Spinal cord injury Flashcards
Ascending tracts
spinothalamic- pain and temp- crosses in SC, dorsal columns- cutaneous and gracilis- touch, sense, vibration- crosses in medulla
spinocerebellar- uncrossed
descending tracts
corticospinal- lateral crosses in medulla, anterior crosses at spinal- lateral motor info to limb, anterior- motor info to axial muscle
vestibulospinal (uncrossed)- integration of head and neck and trunk with extremities
reticulospinal- lateral facilitates flexion and inhibits extension (medial opposite)
rubrospinal (crosses at origin)- control fine movement
tectospinal (crosses at origin)- control muscles in response to visual stimulus
why is the SC vital
conveying sensory info to brain and motor info to and from the periphery, SC lesions may impair motor, sensory and autonomic function
traumatic lesions- 84%
non traumatic SC lesion
degenerative disc disease and SC stenosis, spinal infract, tumour, inflammation of SC, viral infection, developmental/ congenital abnormalities
SC injury
80% of cases occur in males, male aged 15-25, 10-80 cases per million per year
vulnerable areas of the vertebral columns
C5-7- 55% of all, thoracolumbar0 T12, mid thoracic- T4-7
autonomic NS
damage to SC can impact this, parasympathetic- cervical and radial damage and sacral- calms everything down, sympathetic- thoracic and lumbar- responsible for increase BP, HR, Respiratory rate- fight or flight
pathophysiology of SC lesion
need to have normal oxygenation, perfusion, and acid/base balance to aid management of injury
vasogenic oedema and altered blood flow account for clinical deterioration
3 different mechanisms of SC injury
destruction from direct trauma, compression by bone fragment, hamatoma or disc material, schema from damage or impingement on the spinal arteries
what is tetraplegia or quadriplegia
impairment or loss of motor control and/ or sensory function in cervical segment of the cord
it affects all 4 limbs
what is paraplegia
impairment or loss of motor and/or sensory function in thoracic, lumbar and sacral segments
complete SC lesion
complete loss of function below point of injury, outcome more predictable, impairment of motor function
damage to descending pathways- UMN, damage to anterior motor neurone and LMN
spinal shock
at level of lesion- complete destruction of nerve cells= flaccidity, gradually anterior horn cells below level of lesion have ability to recover but have no control from higher centre= spasticity and spasm
incomplete SC lesion
some sparing of neural activity below the level of lesion, more common- 55-65%, outcome less predictable,
incomplete SC lesion- anterior cord syndrome
motor paralysis below lesion, loss of pain and temp, retain proprioception and vibration, cause- disc herination
incomplete SC lesion- central cord syndrome
central cord syndrome- associated with whiplash, motor dysfunction in upper limbs, bladder dysfunction, corticospinal and spinothalamic tract
incomplete SC lesion- brown- squared syndrome
motor deficit and numbness to touch and vibration on same side of lesion, loss of pain and temp sensation on opposite side, most common cause- stab or gunshot wound to cervical or thoracic- spine, crossing and uncrossing of tracts important- crossed will be unaffected
incomplete SC lesion- conus medullaris
presentation- sudden, bilateral radicular pain- less severe LBP- more sensation- peripheral motor- symmetrical and hyperflexic
incomplete SC lesion- cauda equina
presentation- gradual and unilateral radicular pain- more severe LBP- less sensation- saddle area motor- asymmetrical and arcflexic
a total transection of the cord will result in
impairment of deep and superficial
impairment of vasomotor control, postural hypotension, autonomic dysflexia, problems with bladder and bowel function, problems with sexual function
what is autonomic dysreflexia
life threatening, can happen at any stage of SC damage, BP shoots up, intense headaches- try to calm BP, find cause, can be response to pain,
how to classify SCI using AISA scale
determine the sensory and motor level of both sides, determine the single neurological level (lowest segment where normal and motor function) determine wheather the injury is complete or not (sacral sparing), determine ASIA impairment scale grade
ASIA impairment scale- A
complete- no motor or sensory function is preserved in the sacral segments S4-5
ASIA impairment scale- B
incomplete sensory but not motor function is preserved below the neurological level and includes sacral segment S4-5
ASIA impairment scale- c
incomplete, motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade less than 3
ASIA impairment scale- D
incomplete, motor function is preserved below the neurological level and at least half of they key muscles below the neurological level have a muscle grade more than 3
ASIA impairment scale- E
sensory and motor function are normal
defining the level of the lesion
most distal uninvolved segment of the cord + skeletal level of the lesion
e.g. paraplegia below T10, due to fracture dislocation of T8
ASIA myotomes and dermatomes- Cervical and thoracic
C5- sh abd/LR, elbow flexors
C6- wrist extensors/ flexors, pronators and supinators
C7- sh ADD/MR, elbow extensors, C8- finger flex/ext
T1- finger abduction
ASIA myotomes and dermatomes- lumbar and sacral
L2- hip flexors, L3- knee extensors, L5- long toe extensors, S1- ankle PF, S4-5 anal sphincters
