Spinal Cord Injury Flashcards
What is the main cause of spinal cord injury?
Physical trauma
Contact sports, car accident, assualt, fall, alcohol
Are males more or less likely to have spinal cord trauma?
Four times more likely
What percentage of head injuries have a concurrent C-spine injury?
10-20%
What percentage of head injuries have an associated spinal injury elsewhere?
30%
In what percentage of spinal injuries is a neurological deficit seen?
30%
Which spinal cord segments are most prone to injury?
50% C6/7
30% C2
In children, which spinal cord segments are most prone to injury?
C1-2
Heavier heads, lax ligaments
What are the forces involved in injury?
Hyperflexion (forward) Hyperextension (backward) Lateral stress (sideways) Rotation (twisting) Compression (force along axis of spine downward from head or upward from pelvis) Distraction (pulling apart of vertebrae)
What are the likely consequences of flexion injuries?
Fractures and dislocations.
Often leads to neurological injury.
What are the likely consequences of extension injuries?
Fractures (hangman’s, teardrop)
Dislocations (anterior atlanto-axial)
What are the causes of complete cord transection?
Trauma Infarction Transverse myelitis Abscess Tumour
What are the clinical features of complete cord transection?
Complete loss of sensation below lesion " " paralysis " " " " Spinal shock and autonomic dysfunction (higher lesions) Hypotension Priapism
What is brown-séquard syndrome?
Compete spinal hemisection (rare) leading to unilateral cord compression/injury
What are the causes of brown-séquard syndrome?
Penetrating trauma Fractured vertebrae Tumour Abscess Multiple sclerosis
What are the clinical features of brown-séquard syndrome?
Ipsilateral loss of motor function, conscious proprioception, vibration, and touch sensation.
Contralateral loss of pain and temperature sensation.
What is anterior cord syndrome?
Loss of function of anterior portion of spinal cord.
What are the causes of anterior cord syndrome?
Flexion injury (fraction/dislocation of vertebrae, herniated discs) Injury to anterior spinal artery (vascular/atherosclerotic in elderly, iatrogenic secondary to intraoperative aortal cross clamping)
What are the clinical features of anterior cord syndrome?
Flaccid paralysis below level of lesion
Loss of pain/temperature
Autonomic dysfunction (bowel, bladder, sexual)
Preservation of dorsal tract modalities
What are the causes of central cord syndrome?
Trauma (hyperextension (elderly), hyperflexion (younger) of cervical spine) Disruption of blood flow to spinal cord Cervical spinal stenosis Degenerative spinal disease Syringomyelia Central canal ependymoma
What is syringomyelia?
Development of a cyst in the spinal canal, obliterating spinothalamic fibres decussating in white commissure.
What are the clinical features of syringomyelia?
Loss of pain/temperature sensation (‘cape’ distribution)
Light touch and proprioception preserved
What are the clinical features of central cord syndrome?
Motor function lost, moreso in upper than lower extremity
Bladder dysfunction, urinary retention
What are the causes of posterior cord syndrome?
(Rare) Spondylosis Spinal stenosis Infection Vitamin B12 deficiency Occlusion/infarction of one of paired posterior spinal arteries
What are the clinical features of posterior cord syndrome?
Loss of conscious proprioception, vibration, two point discrimination, light touch.
Motor, pain, temperature, and firm touch preserved.
What is the nonsurgical management of cord injuries?
Intubation if C5 or above ICU admission Early C-spine immobilisation (Maintain C-spine restriction for ~6 weeks) PT/OT
When should surgical management of cord injuries be undertaken?
With progressive neurological deficits
Unstable spinal fractures
When should you assume a spine injury is present?
Head injury Unconscious/confused Spinal tenderness Extremity weakness Loss of sensation
