Spinal Injury

Question 1

What parts of the spine are in the lordosis position?

Answer 1

Cervical and lumbar

Question 2

What parts of the spine are in the kyphosis position?

Answer 2

Thoracic

Question 3

What is a dermatome?

Answer 3

An area of skin that is mainly supplied by a single spinal nerve

Question 4

What is a myotome?

Answer 4

Group of muscles that a angel spinal nerve innervates

Question 5

What are the upper limb myotomes?

Answer 5

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

What are the lower limb myotomes?

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

What are the most common causes of spinal injury?

Answer 7

Fall 
Road traffic accident 
Sport 
Knocked over/collision/lifting 
Trauma 
Sharp trauma/assault

Question 8

What are the criteria for complete spinal cord injury?

Answer 8

No motor or sensory function distal to lesion
No anal squeeze
No sacral sensation
ASIA Grade A
No chance of recovery

Question 9

What are the criteria for incomplete spinal cord injury?

Answer 9

Some function is present below site of injury

More favorable prognosis overall

Question 10

What is tetraplegia (quadriplegia)?

Answer 10

Partial or total loss of use of all four limbs and the trunk
Loss of motor/sensory function in cervical segments of the spinal cord

Question 11

What is spasticity?

Answer 11

Increased muscle tone caused by an upper motor neurone lesion

Question 12

What is 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
Possible impairment of function in trunk

Question 13

What are the features of central cord syndrome?

Answer 13

Hyperextension injury
Centrally cervical tracts more involved
Weakness of arms > legs
Perianal sensation & lower extremity power persevered

Question 14

What are the features of anterior cord syndrome?

Answer 14

Hyperflexion injury
Anterior compression fracture 
Damaged anterior spinal artery
Fine touch and proprioception preserved
Profound weakness

Question 15

What are the features of Brown-Sequard syndrome?

Answer 15

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 16

What is the general management of spinal cord injuries?

Answer 16

Airway (C spine control)
Breathing (ventilation and oxygen
Circulation (IV fluids)
Disability (assess neurological function, log rolling)

Question 17

What are the features of spinal shock?

Answer 17

Transient depression of cord function below level of injury
Flaccid paralysis
Areflexia
Last several hours to days after injury

Question 18

What are the features of neurogenic shock?

Answer 18

Hypotension
Bradycardia 
Hypothermia
Injuries above T6 
Secondary to disruption of sympathetic outflow

Question 19

What investigations should be done for spinal injuries?

Answer 19

X rays
CT
MRI

Question 20

What long term management options are available for spinal injuries?

Answer 20

Physiotherapy
Occupational therapy
Psychological support
Urological/sexual counselling