Spinal cord injury

Question 1

Spinal cord injury definition

Answer 1

A disruption to the spinal cord (usually due to trauma)

Question 2

Cauda equina injury definition

Answer 2

Disruption to the nerve roots that lie within the spinal column

Question 3

Epidemiology of spinal cord injury

Answer 3

40k in UK
Males 4:1 females
Age: bimodal distribution

Question 4

Congenital spinal cord injuries

Answer 4

Birth trauma
Spina bifida
Congenital spinal anomaly
Spinal muscular atrophy

Question 5

Cervical lesion between C1 and T1 =

Answer 5

Tetraplegia

Question 6

Thoracic lesion between T2 and L5

Answer 6

Paraplegia

Question 7

AISI impairment scale levels

Answer 7

A (complete)
B (incomplete)
C (incomplete)
D (incomplete)

Question 8

AISI - A

Answer 8

No motor or sensory function is preserved in S5

Question 9

AISI - B

Answer 9

Sensory but not motor function is preserved below the neurological level to S5

Question 10

AISI - C

Answer 10

Motor function preserved, and more than half of key muscles below the neurological level have a muscle grade less than 3

Question 11

AISI - D

Answer 11

Motor function preserved, and at least half of key muscles below the neurological level have a muscle grade of 3 or more

Question 12

Descending motor tracts are where?

Answer 12

Lateral corticospinal

Anterior corticospinal

Question 13

Ascending sensory tracts are where?

Answer 13

Dorsal columns
Anterolateral spinothalamic
Spinocerebellar

Question 14

How is cord injury divided?

Answer 14

Ant. (blood supply lesions)
Post. (dive into empty swimming pools)
Central
Brown-Sequard Syndrome

Question 15

Mobility prognosis for AISI types

Answer 15

A - 1%
B - 35%
C - 75%
D - 100%

Question 16

Excessive vagal stimulation

Answer 16

Lesions above T6 and spinal shock -> loss of parasym control
Overwhelming vagal output - bradycardia + asystole
Prevent by avoiding vagal stimulation -> atropine prior to intubation, suctioning

Question 17

Autonomic dysreflexia

Answer 17

Lesions above T6 in established patients
Precipitated by bladder distension, constipation, skin, soft tissue, bony injuries.
Presents with headache, hypertension, facial flushing, relieve cause, antihypertensives

Question 18

Acute complications

Answer 18

UTI
Resp failure
Pressure sores - osteomyelitis, amyloid, neoplastic change

Question 19

Management of acute spinal cord injury

Answer 19

Bed rest/positioning/skull traction
Prevent further damage to spinal cord
Skin care
Bladder and bowel care
Prevention of thromboembolic and GI complications

Question 20

Management of chronic spinal cord injury

Answer 20

Listen to patient
Appropriate skin care
Bladder and bowel care
Prevention of thromboembolic complications
Different presentations

Question 21

Chronic complications

Answer 21

Progressive neurological declines via syringomelia, neuronal ‘drop-out,’ pain and spasticity.
Rheumatological complications -> degen joint disease, heterotopic ossification