spinal injuries

Question 1

vertebra

Answer 1

Cervical vertebra
bifid spinous process
transverse foramen
Thoracic vertebra
-spinous process
-facets that articulates with ribs
lumbar
-similar like thoracic without facet articulation

Question 2

erector spinae

Answer 2

iliocostalis
longissimus
spinalis

Question 3

dermatome

Answer 3

A dermatome is an area of skin that is mainly supplied by a single spinal nerve.

Question 4

myotome

Answer 4

A myotome is the group of muscles that a single spinal nerve innervates

Question 5

upper limb myotomes

Answer 5

Upper limbs:
		C5  -  Shoulder abduction  (deltoid)
		C 6  - Elbow flexion/ Wrist extensors  (biceps)
		C 7  - Elbow extensors  (triceps)
		C 8  -  Long finger flexors (FDS/FDP)
		T 1  - Finger abduction (interossei)

Question 6

lower limb

Answer 6

L2    - Hip flexion  (iliopsoas)
		L3,4  - Knee extension (quadriceps)
		L4    - Ankle dorsiflexion  (tib ant)
		L5    - Big toe extension  (EHL)
		S1   -  Ankle plantar flexion (gastroc)

Question 7

spinal injury

Answer 7

Majority of people with SCI will have an accompanying column injury

Question 8

common causes of spinal cord injury

Answer 8

road traffic accident
sports and recreational activities
falls

Question 9

ASIA classification

Answer 9

A- complete,
B- Incomplete, sensory preserved below neurologic level extending through sacral segments
C- incomplete- motor functions preserved
key muscles have grade<3
D- motor functions preserved below neurologic level>3
E- normal

Question 10

complete SCI

Answer 10

no motor or sensory distal to lesion
no anal squeeze
no sacral sensation
ASIA grade A
no chance of recovery

Question 11

tetraplegia

Answer 11

quadriplegia
partial or total loss all four limbs and the trunk
loss of motor/ sensory function in cervical segments
Cervical fracture
respiratory failure due to loss of innervation to diaphram
‘C5 keeps you alive’
Spasticity
Phrenic nerve C3-C5

Question 12

paraplegia

Answer 12

Partial or total loss of use of the lower-limbs
Impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord
Arm function spared
Thoracic/Lumbar fractures
Associated chest or abdominal Injuries
Spasticity if injury of spinal cord (i.e. above L1)
Bladder/ Bowel function affected

Question 13

partial cord syndrome

Answer 13

Central cord syndrome
Anterior cord syndrome
Brown-Sequard syndrome

Question 14

central cord syndrome

Answer 14

older patients (arthritic neck)
hyperextension injury
centrally cervical tracts invoved
weakness arms>legs
perianal sensation & lower extremity power preserved

Question 15

Anterior Cord syndrome

Answer 15

hyperflexion injury
anterior compression fracture
damaged anterior spinal artery
fine touch and proprioception preserved
-weakness

Question 16

Brown Sequard Syndrome

Answer 16

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

Question 17

management

Answer 17

prevent a secondary insult

Question 18

neuroprotective interventions

Answer 18

in- field stabilization
ATLS Resuscitation
Pharmacologic agents
prompt medical/ surgical care

Question 19

ATLS

Answer 19

airway (Cervical spine control)
breathing- concomitant chest injuries
Circulation-consider neurogenic shock
loss of sympa tone
vasopressors

Question 20

Spinal vs neurogenic shock

Answer 20

Transient depression of cord function below level of injury
Flaccid paralysis 
Areflexia
Last several hours to days after injury
vs
Hypotension
Bradycardia 
Hypothermia
Injuries above T6 
Secondary to disruption of sympathetic outflow

Question 21

disability

Answer 21

access neuro function
including PR and perianal sensation
log rolling
document

Question 22

surgical fixation

Answer 22

pedicle screws

fixed posteriorly

Question 23

Long term management

Answer 23

spinal cord injury unit
Physiotherapy
occupational therapy
psychological support
urological/ sexual counseling

Question 24

summary

Answer 24

Although spinal fractures are common SCI is rare
Complete injuries have no function below trauma
Incomplete injuries have variable function
Preventing secondary insult is key- ABCD
Assessment involves testing myotomes and dermatomes
Important to understand the difference between neurogenic and spinal shock