Spinal Cord Injury (Lecture) Flashcards
define SCI
Direct or indirect involvement of the spinal cord resulting in the alteration or complete cessation of all CNS fonctions including:
- Motor system
- Sensory system
- AND Autonomic system
anatomy of the spinal cord - vertebral column, peripheral nerves, spinal cord external segment
- 7 cervical, 12 thoracic, 5 lumbar, 5 (fused) sacral 4 (fused) coccyx vertebrae
- maximal flexion at cervical level, lowest at thoracic (majority of thoracolumbar legions)
- 31 pairs of peripheral nerves, named corresponding to the above or below spinal cord segment
- cauda equina distal (45cm) to conus medullaris
describe the relationship between a vertebral injury and how it affects the corresponding neurological segments
- vertebral level does not necessarily correspond to the neurological level
- low cervical = same level
- high thoraccic = 1-2 levels different
- low thoracic and lumbar = 3-4 levels different
describe the internal spect of the spinal cord - grey and white matter
grey (non-myelinated fibres)
- horiszontal pathway
- ventral horn, posterior horn, lateral horn -> (at thoracodorsal level, ANS)
white (myelinated tracts)
- topographic organization: ascending and descending tracts (posterior, anterior, and lateral columns)
- somatotopic organization: within each tract, UE represented in middle area and LE represented in outer area
describe the blood supply to the spinal cord
what is the asia scale?
- americal spinal injury association
- designed for traumatic lesions but used for both traumatic and non
- determines lesion at the SPINAL CORD level and its SEVERITY
- evaluates sensory and motor level with patient in supine
asia definition of tetra vs paraplegia
Tetraplegia
- impairment/loss of motor or sensory function at cervial level (stops at level T1), due to damage of neural elements within the spinal canal
- result is trunk, UE, LE, and pelvic organ impairment
Paraplegia
- impairment or loss of function (motor or sensory) at the thoracic, lumbar or sacral segments (but not cervical) of the SC, secondary to damage of the neural elements within the spinal canal (starts at level T2)
- result is sparing of arm function but impairment at trunk and/or legs (depending of the level of the lesion), bowel/bladder, sexual function
define ASIA complete vs incomplete injury and the scale
complete: absence of sensory and motor function in the lowest scral segments (s4-5)
incomplete: partial preservation of sensory and/or motor function of the lowest scaral segments (s4-5)
- Sacral sensation includes sensation at the anal mucocutaneous junctions as well as deep anal sensation.
- test of motor function is voluntary contraction of the external anal sphincter upon digital examination.
define neurological sensory and motor level wrt the ASIA scale
- neurological level: last segment normal on sensation and motor on both sides
- sensory level: most caudal dermatome with normal sensation to light touch AND pin prick (on each dermatome) - for pin prick 8/10 correct, if clear after 2 or 3 times, dont have to repeat it 10 times - 3 point scale, 0=absent, 1=impaired, 2=normal
- motor level: The most caudal myotome having at least 3/5 and all myotomes above are at 5/5 - patient is supine, evaluate R and L, muscle grade 0-5 (no + or -) *Since there are no myotomes at the trunk level and above C5, the motor level will be the same as the sensory level
- vertebral level: according to x-rays (which has the greatest damage)
what are the reccomended steps in the ASIA classification?
1) Determine sensory levels for the right and left sides.
2) Determine motor levels for the right and left sides.
3) Determine the single neurological level; lowest segment where motor and sensory function is normal on both sides. It is the most cephalad segment as determined in step 1 and 2.
4) Determine if lesion is complete or incomplete (segment S4 S5).
- If no voluntary contraction of the anal sphincter and no anal sensation (sensory score = 0) COMPLETE. Otherwise, LESION IS INCOMPLETE.
5) Determination of ASIA Impairment Scale (AIS)
what is central cord syndrome?
- incomplete lesion
what is Brown-Sequard syndrome?
- incomplete lesion
what is anterior cord syndrome?
- incomplete lesion
what is conus medullaris?
- incomplete lesion
what is cauda equina syndrome?
- incomplete lesion
what is posterior cord syndrome?
- incomplete lesion
SCI clinical manifestations - what does level of the lesion determine and what does severity of the lesion determine?
what are some clinical manifestations of SCI?
describe the clinical manifestation/elinical evaluation wrt voluntary motor function in SCI patients
describe the clinical manifestation/elinical evaluation wrt sensory function in SCI patients
describe the clinical manifestation/elinical evaluation wrt muscle tone function in SCI patients - include the 5 cardinal signs for an upper motor neurone lesion??
how is respiratory function affected for SCI patients?
Deficits depending on the level and severity of the lesion:
- Tetraplegia C1-C3 - AIS A, B ventalator dependant
- Tetraplegia: Weak ineffective cough, ↓ VC
- High paraplegia; effective but weak cough, ↓ VC
- Low paraplegia; strong effective cough (near or normal), normal VC
Describe pain management in SCI patients
what are other things to assess in SCI patients (apart from pain, motor, sensory, etc)
how to treat pressure sores
how to treat postural hypotension
how to deal with autonomic dysreflexia
- can be life threatening
- a relfexive reaction of the sympathetic system caused by a noxious stimulus below the level of the lesion (leasons above T6)
- causes: most often bladder distension, constipation, stretching
- common clinical manifestations: headache, flushing, high BP (150-250 mmHg), other signs of sympathetic activity
what is thrombophlebitis?
describe the complication: contractures
A contracture is a shortening of muscles, tendons, or ligaments after a SCI. Contractures limit movement of a joint.
what is the prognosis for different AIS SCIs?
Functional outcomes:
AIS A, B, NO COMPLICATIONS
END RESULT WILL DEPEND ON:
AGE, MEDICAL HX, COMPLICATIONS, ASSOCIATED CONDITIONS
Describe innervated muscles, available movements, functional outcomes, and treatment emphasis for: C4 SCIs
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Describe innervated muscles, available movements, functional outcomes, and treatment emphasis for: tetra and paraplegia for AIS C and D
