Spinal injury Flashcards
How many vertebrae are there?
33 Vertebrae
7 Cervical
12 Thoracic
5 Lumbar
5 Sacral
4 Coccyx
What are the ligaments present in the spine?
What are their relative positions within the spine?
Anterior longitudinal ligament (In front of the vertebral bodies)
Posterior longitudinal ligament (Behind the vertebral bodies)
Ligamentum flavum (Behind the spinal cord)
Interspinous ligaments (Between vertebrae)
What is the bone that supports the skull?
The odontoid peg on C2
What are the two spinal cord enlargements, and where are they?
The cervical (superior) enlargement (C4-T1)
The lumbar (inferior) enlargement (T9-T12)
What are the protective layers surrounding the spinal cord?
Dura Mater - Tough outer layer
Arachnoid Mater - Web-like layer
Pia Mater - Water tight inner layer sealing cerebrospinal fluid inside
What is a reflex arc?
A neural pathway contained and synapsing within the spinal cord that activates motor neurons and controls an action reflex without routing signals to the brain
The brain receives sensory input while the reflex action occurs
What are the three “Columns” of the spinal column?
Anterior column
- Front half of vertebral body
- Front half of vertebral disc
- Anterior longitudinal ligament
Middle column
- Determines stability of the spine
- Back half of the vertebral body
- Back half of vertebral disc
- Posterior longitudinal ligament
Posterior column
- Pedicles
- Lamina
- Ligamentum flavum
- Interspinous ligaments
What is a burst fracture?
Are these stable fractures?
Where the vertebral body is broken into several pieces, with bone fragments potentially impinging nerves
The middle column of the spine is affected, so this is not a stable fracture
What is a compression/wedge fracture?
Are these stable fractures?
Part of the vertebra (usually anterior) collapses under pressure and becomes wedge-shaped
The middle column of the spine may not be affected, so these can be stable fractures
What is a subluxation fracture?
Are these stable fractures?
When the vertebral body moves significantly, occasionally occuring simultaneously with fractured vertebrae
The middle column of the spine is affected, so this is not a stable fracture
What is a spinal cord injury?
Pressure put on the cord by oedema, swelling, bruising or from vertebrae ceases the ability of neurons to send messages up and down the cord to the brain, affecting the motor and sensory function
What is tetraplegia/quadriplegia?
Spinal injury affecting the upper and lower limbs
What is paraplegia?
Spinal injury affecting just the lower limbs
What is an incomplete spinal cord injury?
An injury that hasn’t completely severed the spine or an injury from which some function can be restored if secondary injury is prevented
Anal tone/sensation may still be present
What is a complete spinal cord injury?
An injury that completely severs the spinal cord
No anal tone/sensation present
What is an upper motor neurone injury?
An injury at T12 and above where reflex arcs are still intact, but the messages can’t get past the damage on the spinal cord
The reflex activity below the level of injury but no control
What is a lower motor neurone injury?
An injury at L1 and below where the spinal cord has been damaged at the site of reflex arcs, so signals can’t loop along sacral nerves to the spinal cord
The reflexes cannot be stimulated due to pathway damage, so there is no reflex, and the muscles are flaccid
What is spinal shock?
The loss of all neurological activity below the level of injury, including autonomic function
Blood pools in the lower extremities and becomes like a distributive shock
What are the acute management strategies for spinal cord injuries?
NBM/IVF for surgeries
4 hourly Neuro obs and neurovascular obs
IDC for accurate fluid balance
“Spinal turns” 2-4 hourly maintaining spinal alignment, monitoring for pressure areas
4 hourly calf measures
Foot pumps
Monitor bowel sounds for signs of paralytic ileus. Diet only to start when bowel sounds present
Analgesia
Education
Psychological care
Where do the nerves that control abdominal muscles exit the spinal cord?
Where do the nerves that control the lower part of the colon and anal sphincter exit the spinal cord?
Abdominal muscles: T6-T12
Lower Colon and Anal Sphincter: S2-S4
Can peristalsis still occur with a spinal injury?
Yes
How are reflexic bowels managed in an upper motor neuron injury (T12 and above)?
Suppositories
Digital stimulation
Gastrocolic reflex
How are flaccid bowels managed in a lower motor neuron injury (L1 and below)?
Manual evacuation (Which the patient can learn to do by themselves)
How are bladders managed in spinal cord injuries?
IDC (Acute stage)
Intermittent catheterisation (Patient can learn to do it themselves)
