Spinal cord injury

Question 1

Ascending tracts

Answer 1

spinothalamic- pain and temp- crosses in SC, dorsal columns- cutaneous and gracilis- touch, sense, vibration- crosses in medulla
spinocerebellar- uncrossed

Question 2

descending tracts

Answer 2

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

Question 3

why is the SC vital

Answer 3

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%

Question 4

non traumatic SC lesion

Answer 4

degenerative disc disease and SC stenosis, spinal infract, tumour, inflammation of SC, viral infection, developmental/ congenital abnormalities

Question 5

SC injury

Answer 5

80% of cases occur in males, male aged 15-25, 10-80 cases per million per year

Question 6

vulnerable areas of the vertebral columns

Answer 6

C5-7- 55% of all, thoracolumbar0 T12, mid thoracic- T4-7

Question 7

autonomic NS

Answer 7

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

Question 8

pathophysiology of SC lesion

Answer 8

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

Question 9

3 different mechanisms of SC injury

Answer 9

destruction from direct trauma, compression by bone fragment, hamatoma or disc material, schema from damage or impingement on the spinal arteries

Question 10

what is tetraplegia or quadriplegia

Answer 10

impairment or loss of motor control and/ or sensory function in cervical segment of the cord
it affects all 4 limbs

Question 11

what is paraplegia

Answer 11

impairment or loss of motor and/or sensory function in thoracic, lumbar and sacral segments

Question 12

complete SC lesion

Answer 12

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

Question 13

incomplete SC lesion

Answer 13

some sparing of neural activity below the level of lesion, more common- 55-65%, outcome less predictable,

Question 14

incomplete SC lesion- anterior cord syndrome

Answer 14

motor paralysis below lesion, loss of pain and temp, retain proprioception and vibration, cause- disc herination

Question 15

incomplete SC lesion- central cord syndrome

Answer 15

central cord syndrome- associated with whiplash, motor dysfunction in upper limbs, bladder dysfunction, corticospinal and spinothalamic tract

Question 16

incomplete SC lesion- brown- squared syndrome

Answer 16

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

Question 17

incomplete SC lesion- conus medullaris

Answer 17

presentation- sudden, bilateral
radicular pain- less severe 
LBP- more
sensation- peripheral
motor- symmetrical and hyperflexic

Question 18

incomplete SC lesion- cauda equina

Answer 18

presentation- gradual and unilateral 
radicular pain- more severe 
LBP- less
sensation- saddle area
motor- asymmetrical and arcflexic

Question 19

a total transection of the cord will result in

Answer 19

impairment of deep and superficial
impairment of vasomotor control, postural hypotension, autonomic dysflexia, problems with bladder and bowel function, problems with sexual function

Question 20

what is autonomic dysreflexia

Answer 20

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,

Question 21

how to classify SCI using AISA scale

Answer 21

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

Question 22

ASIA impairment scale- A

Answer 22

complete- no motor or sensory function is preserved in the sacral segments S4-5

Question 23

ASIA impairment scale- B

Answer 23

incomplete sensory but not motor function is preserved below the neurological level and includes sacral segment S4-5

Question 24

ASIA impairment scale- c

Answer 24

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

Question 25

ASIA impairment scale- D

Answer 25

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

Question 26

ASIA impairment scale- E

Answer 26

sensory and motor function are normal

Question 27

defining the level of the lesion

Answer 27

most distal uninvolved segment of the cord + skeletal level of the lesion
e.g. paraplegia below T10, due to fracture dislocation of T8

Question 28

ASIA myotomes and dermatomes- Cervical and thoracic

Answer 28

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

Question 29

ASIA myotomes and dermatomes- lumbar and sacral

Answer 29

L2- hip flexors, L3- knee extensors, L5- long toe extensors, S1- ankle PF, S4-5 anal sphincters