Spinal cord injury

Question 1

What are 2 examples of types of insults that can cause spinal cord injury without fracture?

Answer 1

1. Vasular insults
2. Extension/flexion injuries

Question 2

How will a complete spinal cord transection manifest in terms of clinical signs?

Answer 2

complete loss of all function below that level

Question 3

What type of patterns of clinical features are produced by incomplete spinal cord injuries?

Answer 3

very variable patterns

Question 4

What is the initial management of any spinal cord injury?

Answer 4

immobilisation

Question 5

What is the key investigation in suspected spinal cord injury?

Answer 5

urgent CT/MRI

Question 6

What are 3 key types of spinal cord tracts, and what are their functions and where they cross over?

Answer 6

1. Spinothalamic tract: ascending, pain and temperature, crosses at level of entry into spinal cord
2. Dorsal column : ascending, fine touch, vibration/proprioception, crosses in medulla
3. Corticospinal tract: descending, motor function, cross in pyramids of medulla

Question 7

What are 7 types of spinal cord injury to be aware of?

Answer 7

1. Spinal cord transection
2. Anterior cord syndrome
3. Central cord syndrome
4. Posterior cord syndrome
5. Brown-Sequard syndrome
6. SCIWORA: spinal cord injury without radiological abnormality
7. Spinal shock

Question 8

Will recovery occur following complete spinal cord transection?

Answer 8

no

Question 9

What determines recovery/residual function following incomplete spinal cord transections?

Answer 9

according to pattern and severity of injury

Question 10

What are 2 examples of causes of anterior cord syndrome?

Answer 10

1. Flexion injuries
2. Venous thrombosis

Question 11

Which tracts will be damaged and which will be spared in anterior cord syndrome?

Answer 11

• damage to corticospinal and spinothalamic tracts
• sparing of dorsal columns

Question 12

What type of clinical features will be seen in anterior cord syndrome?

Answer 12

loss of motor function and pain/temperature, with preservation of proprioception

Question 13

Which age group is typically affected by central cord syndrome and what is often the cause?

Answer 13

elderly, degenerative bony changes

Question 14

What are the clinical features of central cord syndrome?

Answer 14

• variable levels of quadriplegia with arms affected more than legs (upper limb motor fibres placed more centrally)
• sensory involvement is variable

Question 15

Which tracts will be damaged and which will be spared in posterior cord syndrome?

Answer 15

• damage to dorsal columns leading to loss of fine touch/proprioception
• preservation of corticospinal tract therefore preservation fo motor function

Question 16

What causes Brown-Sequard syndrome?

Answer 16

hemisection of the spinal cord e.g. following penetrating injury

Question 17

What are the clinical signs of Brown sequard syndrome?

Answer 17

• ipsilateral loss of fine touch and proprioception
• ipsilateral reduction of motor function
• contralateral loss of of pain/temperature

Question 18

What causes the clinical picture seen in Brown sequard syndrome?

Answer 18

• all types of tracts affected but only on one side of the spinal cord
• due to where these pathways cross sides, pain and temperature (conveyed by spinothalamic) will be lost on the contralateral side while fine touch and proprioception (conveyed by dorsal column) will be lost on the ipsilateral side
• motor function will be reduced on the ipsilateral side

Question 19

What is the management of Brown-Sequard syndrome?

Answer 19

immobilisation, urgent imaging, advice from spinal unit

Question 20

Which age group is typically affected by SCIWORA (spinal cord injury without radiological abnormality)?

Answer 20

children <8 years but can also be present in adults

Question 21

Why does SCIWORA tend to affect children?

Answer 21

the increased flexibility in paediatric spines can allow severe spinal injury to occur in the absence of abnormal X-ray findings

Question 22

What characterises SCIWORA?

Answer 22

history or, or examination findings of, neurological deficit, without abnormal x-ray findings

Question 23

What is the management of SCIWORA?

Answer 23

• immobilisation
• arrange urgent MRI scan
• senior opinion needed to direct further management

Question 24

What is the definition of spinal shock?

Answer 24

loss of sensation, motor function, and reflexes following spinal cord injury, which is followed by a gradual recovery of reflexes below the level of injury

Question 25

How long does spinal shock typically last for?

Answer 25

24-48 hours

Question 26

What signals the end of spinal shock?

Answer 26

return of reflexes

Question 27

Which is one of the first reflexes to return in recovery from spinal shock?

Answer 27

bulbocarvernosus reflex (compressing glans penis/clitoris) and observe contraction of anal sphincter

Question 28

What abnormalities may persist following resolution of spinal shock?

Answer 28

hyperreflexia and hypertonia

Question 29

Will sensory and motor function return with the return of reflexes following spinal shock?

Answer 29

• yes, may if incomplete spinal injry
• absence of return despite return of reflexes indicates complete spinal cord injury, poor prognosis