Spinal issues Flashcards
Who are spinal cord injuries seen in?
Males > females
20-29 years
What are the causes of spinal cord injuries?
Trauma Degenerative orthopaedic Tumours Spinal cord infarct Transverse myelitis Thoracoabdo aortic aneurysm
What are the most common traumatic causes pf spinal cord injury?
Falls
RTA
SPorts
What are the signs and symptoms of a complete spinal cord injury?
No motor or sensory function distal to lesion
No anal squeeze
No sacral sensation
ASIA grade A
What are the clinical features of an incomplete spinal cord injury?
Some function present below site of injury
ASIA grade B-D
What are the levels of the ASIA classification?
A= complete B= incomplete, sensory but no motor below lesion C= incomplete, motor function preserved grade <3 D= incomplete, motor function prserved grade >3 E= normal
What are the patterns of spinal cord injury?
Quadraplegia Paraplegia Central cord syndrome Anterior cord syndrome Brown- Sequard syndrome
What is quadriplegia?
Partial or total loss of use of all limbs and trunk
Spastic weakness
Rest failure if above C5
What is paraplegia?
Partial or total loss of use of lower limbs
Spastic weakness if injury above L1
Bladder and bowel involvement
Arms spared but trunk may be involved
Who is central cord syndrome seen in?
Older patients
What is central cord syndrome?
Hyperextension injury of neck where cervical tracts involved
Weakness of arms
Perianal and lower limbs preserved
What is anterior cord syndrome?
Hyperflexion injury causing anterior compression fracture and damaged anterior spinal artery
Profound weakness but vibratory sense, fine discrimination and proprioception spared
What is Brown-Sequard syndrome?
Hemisection of cord
Paralysis and loss of proprioception and fine touch of affected side below lesion and loss of pain and temperature sensation on opposite side
What is the most common cause of Brown Squared syndrome?
Penetrating injury
What causes neurogenic shock?
Injuries above T6
What does neurogenic shock cause?
Hypotension, bradycardia and hypotermia
Secondary to disruption of sympathetic outflow
What is spinal shock?
Transient depression of cord function below level of injury
Flaccid paralysis, areflexia
Lasts several hours to days
What is the emergent management of a spinal injury?
Airway
Breathing
Circulation- IV fluids
Disability- assess neurological function
What imaging is done for spinal injuries?
Xray and CT
MRI if neurological deficit or in children
What is the indication for surgical fixation in spinal injuries?
Unstable fracture
What is the long term management of spinal injuries?
Spinal cord injury unit Physio OT Psychological support Urological/sexual counselling
What causes radiculopathy?
Compressed nerve roots
What are the signs and symptoms of radiculopathy?
Limb pain worse than back pain
Root tension signs- using muscle exacerbates pain
Root compression signs- weakness and sensation changes
What is the treatment of radiculopathy?
Analgesia
Physio
Referral if no improvement after 12 weeks
