Spinal Injury

Question 1

what is a myotome

Answer 1

a group of muscles innervated by a single spinal nerve

Question 2

what is a dermatome

Answer 2

an area of skin mainly innervated by a single spinal nerve

Question 3

what is spasticity

Answer 3

increased muscle tone from an UMN lesion

Question 4

what is quadriplegia

Answer 4

partial or total loss of all 4 limbs and loss of motor/sensory in cervical segments of the spinal cord

Question 5

what is paraplegia

Answer 5

partial or total loss of the lower limbs and loss of motor/sensory in the thoracic, lumbar and sacral segments of the spinal cord

Question 6

what proportion of people with a spinal injury will have a spinal cord injury

Answer 6

15%

Question 7

why can you not assess the grade of spinal injury immediately after the trauma

Answer 7

because they may be in spinal shock

Question 8

features of spinal shock

Answer 8

lasting several hours to days
temporary impaired function below level of injury
flaccid paralysis
areflexia

Question 9

classification system for spinal cord injury

Answer 9

ASIA

Question 10

ASIA grade A

Answer 10

complete - no sensory or motor in S4-5

Question 11

difference between complete and incomplete spinal cord injury

Answer 11

complete is total loss of motor and sensory distal to lesion with no chance of recovery. Incomplete is anything less severe

Question 12

ASIA grade B

Answer 12

sensory preserved in at least sacral but not motor

Question 13

ASIA grade C

Answer 13

sensory preserved and motor preserved but muscles have grade <3

Question 14

ASIA grade D

Answer 14

sensory preserved and motor preserved with muscle grade =>3

Question 15

ASIA grade E

Answer 15

sensory and motor normal

Question 16

true/false - incomplete spinal cord injury has no chance of recovery

Answer 16

false - is a more favourable prognosis than complete and can recover

Question 17

which ASIA grade is most severe

Answer 17

A

Question 18

what level of injury causes quadriplegia

Answer 18

cervical - often a fracture

Question 19

what level of injury causes paraplegia

Answer 19

thoracic and lumbar - abdominal injuries

Question 20

true/false - bladder and bowel function are affected in paraplegia

Answer 20

true - everything from level down, encompasses bladder and bowel innervation

Question 21

innervation of bladder

Answer 21

T12-L2 and S2-4

Question 22

effect on bladder of an injury above T12

Answer 22

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

Question 23

effect on bladder of an injury below T12

Answer 23

damaged parasympathetic outflow to bladder –> detrusor paralysed –> overflow incontinence

Question 24

true/false - an injury below L1 will result in spasticity

Answer 24

false - spasticity in injuries above L1

Question 25

what function is affected in quadriplegia because of C3-5 being cut off

Answer 25

diaphragm –> respiratory function impaired

Question 26

what syndrome is caused by hyperflexion of the neck

Answer 26

anterior cord syndrome

Question 27

syndrome caused by hyperextension of the neck

Answer 27

central cord syndrome

Question 28

what syndrome is common in elderly patients with an arthritic neck

Answer 28

central cord syndrome

Question 29

pathophysiology of anterior cord syndrome

Answer 29

direct compression of anterior cord or by thrombosis or compression of the anterior spinal artery

Question 30

presentation of central cord syndrome

Answer 30

loss of motor and sensation in arms and hands but lower limbs fine (because their more lateral in the corticospinal tract)

Question 31

pathophysiology of central cord syndrome

Answer 31

central corticospinal tract is injured

Question 32

what tract is damaged in anterior cord syndrome affected pain and temperature

Answer 32

lateral spinothalamic

Question 33

presentation of anterior cord syndrome

Answer 33

paralysis below lesion and loss of pain and temperature

Question 34

what is brown-sequard syndrome

Answer 34

half of the cord is cut

Question 35

presentation of brown-sequard syndrome

Answer 35

paralysis and loss of proprioception on cut side

loss of pain and temperature on oppositie side

Question 36

tract of pain and temperature and where does is swap sides

Answer 36

lateral spinothalamic - at level of entry

Question 37

tract of fine touch, proprioception and vibration and where does it swap sides

Answer 37

dorsal tract - cuneate nucleus of medulla

Question 38

initial management of spinal injury

Answer 38

ABCD
Advanced Trauma Life Support
get some imaging done

Question 39

what imaging is best for bone anatomy

Answer 39

CT

Question 40

breakdown of ABCD for spinal injury

Answer 40

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

Question 41

surgical treatment in spinal cord injuries

Answer 41

fixation of any fractures, usually from posterior with pedicle screws

Question 42

long term rehab

Answer 42

• spinal cord injury unit
• physiotherapy
• ot
• psychological support
• urinary and sexual counselling

Question 43

what imaging should you do if there is a neurological deficit found or they’re a child

Answer 43

MRI

Question 44

effect of an injury above reflex nerve on reflex

Answer 44

normal

Question 45

effect of an injury below the level of reflex nerve

Answer 45

increased reflex

Question 46

effect of an injury at the level of the reflex nerve

Answer 46

absent