Spinal cord lesions

Question 1

What area of the rib restricts thoracic rotation?

What are high areas of stress in the spine?

Answer 1

Rib restricts thoracic rotation.

L1, T12, C6,C7

Question 2

Describe the curvature of the spine

Answer 2

Cervical/thoracic- lordosis- inward curvatue
Thoracic/lumbar-kyphosis- outwards curvarture
Lumbar/Sacral- lordosis- inwards curvature

Question 3

What is conus medularis?

What does damage to this present as?

What is cauda equina?

Answer 3

Termination of the spinal cord

Upper and lower motor neuron signs

Tail of spinal cord

Question 4

What is a dermatome?

Answer 4

Area of skin supplied by a single spinal nerve

Question 5

What is a myotome?

Answer 5

Group of muscles that a single spinal nerve innervates

Question 6

What are the myotomes of the upper limbs?

Answer 6

C5- shoulder abduction
C6- elboww flesion/wrist extensors
C7- elbow extensors
C8- long finger flexors
T1- finger abduction

Question 7

What are the myotomes of the lower limb

Answer 7

L2- hip flexion
L3- knee extension
L4- ankle dorsiflexion
L5-Big toe extension
S1- ankle plantar flexions

Question 8

What are the signs of a neck fracture

How are these related to spinal cord injuries

Answer 8

Bi-facet, neck dislocation, neck pain, neurological signs- parasthesia, C6 and below

15% of people of people with a fracture/ dislocation will have a spinal cord injury

Question 9

What are the two type of spinal cord injuries?

Answer 9

Complete- no motor or sensory function distal to lesion
No anal power
No sacral sensation
ASIA grade A
no chance of recovery

Incomplete- some function is present below site of injury
more favourable prognosis

cant classify straight way, patient may have spinal shock

Question 10

What is the asia classification of spinal injuries?

Answer 10

A- complete- no sensory or motor functions present in sacral segments

B- incomplete sensory but not motor function preserved below the neurolgic level and extending through sacral S4-S5

C- Incomplete- motor function preserved below the neurological level, majority of key mecles have a grade <3

D incomplete motor function preserved below neurolgic level, majority of key muscles have a grade >3

E-normal motor and sensory function

Question 11

What are the different categories of injury in spinal cord pathologies?

Answer 11

Quadraplegia
Paraplegia
Central cord syndrome
Anterior Cord syndrome
Brown-sequard syndrome

Question 12

What is quadraplegia?

Answer 12

Partial or total loss of function of all four limbs and the trunk
Loss of motr/sensory function in cervical segments of the spinal cord

Question 13

What is the typical cause of quadraplegia

Answer 13

Cervical fracture,

leads to respiratory failure due to loss of innervation of the diaphragm
Phrenic nerve C3-C5, keeps you alive
spasticity

Question 14

What is spasticity?

Answer 14

Increased muscle tone
Upper motor neuron lesion
Spinal cord and above CNS
Injuries above L1

Question 15

What is paraplegia?

Answer 15

Partial or total loss of the lower limbs
Impairment or loss of motor/sensory function
Arm function spared
Possible impairment of function in trunk

Question 16

What are the typical symptoms of paraplegia?

Answer 16

Thoracic/lumbar fractures
Associated chest or abdominal injuries
Spasticity if injury of spinal cord (above L1)
Bladder/ bowel function affected

Question 17

What is central cord syndrome

Answer 17

Older patients with arthritic neck
Hyperextension injury
Centrally cervical tracts more involved
Weakness of arms>legs
Perianal sensation and lower extremity persevered

Question 18

What is anterior cord syndrome

Answer 18

Hyperflexion injury
Anterior compression fracture
Damaged anterior spinal artery
Fine touch and proprioception preserved
Profound weakness

Question 19

What is brown-sequard syndrome

Answer 19

Hemi-section of the cord
Penetrating injuries
paralysis of the affected side (corticospinal)
Loss of proprioceptions and fine deiscrimination (dorsal columns)
Pain and temperature loss on the opposite side below the lesion(spinothalamic)

Question 20

What are the management plans in spinal cord injuries

Answer 20

Prevent secondary insult. This can be done through advanced trauma life support, and ABCDE

Question 21

What is spinal shock?

Answer 21

transient depression of the spinal cord function below level of injury
Flaccid paralysis
Areflexion
Lasts several hours days

Question 22

What is neurogenic shock?

Answer 22

Hypotension
Bradycardia
Hypothermia
Injuries above T6
Secondary to disruption of sympathetic outflow.

Question 23

What imaging should be carried out in those with spinal cord injuries?

Answer 23

X-rays
Ct scanning
MRi- if neurological deficit or children

Question 24

When is surgical fixation required?

Answer 24

Unstable fractures
Vast majority fixed posterorly
Pedicle screw preferred method

Question 25

What is the long term management of spinal cord injury?

Answer 25

Spinal cord injury unit
Physio
Occupational therapy
Psychological support
Urological/sexual councelling.