Spinal injury

Question 1

How many vertebrae are there?

Answer 1

33 Vertebrae

7 Cervical
12 Thoracic
5 Lumbar
5 Sacral
4 Coccyx

Question 2

What are the ligaments present in the spine?

What are their relative positions within the spine?

Answer 2

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)

Question 3

What is the bone that supports the skull?

Answer 3

The odontoid peg on C2

Question 4

What are the two spinal cord enlargements, and where are they?

Answer 4

The cervical (superior) enlargement (C4-T1)

The lumbar (inferior) enlargement (T9-T12)

Question 5

What are the protective layers surrounding the spinal cord?

Answer 5

Dura Mater - Tough outer layer
Arachnoid Mater - Web-like layer
Pia Mater - Water tight inner layer sealing cerebrospinal fluid inside

Question 6

What is a reflex arc?

Answer 6

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

Question 7

What are the three “Columns” of the spinal column?

Answer 7

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

Question 8

What is a burst fracture?

Are these stable fractures?

Answer 8

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

Question 9

What is a compression/wedge fracture?

Are these stable fractures?

Answer 9

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

Question 10

What is a subluxation fracture?

Are these stable fractures?

Answer 10

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

Question 11

What is a spinal cord injury?

Answer 11

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

Question 12

What is tetraplegia/quadriplegia?

Answer 12

Spinal injury affecting the upper and lower limbs

Question 13

What is paraplegia?

Answer 13

Spinal injury affecting just the lower limbs

Question 14

What is an incomplete spinal cord injury?

Answer 14

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

Question 15

What is a complete spinal cord injury?

Answer 15

An injury that completely severs the spinal cord

No anal tone/sensation present

Question 16

What is an upper motor neurone injury?

Answer 16

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

Question 17

What is a lower motor neurone injury?

Answer 17

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

Question 18

What is spinal shock?

Answer 18

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

Question 19

What are the acute management strategies for spinal cord injuries?

Answer 19

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

Question 20

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?

Answer 20

Abdominal muscles: T6-T12

Lower Colon and Anal Sphincter: S2-S4

Question 21

Can peristalsis still occur with a spinal injury?

Answer 21

Yes

Question 22

How are reflexic bowels managed in an upper motor neuron injury (T12 and above)?

Answer 22

Suppositories

Digital stimulation

Gastrocolic reflex

Question 23

How are flaccid bowels managed in a lower motor neuron injury (L1 and below)?

Answer 23

Manual evacuation (Which the patient can learn to do by themselves)

Question 24

How are bladders managed in spinal cord injuries?

Answer 24

IDC (Acute stage)

Intermittent catheterisation (Patient can learn to do it themselves)