Spinal Cord Injury (Exam 2) Flashcards
What is a traumatic SCI and what is it caused by?
- Irreversible damage to the spinal cord
- Caused by: mechanical force
Traumatic SCI: MOI
What factors can affect vertebral injury?
- Direction of force applied to system
- Position of person’s head at time of injury
- Magnitude, rate of application and duration of injuring force
- Point of application
What are the most common damaging forces in the C-spine?
- Flexion
- Vertical loading
- extension
In hyper flexion injury anterior structures are (BLANK) and posterior structures are (BLANK)
- Compression anterior
- Posterior are distracted
What areas of the C-spine are most commonly injured during hyper -flexion injury?
C5-C7
What type of cord syndrome can be caused because of a hyper-flexion?
anterior cord syndrome
(Cervical) Flexion with rotation mechanism of SCI is often seen with what?
Lateral flexion
What does flexion with rotation MOI often result in?
- Dislocation and locking of a single facet joint
- Possible fracture of lamina or pedicle
What neurological damage can occur in a flexion with rotation MOI?
- Brown Sequard
- Nerve roots
A vertical compression/axial loading MOI occurs with what type of force?
High velocity blow to top of head
Vertical compression/axial loading MOI often have what injury associated with them?
- Often have burst fracture
- Fracture fragments may migrate posteriorly and enter spinal canal and lodge in cord
- Rupture of disc
Where does vertical compression/axial loading most often occur in the C-spine?
C4-C5 resulting in complete quadriplegia
What force cause can cause a hyperextension injury to the cervical spine?
Strong posterior force
- Rear end collision
- Fall & hit chin or forehead
With hyperextension of cervical spine structure anterior are (BLANK) and structures posterior are (BLANK)
- Anterior is distracted
- Posterior is compressed
What cord lesion can hyperextension cause?
Central cord lesion
Why is the thoracic spine more stable than the cervical spine?
Rib cage T1-T10
What junction is most commonly injured?
T12-L1
Flexion MOI of the thoracic spine result in what injuries?
- Wedge fracture
- Posterior ligamentous complex may be damaged due to distractive forces (severe)
Vertebral compression MOI of the thoracic spine results in what injuries?
- Burst fractures result in bone fragments into spinal canal
- Penetrating injury
What force causes a flexion - rotation injury to the lumbar spine?
Posterior to anterior force directed at rotated vertebral column
What injuries are typically caused by flexion-rotation injuries to the lumbar spine?
- Typically causes fracture & dislocation
- Posterior ligamentous complex is ruptured accompanied by vertebral body fractures
Flexion-distraction (Chance Fracture) often results from what?
Use of lap belt without shoulder restraint
How does lap belt cause a flexion - distraction (Chance Fracture)?
- Lap belt becomes a pivot point (fulcrum)
- Flexion distraction force from that point
In a flexion-distraction (Chance Fracture) how are fractures and ligamentous tears oriented?
- Where is the injury?
- What other injuries may occur?
- Oriented: horizontally
- Injury in thoraco-lumbar junction
- May have severe internal injuries
In traumatic SCI often secondary microvascular, biochemical, and cellular processes happen what can this result in?
- Apoptosis, Edema, Inflammation
- Release of glutamate
- Imbalance of calcium levels
What are the 6 etiologies of non traumatic SCI?
- Vascular damage (hemorrhage, ischemia, AVM)
- Space occupying lesion (neoplasm, syrinx, abscess)
- Infection (transverse myelitis)
- Primary damage (MS, ALS)
- Compression (degenerative joint disease)
- Myelomeningocele (most serious form of Spina Bifida)
What is tetraplegia?
What area of the spine is injured to result in tetraplegia?
- Tetraplegia: involvement of all 4 extremities and the trunk
- C1-C8
What is paraplegia?
What area of the spine is inured to result in paraplegia?
- Paraplegia: Involvement of the legs and part of the trunk
- T1-S5
For an injury to be classified as incomplete what needs to be spared?
Some sparing of sensory and/or motor function
Where is the highest SCI injury frequency at?
C5-C7 and T12-L2
T/F: SCI result in a lot of financial impact
True
What is the most common spinal cord injury diagnosis?
Incomplete tetra
What is the ABC of the initial management of SCI?
Airway
Breathing
Circulation
What is the initial management of SCI?
- Management of life threatening injuries
- Spinal stabilization/immobilization (no A/PROM, backboard, C- collar)
- Transportation to trauma center
After arriving at the trauma center after SCI what is done?
- Ensure optimal ventilation & circulation
- Diagnosis of SCI (physical, neurological & imaging)
What are the types of imaging used to diagnosis SCI?
- Radiographs
- CT
- Myelography
- MRI
What radiographs will be used to diagnose SCI?
- C -Spine lateral radiographs (rapid and effective w/ 85% accuracy)
- Open mouth & AP radiographs (almost 100% accuracy)
What information does a CT give when diagnosing SCI?
Valuable information on impingement on neuronal canal as well as bony limits of spinal cord
T/F: Myelography is rarely used alone, may be used in conjunction with CT
True
What information does a MRI give when diagnosing SCI?
- Appropriate imaging technique for visualizing the necessary tissue
- However, in acute SCI other equipment in the surrounding area may limit its use
Once the patent is in the ICU they receive close monitoring of what systems?
- Respiratory Status
(may require ventilator) - Organ function
- Cardiovascular status
(avoid hypotension & hypoxia) - Bowel/bladder management (catheter insert)
- Integumentary integrity
T/F: There is not evidence to support the use of pharmacologic agents to improve outcomes
True
What is the intent of high dose steroids?
- Reduce edema to increase motor recovery
New research shows does not lead to improved functional outcomes & can have negative effects
What is the purpose of acute pharmacological management of SCI?
- Aimed at managing neurologic sequelae & secondary complication (pain, heartburn/ulcers, infection, constipation, preventive)
What is the intent of local & systemic hypothermia?
- Reduce secondary damage & neuroprotection
- Body temp is systematically cooled to minimize secondary ischemia. cell death, oxidative stress, inflammation & edema
T/F: Further research is needed on the effectiveness and dosage of local & systemic hypothermia
True
When is an open reduction surgery indicated?
- Unstable fracture site
- Cord compression
- Malalignment
- Deteriorating neuro status