateral loss of spinothalamic

• Ipsilateral: weakness or motor paralysis loss of proprioception vibratory sense and 2 point discrimination Decreased DTR Clonus Spasticity
• Contralateral: loss of p! and temp below level of lesion

Question 5

Incomplete SCI - Anterior Cord

Answer 5

• Loss of anterior cord, bilateral corticospinal and spinothalamic tracts
• related to flexion injuries of the cervical spine
• loss of motor function, pain and temperature below lesion

Question 6

Incomplete SCI - Central Cord

Answer 6

• Loss of spinothalamic tract and ventral horn (cervical)
• Hyper-extension injuries w/ minor trauma to cervical region
• affects UE sensation and motor functioning with normal LE functioning
• Most common incomplete SCI accounting for 30% all incomplete forms of tetraplegia

Question 7

Incomplete SCI - Posterior Cord

Answer 7

• Loss of dorsal columns bilateral
• Bilateral loss of proprioception, discrimination
• Intact motor function, pain and light touch

very rare deficits of kinesthesia and proprioception -an ataxic gait with wide BOS may result

Question 8

Incomplete SCI - Cauda Equina

Answer 8

• Loss of long nerve roots at or below L1
• flaccid paralysis with no spinal/reflex activity & bowel/bladder
• regeneration is possible because of damage to nerve roots)

Question 9

Incomplete SCI - Sacral Sparing

Answer 9

Most centrally located tracts are intact -perianal sensatoin -rectal sphincter contraction -cutaneous innervation in the saddle area -active contraction of sac rally innervated toe flexors

Question 10

Complications Post SCI

Answer 10

-decubitus ulcers -respiratory (most common cause of Death) -contractures -osteoporosis -DVT -GI problems -Autonomic dysreflexia -orthostatic hypotension -heterotopic bone formation

Question 11

Pulmonary Terms w/ SCI - Vital Capacity

Answer 11

• Diaphragm (C3-C5), Intercostals (T1-T12), Abdominals (T5-T12), Trap (C1-C4), SCM (C1-C3), Scalenes (C3-C5) and Levator (C3-C5)
• C1-C3: <15% of normal for pts on ventilators
• C3-C4: VC often around 15%
• Lesions below C4: average VC 58%
• C6-C8: initially 30% may improve to 50-50%
• High thoracic lesions: VC 58-73%
• T10-T12 VC may be initially low but will improve to 100% generally before discharge

Question 12

Pulmonary Terms w/ SCI - Cough

Answer 12

• ability to expectorate crucial for lung hygiene
• C1-T3: weak or nonfunctional cough
• T4-T8: weak cough
• T10+ functional cough
• Manual cough assistance for C6 or below
• Frog/Glossopharyngeal breathing: high level quads in which aggressive use of tongue, laryngeal and pharyngeal structures are used as respiratory pump to gulp air and increase VC