Spinal injury (part of spinal symposium)

Question 1

Which myotomes supply which arm muscles?

Answer 1

Shoulder Abduction - Deltoid - C5

Elbow flexion & Wrist extension = C6

Elbow extension = C7

Finger flexion (FDS/P) = C8

Finger Abduction (interossei) = T1

Question 2

Which myotomes supply the lower limbs?

Answer 2

Hip flexion - Iliopsoas - L2

Knee Extension - Quads - L3/4

Ankle Dorsiflexion - Tib Ant - L4

Hallucis Extension - EHL - L5

Ankle Plantar Flexion - Gastroc - S1

Question 3

Peak demographic for a spinal cord injury?

Answer 3

Males 20-29yrs

Majority caused by falls or RTAs

Question 4

How do we grade spinal injuries?

Answer 4

ASIA grading A–>E

A = complate (no sensory/motor function preserved)

B-D = Incomplete

E = Normal function

Question 5

Define Quadraplegia and how it happens?

Answer 5

Partial/total loss of use of all 4 limbs & trunk

Due to damage in cervical cord (Phrenic keeps you alive)

Question 6

Define Paraplegia?

Answer 6

Partial/total loss of use of lower limbs +/- bladder/bowel

Thoracic/lumbar/sacral injury

Question 7

What type of injury is likely to occur in an elderly patient who falls and hyperextends their neck?

Answer 7

A central Cord Syndrome

Damage to the central cervical tracts in older people with arthritic necks who hyperextend, typically when falling

Question 8

How does a central cord syndrome look?

Answer 8

Weakness greater in arm than legs

Perianal sensation & lower limb power largely preserved

Question 9

What happens in anterior cord syndrome?

Answer 9

You daage everything but the dorsal columns –> Profound weakness but retaining fine touch and proprioception

Question 10

How could an anterior cord syndrome be caused?

Answer 10

• Hyperflexion
• Ant Compression fracture
• Ant Spinal artery damage

Question 11

What is brown-sequard syndrome?

Answer 11

Hemi-section of the cord due to a penetrating injury

Question 12

How does brown-sequard syndrome present?

Answer 12

Ipsilateral Paralysis (CST damage)
Ipsilateral loss of proprioception & fine touch (dorsal columns)
Contralateral loss of pain & temp (STT)

Question 13

When are you likely to see brown-sequard syndrome?

Answer 13

Let’s just say if you do ever see it make sure to check the sky for flying pigs

Question 14

How do you manage an acute Spinal cord injury?

Answer 14

ABCD incl:

• C-spine control
• Ventilation & O2
• Fluids
• Vasopressors for neurogenic shock
• Log rolling
• Assess neuro function incl. PR & perinanal sensation

Question 15

How can you spot neurogenic shock (not spinal shock) in a SCI?

Answer 15

Following injury above T6 - if patient develops hypothermia, bradycardia and hypotension (due to symp outflow damage)

Question 16

How can you differentiate spinal shock from the actual SCI?

Answer 16

Spinal shock is:

• Transient (hrs to days)
• Flaccid paralysis (vs spastic)
• Areflexia (vs hyperreflexic)

Question 17

What’s the preferred method for fixing a spinal injury?

Answer 17

If it’s an unstable fracture –> Pedicle screw

Question 18

What can we provide long term for a SCI patient?

Answer 18

• Transfer to SCI unit
• Physio
• OT
• Psychological support
• Urological & sexual counselling