Spinal Injury Flashcards
what is a myotome
a group of muscles innervated by a single spinal nerve
what is a dermatome
an area of skin mainly innervated by a single spinal nerve
what is spasticity
increased muscle tone from an UMN lesion
what is quadriplegia
partial or total loss of all 4 limbs and loss of motor/sensory in cervical segments of the spinal cord
what is paraplegia
partial or total loss of the lower limbs and loss of motor/sensory in the thoracic, lumbar and sacral segments of the spinal cord
what proportion of people with a spinal injury will have a spinal cord injury
15%
why can you not assess the grade of spinal injury immediately after the trauma
because they may be in spinal shock
features of spinal shock
lasting several hours to days
temporary impaired function below level of injury
flaccid paralysis
areflexia
classification system for spinal cord injury
ASIA
ASIA grade A
complete - no sensory or motor in S4-5
difference between complete and incomplete spinal cord injury
complete is total loss of motor and sensory distal to lesion with no chance of recovery. Incomplete is anything less severe
ASIA grade B
sensory preserved in at least sacral but not motor
ASIA grade C
sensory preserved and motor preserved but muscles have grade <3
ASIA grade D
sensory preserved and motor preserved with muscle grade =>3
ASIA grade E
sensory and motor normal
true/false - incomplete spinal cord injury has no chance of recovery
false - is a more favourable prognosis than complete and can recover
which ASIA grade is most severe
A
what level of injury causes quadriplegia
cervical - often a fracture
what level of injury causes paraplegia
thoracic and lumbar - abdominal injuries
true/false - bladder and bowel function are affected in paraplegia
true - everything from level down, encompasses bladder and bowel innervation
innervation of bladder
T12-L2 and S2-4
effect on bladder of an injury above T12
reflex bladder - won’t be aware of it filling and a constantly relaxed external sphincter.
spinal reflex still intact to contract detrusor in response to wall stretch (parasympathetic)
so bladder empties as it fills
effect on bladder of an injury below T12
damaged parasympathetic outflow to bladder –> detrusor paralysed –> overflow incontinence
true/false - an injury below L1 will result in spasticity
false - spasticity in injuries above L1
what function is affected in quadriplegia because of C3-5 being cut off
diaphragm –> respiratory function impaired
what syndrome is caused by hyperflexion of the neck
anterior cord syndrome
syndrome caused by hyperextension of the neck
central cord syndrome
what syndrome is common in elderly patients with an arthritic neck
central cord syndrome
pathophysiology of anterior cord syndrome
direct compression of anterior cord or by thrombosis or compression of the anterior spinal artery
presentation of central cord syndrome
loss of motor and sensation in arms and hands but lower limbs fine (because their more lateral in the corticospinal tract)
pathophysiology of central cord syndrome
central corticospinal tract is injured
what tract is damaged in anterior cord syndrome affected pain and temperature
lateral spinothalamic
presentation of anterior cord syndrome
paralysis below lesion and loss of pain and temperature
what is brown-sequard syndrome
half of the cord is cut
presentation of brown-sequard syndrome
paralysis and loss of proprioception on cut side
loss of pain and temperature on oppositie side
tract of pain and temperature and where does is swap sides
lateral spinothalamic - at level of entry
tract of fine touch, proprioception and vibration and where does it swap sides
dorsal tract - cuneate nucleus of medulla
initial management of spinal injury
ABCD
Advanced Trauma Life Support
get some imaging done
what imaging is best for bone anatomy
CT
breakdown of ABCD for spinal injury
Airway - keep c-spine good
Breathing - ventilation, O2 and check for chest injuries
Circulation - vasopressors if in shock (low BP, high HR), fluids
Disability - assess neuro function esp perianal sensation
surgical treatment in spinal cord injuries
fixation of any fractures, usually from posterior with pedicle screws
long term rehab
- spinal cord injury unit
- physiotherapy
- ot
- psychological support
- urinary and sexual counselling
what imaging should you do if there is a neurological deficit found or they’re a child
MRI
effect of an injury above reflex nerve on reflex
normal
effect of an injury below the level of reflex nerve
increased reflex
effect of an injury at the level of the reflex nerve
absent
