Spinal Cord Trauma Flashcards by Danielle Hayes

Where does the spinal cord finish?

L1 & L2

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The ventral ramus is primarily ___- & the dorsal ramus is primarily ______.

ventral–motor

dorsal–sensory

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What qualifies as spinal trauma?

injury has occurred to any of the following structures in the vertebral column:
Bony elements
Soft tissues
Neurological structures

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What are the 2 main concerns of spinal trauma?

Instability of the vertebral column

Actual or potential neurological injury

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What is the most common way to get spinal cord injury? Which area of the spinal cord is most commonly injured?

MVA/Traffic accidents–cervical spinal cord injury

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What is the SCI rating of spinal cord injuries?

A-E
A is the worst (complete)E is the best (recovery)
the others are sensory only (B), motor useless (C), motor useful (D)

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Why do we get so many cervical lesions?

the mobility of the head. Head is so heavy & lying on something so slender.

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Why is the thoracolumbar junction vulnerable?

T levels protected b/c of ribs

the other levels aren’t as protected.

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What is the age of most patients who get a spinal cord injury?

in their 20s-30s

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Which % of patients with spinal cord injuries die at the site of the accident?

Mortality of 48- 79% at the time of the accident

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What % of patients who go to the hospital die after SCI?

Deaths after admission: 4.4- 16.7%B/c of DVT & PE

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What is the case fatality rate for patients who reached the hospital alive?

Case fatality rate of 13% for those who reached the hospital alive

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What is the median age of patients with SCI now?

Prevalence date indicate that the median age of persons with SCI is approximately 27 years

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T/F The average age of SCI patients is rising.

True.

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What is the primary injury of SCI? Is this preventable via actions of doctors?

Involves the initial mechanical injury due to local deformation and energy transformation **docs can’t do much.

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What is the secondary injury of SCI? Is this preventable via actions of doctors?

encompass a cascade of biochemical and cellular processes which are initiated by the primary process and which may cause ongoing cellular damage and even cell death **Yes, this is what we focus on.

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When you talk about a patient’s neurological level…what do you mean?

The neurological level (motor or sensory) is defined as the lowest level that has completely normal motor and sensory function bilaterally

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Which demographic is central cord syndrome common in? What is involved in this?

elderly patients
Most common incomplete cord syndrome
Acute hyperextension injury in older patient with cervical stenosis
Prognosis: Most (>50%) regain ambulation

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When do you usu see Brown-Sequard syndrome? What is involved in this?

seen usu in stabbingsSpinal cord hemisectionPenetrating traumaSome burst fracturesPrognosis: 90% regain ambulation as well as anal and urinary sphincter tone**Ipsilateral loss of motor function, joint position and vibratory senseContralateral loss of pain and temp sensation

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What is anterior cord syndrome? When is this usually seen?

**seen with cardiac bypass, when mistakes are made & you get anterior spinal artery infarction. Can be seen with central disc herniations compressing anterior spinal arteryPrognosis: Poor. Only 10-20% recover functional motor controlBilateral loss of motor function as well as pain/temperature sensationJoint position sense, vibration, some light touch remains intact

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What is a complete injury?

no preservation of any motor/sensory function more than 3 segments below the level of the injury
About 3% of patients with complete injuries on initial examination develop some recovery within 24 hours
Poor prognosis for recovery
ASIA A

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What is an incomplete injury?

Sensation (including proprioception) or voluntary movement in the lower limbs “sacral sparing”: sensation around the anus and buttocks or anal tone is spared**if any sacral sensation–incomplete injury probably–more room for recovery.

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What is a stable injury?

Spine can withstand physical loadsNo significant displacement or deformity to bone or soft tissue**will heal normally, no surgery necessary.

What is an unstable injury?

Spine may not be able to carry normal loadsMost likely have significant deformity and painPotential for catastrophic neurologic injury**surgery may be necessary

What is spinal shock?

Transient physiological disruption which leads to a hypotonic areflexic state Should not impair initial assessment as motor and sensory components only affects for <1 hr

How do you get a more profound spinal shock?

the higher the level of the injury--more severe the SCI & longer & more profound spinal shock

T/F Spinal shock is the same as neurogenic shock.

False. Different

When you see a patient after an accident...will you see spinal shock?

you will see a loss of reflexes, but you will probably not see a loss of motor fcn b/c it lasts less than an hour. They are probably over it by then.

What are your expected outcomes for SCI patients? What is your goal?

Complete injuries rarely walk again Incomplete injuries may make a near normal recovery **Patient grade B-->27% may become grade D. That is a big difference. Every level saved--affects dependence.

Which types of patients should be suspected of SCI?

All victims of significant trauma Trauma patients with loss of consciousness Minor trauma patients with complaints referrable to the spine (neck or back pain or tenderness) or spinal cord (numbness or tingling in an extremity, weakness or paralysis) Any patient with priapism or diaphragmatic breathing

If you are at the scene of the accident...which precautions should be taken?

rigid hard collar-stabilize the neck sandbags, straps & taping as required spinal boardlog rolls & spine lifts

What is involved in the ER evaluation of an SCI patient?

Avoid hypotension/hypoxia Steroids Imaging: MRI as a limited role Check for other masked injuries b/c they aren't feeling pain check respiratory status, cervical injury--compromised diaphragm.

T/F The hypovolemic shock is the same as neurogenic shock.

False. Neurogenic has to do with sympathetic output

What are the goals of surgeries for SCI?

Reduction / Realignment Decompression-want to take off any pressure on nerves Stabilization

What are the indications of decompression for incomplete injuries?

this is indicated for all patients with ongoing cord compression

What are the indications of decompression for complete injuries?

consider recovery of local nerve root/myotomal segment | want to prevent syringomyelia/posttraumatic cystic degeneration (reduction in intramedullary pressure)

What are the neuroprotective interventions that try to prevent primary injuries from causing secondary spinal cord damage?

In Field Stabilization ATLS Resuscitation Prompt Medical/Surgical Care Pharmacologic Agents

What are the pharmacological agents that have been used to prevent secondary injury with SCI?

Corticosteroids--Methylprednisolone --Tirilazad mesylate NaloxoneGM-1 ganglioside

T/F Vigorous maintenance of MAP > 85 mmHg is helpful for prevention of secondary injury.

True.

What is the possible MOA of corticosteroids in prevention of secondary injury for SCI?

scavenging of free radicals and inhibition of lipid peroxidation * attenuation of inflammation improvement of regional blood flow

What is the name of the study that looked at corticosteroids being used in SCI patients?

NASCIS I, II, III

What are the complications of using corticosteroids on SCI patients?

PneumoniaPressure soresGI bleedingDVTDecreased wound healing

Where is GM-1 (a ganglioside, glycosphingolipid) found?

found in neuronal membranes near the synapsePlay a role in neurite outgrowthPromote regeneration and sproutingPromote plasticity

Do docs today use corticosteroids to treat SCI?

NO--no longer.

Do docs today use GM-1 to treat SCI?

Nope, no longer.

What is the definition of early decompression surgery?

“Early” defined as <72 hours

What are the pros & cons of early decompression surgery?

PROS: early decompression may lead to better outcomesCONS: A swollen cord is more likely to be damaged and other injuries may lead to higher morbidity & mortality. Late surgery allow medical and neurological stabilization of the injured patient No Class I evidence to support early decompression except for the reduction of bilaterally jumped facet joints

What is the recommended guideline for timing of decompression surgery for cervical spine trauma in patients with neurologically deteriorating patients?

urgent decompression warranted

What is the recommended guideline for timing of decompression surgery for cervical spine trauma in patients with neurologically stable patients?

controversialbiological rationale for early interventionno compelling evidence exist from clinical human studies

Is hypothermia a good idea for treating SCI?

As of now, no.

In damage control spinal surgery, you have realistic surgical control...and may perform which types of surgeries?

Closed reductionAnterior cervicalLimited / temporizing posterior short segment stabilization

The dens is also called what?

the odontoid process

If you get a fracture across your dens (Type II fracture)...what is an extra complication?

you compromise the blood supply (like with scaphoid) & make healing very difficult.

What is a crush fracture?

body of the vertebrae farther away from the spinal cord is damaged

What is a burst fracture?

damage body of vertebrae that is closer to the spinal cord-->more concerning than crush fracture**Violent compressive load with failure of anterior and middle columns; unstable fractureLoss of vertebral heightRisk of retropulsed bone and neuro injury