Spinal Injury Flashcards
what are spinal segments
section of the cord from which a pair of spinal nerves are given off
what is spinal cord injury classification
Quadriplegia- injury in cervical region (all 4 limbs affected)
Paraplegia- injury in thoracic, lumbar or sacral segments (2 extremeties affected)
Injury is either complete or incomplete. whats the difference between both
Complete injury- no information (ascending + descending tract) passing through the injured spinal cord level
Incomplete injury- there is some information passing through the injured spinal cord level
what are the types of incomplete injury, describe them
central cord syndrome- typically in older patients, low velocity fall (periphery is preserved)
anterior cord syndrome - vascular abnormality as blood supply of SC in anterior
posterior cord syndrome
brown-sequard syndrome- usually due to penetrating injuries like stab wounds or gunshots
cauda-equina syndrome- bony compression or disc protrusions in lumbar or sacral regions
what is the definition of spinal shock
temporary suppression of all reflex activity below the level of injury
occurs immediately after the injury
which sign is one of the first reflexes to re-appear as spinal shock subsides
Babinski sign- stroking the foot
Normal- toes face downwards
Abnormal- toes face upwards
what are the symptoms of spinal shock
Flaccid paralysis- muscle weakness and reduced muscle tone
Areflexia- muscles over-react to stimuli
Loss of sensation
Loss of bladder and bowel reflexes
what are the phases of spinal shock
- Areflexia (0-1 days)
- Initial reflex return (1-3 days)
- Initial hyperreflexia (1-4 weeks)
- Hyperreflexia and spasticity (1-12 months)
what is neurogenic shock
The body’s response to the sudden loss of sympathetic control, only parasympathetic control remains. Occurs in people who have spinal cord injury above T6 (>50% loss of sympathetic innervation)
what is the clinical triad of neurogenic shock
Hypotension- due to decreased sympathetic tone- sudden massive dilation
Hypothermia
Bradycardia- results from unopposed vagal tone and exacerbates by hypothermia
what is the surgical treatment for spinal injury
Acute spinal surgery
- allows stablisation
- decompression
what are the long-term complications of immobilisation due to spinal cord injury ? what other respiratory complication may occur ?
pressure ulcers
Deep vein thrombosis
pulmonary embolism
pneumonia
what is an upper and lower motor neuron lesion
UMN- lesion of the brain or spinal cord
LMN- lesion of the peripheral nerves
what are the signsof UMN lesion
Muscle weakness
increased tone
increased reflexes
what are the signs of LMN lesion
Muscle weakness and wasting
Reduced tone
reduced reflexes
fasciculations - involuntary muscle twitch
How will injury to spinal cord level C3,4 and 5 result in respiration problems and what can be done to fix it
- C 3,4 and 5 gives rise to phrenic nerve
- phrenic nerve innervates the diaphragm (important muscle in respiration)
- if section above is damaged -> disconnection of all the motor neurons innervating the respiratory muscles from the respiratory centres in brain stem.
- -> breathing ceases so artificial ventilation is required
How will injury to spinal cord level C6 and 7 result in respiration problems
- C6 and 7 innervates the intercostal muscles
- innervation to the diaphragm remains -> breathing remains intact
- > Paradoxical breathing
Does damage to lower segments affect respiration
No
if spinal damage is above lumbosacral region, then how is bladder control affected
Lumbosacral region escapes direct damage
- Reflex returns a few weeks following injury
- When the sensory bombardment of the cord from the stretch receptors in the bladder wall reaches a threshold, emptying is initiated -> automatic bladder
after bladder control is problematic due to damage in lumbosacral region. how do patients indirectly control micurition
- As bladder fills, input to the cord from bladder wall stretch receptors produces reflex rise in BP by spinal mechanism
BP regulation is deficient in the patient and hence the rise is greater than in normal people -> appears as flushing of face and signals patient to go to the toilet - Scratching of thigh increases sensory bombardment of sacral region -> facilitates micturition reflex and bladder empties
what does incomplete emptying of bladder leads to
increased risk of UTI
Kidney damage
what is the management for bladder control
indwelling catheter or self-catheterisation
how does somatic reflex return following spinal cord injury
Never regain voluntary control of skeletal musculature
o Reflex activity gradually recovers:
o Flexor reflexes return first: ankle, knee and hip in sequence
o Extensor reflexes return about 6 months after transection. Tend to be exaggerated leading to spastic paralysis
o Final stage is a predominant extensor activity with extensor spasms
o Extensor tendon reflexes are exaggerated –> hyperreflexia
how does autonomic reflex return following spinal cord injury
- Mass reflex (autonomic dysreflexia) occurs- uncontrolled activation of both autonomic and somatic motor systems occurs e.g. any stimulation below the level of lesion results in flexor spasm, defecation and sweating
o Trivial stimulus to groin or soles of feet -> flexion of legs, defecation, micturition and erection in men -> socially embarrassing
o Profound sweating that can be triggered by cutaneous stimulation
o BP control remains more unstable than in normal people
o BP rises with filling of bladder -> stretch receptor bombardment
o Postural hypotension -> autonomic
compensation is inadequate –> BP falls and subject may faint
How are motor and sensory information investigated for spinal injury patients
- Motor: ASIA charts
- Sensory: pin prick, light touch and sacral sparing
what are symptoms of cauda equina syndrome?
leg numbness and weakness
bowel and bladder dysfunction
back pain
saddel parasthesia
