Spinal Cord trauma Flashcards
Arm abduction ?
C5, C6, deltoid
Elbow flexion ?
C5, C6, biceps
Wrist extension ?
C6, C7, extensor carpi radialis
Elbow extension ?
C7, C8, triceps
Finger abduction and Hand grasp ?
C8, T1,
hand intrinsics,
flexor digitorum profundus
Chest muscles ?
T2-T7
Abdominal muscles ?
T9-T12
Hip flexion ?
L1, L2, L3,
Iliopsoas
Knee extension ?
L2, L3, L4
Quads
Knee flexion ?
L4, L5,S1, S2
hamstrings
Ankle dorsiflexion ?
L4, L5
Great toe extension ?
L5, S1
extensor hallicus longus
Ankle Plantar flexion ?
S1, S2
gastrocnemius
Voluntary rectal tone ?
S2, S3, S4
bladder /anal sphincter
SC Anatomy and physiology own notes ?
C - it is above the bone
T - it is below the bone
know where the injury is and what it can cause here
Two main phases of spinal cord injury ?
Direct mechanical injury
Tissue degeneration phase
Direct mechanical injury facts ?
hemorrhage into the cord
formation of edema at the injured site
vasospasm and thrombosis of the small arterioles
–Local spinal cord blood flow is decreased.
Tissue degeneration phase
facts ?
begins within hours of injury
release of membrane-destabilizing enzymes and mediators of inflammation
disruption of calcium channel pathways
Lipid peroxidation and hydrolysis
inflammatory phase causes more injury so steroid!
lesion types ?
Spinal shock
Complete
incomplete
Spinal shock definition ?
initial loss of all reflex activities below the area of injury
Complete definition ?
absence of sensory and motor function below the level of injury
lesions cannot be deemed complete until spinal shock has resolved
Incomplete definition ?
sensory, motor, or both functions are partially present below the neurologic level of injury
Spinal cord trauma patho own notes ?
warm shock cause massive vasodilation, warm and the BP drops and they have a bradycardia
no sympathetic innervation
Determination of acute unstable injuries ?
Any C1-C2 injury (atlas and axis - connection site to the skull)
Disruption of at least two columns
Degree of vertebral body compression
neuro deficits
Degree of vertebral body compression to be considers unstable ?
> 25% for the third to seventh cervical
> 50% in the thoracic or lumbar
Anterior cord etiology ?
Direct anterior cord compression
flexion of C-spine
Thrombosis of anterior spinal artery
Anterior cord sxs. ?
Complete paralysis below the lesion w/ loss of pain and temp sensation
Preservation of proprioception and vibration
Central cord etiology ?
Hyperextension injuries
Disruption of blood flow in the spinal cord
C-spine stenosis
Central cord sxs. ?
Quadriparesis
greater in the UE than the LE
some loss of pain and temp sensation, also greater in the UE
Brown-Sequard etiology ?
Transverse hemisection of the SC
Unilateral cord compression
Brown-Sequard sxs. ?
Ipsilateral Spastic paresis
loss of proprioception and vibratory sensation and
contralateral loss of pain and temp.
Cauda Equina etiology ?
Peripheral nerve injury
cauda equina sxs. ?
Variable motor and sensory loss in the LE
sciatica, bowel, bladder dysfunction
saddle anesthesia
Spinal cord trauma prevalence ?
40 cases per million
more frequently on weekends, holidays, and during summer months
Spinal cord trauma demographic ?
mean age of 40 years old
male-to-female ratio 4 to 1
Spinal cord trauma etiology ?
MVA 42%
Falls 27%
Violence 15% (primarily gunshot wounds)
Sports 8%
Other 8%
Spinal cord trauma: Prehospital immobilization type ?
Cervical spine (hard collar and/or bilateral blocks)
Backboard
Spinal cord trauma: Prehospital immobilization indications ?
Tenderness
Neurologic complaints
High risk mechanism
Spinal cord trauma Hx. ?
Mechanism
Pain
Weakness
- Focal
- Paralysis
Paresthesias
Incontinence
Spinal cord trauma PE ?
Neurogenic shock
Vertebral tenderness
Motor loss
Reflex loss
Sensory loss
Neurogenic shock
sxs. ?
warm, peripherally
vasodilated
hypotensive
relative bradycardia
Caution
**hypotension in the trauma patient can never be presumed to be caused by neurogenic shock until other possible sources of hypotension have been excluded
SC trauma: Reflex loss - anogenital indicates complete SC damage ?
Bulbocavernosus
Cremasteric
Anal wink
Reflex: Biceps ?
C5, C6
Reflex: Brachioradialis ?
C6
Reflex: Triceps ?
C7
Reflex: Patellar ?
L4
Reflex: Achilles tendon ?
S1
SC trauma: C-spine - low risk ?
X-ray cervical spine
SC trauma: C-spine - high risk ?
CT cervical spine
You dont need to get a C-spine XR if they meet what criteria ?
NEXUS
NEXUS criteria ?
National Emergency X-Radiography Utilization Study Criteria
C-spine XR Unnecessary if meet each criteria ?
Absence of midline cervical tenderness
Normal level of alertness and consciousness
No evidence of intoxication
Absence of focal neurologic deficit
Absence of painful distracting injury
**what you can use to clear someone of cervical spine ijurt **
Canadian cervical spine rule also used ?
Goal is “clinically important” injuries
SC trauma: if you get a C-spine XR what views ?
lateral, anteroposterior, and odontoid performed
single lateral cervical spine film will identify approximately 90% of injuries to bone and ligaments
Cervical spine xray
you can find what ?
Poor for identifying C1-C2 injuries
Column disruption
Compressions
What imaging is better for SC trauma ?
Cervical spine CT
Better imaging than plain films
More sensitive and specific
Thoracic or lumbar spine
initial imaging ?
XR
Thoracic or lumbar spine
if abd. or major trauma ?
CT
Thoracic or lumbar spine
ID nerve damage?
MRI
Thoracic or lumbar spine x-ray ?
initial imaging of these spinal levels
Anterior and lateral films are generally obtained
Thoracic or lumbar CT
indications ?
Proven bony spinal injury
neurologic deficits (with normal plain films)
severe neck or back pain (with normal plain films)
Thoracic or lumbar CT
for multisystem trauma ?
Thoracic and abdominal CT scans reformatted
reconstruct images of the thoracic and lumbar spine
Thoracic or lumbar CT
purpose and findings ?
Anatomy of an osseous injury
Grade canal impingement
Assess stability
Thoracic or lumbar MRI
indications ?
Test of choice for anatomy of nerve injury
Helpful for identifying herniated disks or spinal cord contusions
Thoracic or lumbar MRI
limitations ?
Not as sensitive as CT for detecting bone injuries
SC trauma complications ?
Neurogenic shock
SC trauma goals of tx. ?
prevent secondary injury
alleviate cord compression
establish spinal stability
SC trauma: all spine trauma tx. ?
- Airway considerations
- Make sure cervical spine stabilized
Remove from backboard
Order appropriate imaging
SC trauma: If neurologic deficit or unstable tx. ?
Consult spinal surgery immediately
SC trauma: If blunt trauma
tx. ?
High dose corticosteroids (methylprednisolone)
SC trauma: Neurogenic shock tx. ?
Stabilization cervical spine
IV crystalloid
-mean arterial blood pressure at 85 to 90 mm Hg
If insufficient
-inotropic pressor (atropine, dobutamine)
Identify possible other causes
SC trauma: airway considerations ?
any patient with an injury at C5 or above should have his or her airway secured via endotracheal intubation
**above C5 careful of phrenic nerve injury - it innervates the diaphragm
SC trauma: Operative management ?
Determined by spinal surgeon
SC trauma: Nonoperative stabilization choices ?
Philadelphia collar
Miami J collar
-May have thoracic extension
Halo vest
- Gold standard
- Very invasive
Operative management
common indications ?
Neurologic deterioration– URGENT SURGERY
Instability
SC trauma: Thoracic and lumbar spine injury
- Nonoperative patients ?
Usually not immobilized, very difficult
Educate to restrict movements
LeFort I description ?
maxilla only
LeFort II description ?
maxilla and zygomatic
LeFort III description ?
zygomatic and orbits
