Spinal Injuries Flashcards
Spinal cord
8 cervical nerves (C1-C8) 7 cervical vertebrae 12 thoracic nerves (T1-T12) 5 Lumbar nerves (L1-L5) 5 Sacral nerves (S1-S5) 1 coccygeal pair
Function of the spinal cord
- conduction
- locomotion
- reflexes
What is the function of the cerebral column and spinal column?
Support/protect the spinal cord
What are two reflexes controlled by the spinal cord?
- Micturition - external sphincter contracted to hold urine
- Digestion to defecation - gastrocolic and duodenocolic relflex –> peristalsis
Spinal cord injury is
damage to the spinal cord caused by concussion, contusion, compression, laceration, transection, hemorrhage, damage to blood supply, damage to blood vessels in the cord
SCI can be classified by
- Mechanism of injury
- Skeletal and neurological level of injury
- Degree of injury
Examples of mechanism of injury are
Flexion
Hyperextension
Flexion-rotation
Extension-ratation
What is the most unstable mechanism of injury?
Flexion-rotation recuasse ligaments are torn that stabilize the spine and it usually has the most severe neuro deficits
Skeletal and neurological level of injury
Skeletal - vertebrae and ligaments - level of damage to bones and ligaments
Neurological - lowest segment of spinal cord with sensory and motor function
Degree of injury
How much motor/sensory is lost
Complete = total sensory and motor loss
Incomplete = mix sensory and motor loss
What is the American spinal injury association (ASIA)?
determines the level of impairment for a spinal cord injury
Diagnosis of a spinal cord injury
- CT - gold standard for bone injury
- MRI - gold standard for degree of injury like soft tissue and neural changes
- ASIA - docs use this to determine specific level of injury by assessing sensory and motor level that are affected
Primary SCI
occurs at the time of the impact
Immediate stretch or laceration of spinal cord
Secondary SCI
Ongoing progressive damage that occurs minutes, hours, days after primary
What can secondary SCI cause?
tissue hypoxia and further damage to the spinal cord
Cervical nerves function is
head, neck, breathing, upper arms, wrists, hands
Thoracic nerves function is
chest and abdominal muscles, internal organs
Lumbar nerves function is
legs muscles
Sacral nerves function is
bathroom capabilities, ability to reproduce
C3, 4, 5
“keep a fella alive”
Breathing
C1-4
ventilator and 24 hr/day care
C4
requires mouth stick to use wheelchair
C5
10hr/day care
C6
might be able to use hand control on wheelchair
6hr/day care
T6
non motorized wheelchair with full independence
L1
can ambulate with long leg braces, control of leg and not at risk for AD, flaccid bowel and bladder
L3-4
ambulate completely independently but can’t stand for long periods
C8 and above are…
tetraplegic - can’t move legs or arms
T1 is…
paraplegic - can’t move legs, breath on their own, move move upper back and arms, at risk for AD, spastic bowel and bladder
Phrenic nerve is responsible for
C3-C5
Breathing
Spinal shock
Temporary loss of reflexes and paralysis below level of injury and bowel and bladder dysfunction
Lasts days to weeks
Neurogenic shock
Loss of sympathetic NS tone for someone with a T6 injury or above.
Form of disruptive shock
Hypotension and bradycardia
Warm or cold, dry extremities, not able to auto regulate temp by sweating or shivering
Anterior cord syndorme
Not common
r/t flexion injury
Loss of motor, pain, and temperature below injury
Intact: position, vibration, and touch sense
Central cord syndrome
More common cervical injury
Incomplete loss
Motor and sensory loss in upper and lower extemities
Upper are more weak than lower
Brown-sequard syndrome
Usually from penetrating injuries - knives, GSW, disc rupture
Loss of pain and temp sensation on opposite side
Loss of voluntary motor control , vibration and positioning on same side
Conus medullaris injury
Lowest portion of spinal cord
Function in legs are preserved, weak or flaccid
Decrease in or loss of sensation in perianal area
Bladder and bowel issues
Impotence
Cauda Equine injury
Lumbar and sacral nerve roots Asymetrical distal weakness Flaccid paralysis of lower extremities Complete loss of sensation in saddle area Bladder and bowel issues Severe, radicular, asymmetric pain
Stabilization of the spine immediately after surgery
rigid cervical collar and supportive backboard
How do you change positions of a patient with a SCI
logroll the patient