Spinal Symposium Flashcards
Dermatome
-a dermatome is an area of skin that is mainly supplied by a single spinal nerve
Myotome
-a myotome is the group of muscles that a single spinal nerve innervates
C5 movement
-shoulder abduction (deltoid)
C6 movement
-elbow flexion/wrist extension (biceps)
C7 movement
-elbow extension (triceps)
C8 movement
-long finger flexors (FDS/FDP)
T1 movement
-finger abduction (interossei)
L2 movement
-hip flexion (iliopsoas)
L3, L4 movement
-knee extension (quadriceps)
L4 movement
-ankle dorsiflexion (Tibialis anterior)
L5 movement
-big toe extension (extensor hallucis longus)
S1 movement
-ankle plantar flexion (gastrocnemius)
Complete spinal cord injury presentation
- no motor or sensory function distal to lesion
- no anal squeeze
- no sacral sensation
- ASIA Grade A
- no chance of recovery
Incomplete spinal cord injury presentation
- some function is present below site of injury
- more favorable prognosis overall
ASIS classification A
A - Complete. No sensory or motor function preserved in sacral segments S4-S5
ASIS classification B
B - Incomplete. Sensory but not motor function preserved below the neurological level and extending through sacral segments S4-S5
ASIS classification C
C - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade <3
ASIS classification D
D - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade >3
ASIS classification E
E - Normal motor and sensory function
Quadriplegia
- Partial or total loss of use of all four limbs and the trunk
- Loss of motor/sensory function in cervical segments of the spinal cord
- Respiratory failure due to loss of innervation of the diaphragm
- Spasticity
Paraplegia
- Partial or total loss of use of the lower-limbs
- Impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord
- Spasticity if injury of spinal cord (i.e. above L1)
- Bladder/ Bowel function affected
Central cord syndrome
- Older patients (arthritic neck)
- Hyperextension injury
- Central cervical tracts more involved
- Weakness of arms > legs
- Perianal sensation & lower extremity power persevered
Anterior cord syndrome
- Hyperflexion injury
- Anterior compression fracture
- Damaged anterior spinal artery
- Fine touch and proprioception preserved
- Profound weakness
Brown–Sequard Syndrome
- Hemi-section of the cord
- Penetrating injuries
- Paralysis on affected side (corticospinal)
- Loss of proprioception and fine discrimination (dorsal columns)
- Pain and temperature loss on the opposite side below the lesion (spinothalamic)
Spinal shock
- Transient depression of cord function below level of injury
- Flaccid paralysis
- Areflexia
- Last several hours to days after injury
Neurogenic shock
- Hypotension
- Bradycardia
- Hypothermia
- Injuries above T6
- Secondary to disruption of sympathetic outflow
Surgical fixation of spinal cord injury
- Unstable fractures
- Vast majority fixed from posteriorly
- Pedicle screws preferred method
Long term management of spinal cord injury
- Physiotherapy
- Occupational therapy
- Psychological support
- Urological /Sexual counselling
Intervertebral disc joint type
-secondary cartilaginous
Intervertebral disc prolapse
- Annulus fibrosus
- Tough outer layer - Nucleus pulposus
- Gelatinous core - Annulus may tear and nucleus prolapse
- Can cause cord / nerve root compression - Disc prolapses are usually posteriolateral
Nerve root pain management
- Physiotherapy
- Strong analgesia
- Referral after 12 weeks
- Imaging - MRI
Disc problems
- Bulge (generalised) – common, majority asymptomatic
- Protrusion (annulus weakened but still intact)
- Extrusion (through annulus but in continuity)
- Sequestration (dessicated disc material free in canal)
Cauda equina syndrome aetiology
- central lumbar disc prolapse (commonest)
- tumours
- trauma or spinal stenosis
- infection (epidural abscess)
- iatrogenic (spinal surgery or manipulation, spinal epidural injection)
Cauda equina syndrome clinical features
-Injury or precipitating event
-Location of symptoms (bilateral buttock & leg pain + varying dysaethesiae + weakness)
–Bowel or bladder dysfunction (urinary retention +/- incontinence overflow)
–PR exam - saddle anaesthesia (perianal loss of sensation), loss of anal tone & anal reflex
–High index of suspicion in spinal post-op patients with increasing leg pain in presence of urinary retention
Cauda equina radiological investigations
- MRI
- CT myelogram if MRI contraindicated
Cauda equina syndrome treatment
- operative
- within 48 hours
Cervical and lumbar spondyosis
- Common
- Degenerative change at facet joints, discs, ligaments, etc.
- If severe, can compress whole cord causing myelopathy
- UMN signs in limbs (increased tone, brisk reflexes, etc.)
Ligaments around vertebrae
- Anterior Longitudinal Ligament (ALL – along the front of the vertebral bodies – broad, strong)
- Posterior Longitudinal Ligament (PLL – along the backs of the vertebral bodies, i.e. front of the spinal canal; narrower)
- Ligamentum Flavum (between laminae)
- Interspinous and Supraspinous Ligaments (between spinous processes)
- Intertransverse Ligament (between transverse processes)
Spinal Claudication
- Usually bilateral
- Sensory dysaesthesiae
- Posterior weakness (drop foot – tripping)
- Takes several minutes to ease after stopping walking
- Worse walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding bicycle
Lateral recess stenosis treatment
- Nerve root injection
- Epidural injection
- Surgery
Central stenosis treatment
- Epidural steroid injection
- Surgery
Foraminal stenosis
- Nerve root injection
- Epidural injection
- Surgery
ASIS B
B - Incomplete. Sensory but not motor function preserved below the neurological level and extending through sacral segments S4-S5
ASIS C
C - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade <3
ASIS D
D - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade >3
ASIS E
E - Normal motor and sensory function
