Spinal cord lesions Flashcards
What area of the rib restricts thoracic rotation?
What are high areas of stress in the spine?
Rib restricts thoracic rotation.
L1, T12, C6,C7
Describe the curvature of the spine
Cervical/thoracic- lordosis- inward curvatue
Thoracic/lumbar-kyphosis- outwards curvarture
Lumbar/Sacral- lordosis- inwards curvature
What is conus medularis?
What does damage to this present as?
What is cauda equina?
Termination of the spinal cord
Upper and lower motor neuron signs
Tail of spinal cord
What is a dermatome?
Area of skin supplied by a single spinal nerve
What is a myotome?
Group of muscles that a single spinal nerve innervates
What are the myotomes of the upper limbs?
C5- shoulder abduction C6- elboww flesion/wrist extensors C7- elbow extensors C8- long finger flexors T1- finger abduction
What are the myotomes of the lower limb
L2- hip flexion L3- knee extension L4- ankle dorsiflexion L5-Big toe extension S1- ankle plantar flexions
What are the signs of a neck fracture
How are these related to spinal cord injuries
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
What are the two type of spinal cord injuries?
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
What is the asia classification of spinal injuries?
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
What are the different categories of injury in spinal cord pathologies?
Quadraplegia Paraplegia Central cord syndrome Anterior Cord syndrome Brown-sequard syndrome
What is quadraplegia?
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
What is the typical cause of quadraplegia
Cervical fracture,
leads to respiratory failure due to loss of innervation of the diaphragm
Phrenic nerve C3-C5, keeps you alive
spasticity
What is spasticity?
Increased muscle tone
Upper motor neuron lesion
Spinal cord and above CNS
Injuries above L1
What is paraplegia?
Partial or total loss of the lower limbs
Impairment or loss of motor/sensory function
Arm function spared
Possible impairment of function in trunk
What are the typical symptoms of paraplegia?
Thoracic/lumbar fractures
Associated chest or abdominal injuries
Spasticity if injury of spinal cord (above L1)
Bladder/ bowel function affected
What is central cord syndrome
Older patients with arthritic neck Hyperextension injury Centrally cervical tracts more involved Weakness of arms>legs Perianal sensation and lower extremity persevered
What is anterior cord syndrome
Hyperflexion injury Anterior compression fracture Damaged anterior spinal artery Fine touch and proprioception preserved Profound weakness
What is brown-sequard syndrome
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)
What are the management plans in spinal cord injuries
Prevent secondary insult. This can be done through advanced trauma life support, and ABCDE
What is spinal shock?
transient depression of the spinal cord function below level of injury
Flaccid paralysis
Areflexion
Lasts several hours days
What is neurogenic shock?
Hypotension Bradycardia Hypothermia Injuries above T6 Secondary to disruption of sympathetic outflow.
What imaging should be carried out in those with spinal cord injuries?
X-rays
Ct scanning
MRi- if neurological deficit or children
When is surgical fixation required?
Unstable fractures
Vast majority fixed posterorly
Pedicle screw preferred method
What is the long term management of spinal cord injury?
Spinal cord injury unit Physio Occupational therapy Psychological support Urological/sexual councelling.
