Spinal Symposium

Question 1

Which myotomes supply which upper 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 = complete (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)
May present with spasticity

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

Hyperflexion injury

You damage 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 art 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

How do you manage an acute Spinal cord injury?

Answer 13

ABCD incl:

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

Question 14

How can you spot neurogenic shock in a SCI?

Answer 14

Injury above T6 with -hypothermia

• bradycardia
• hypotension (due to symp outflow damage)

Question 15

How can you differentiate spinal shock from neurogenic

Answer 15

Spinal shock is:

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

Question 16

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

Answer 16

If it’s an unstable fracture –> Pedicle screw

Question 17

What can we provide long term for a SCI patient?

Answer 17

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

Question 18

What would you see in brown -sequard syndrome?

Answer 18

• Paralysis of affected side
• Loss of proprioception and fine discrimination on affected side
• Pain and temperature loss on the opposite side of the lesion.

Question 19

what is spasticity?

Answer 19

• Increased muscle tone
• Upper motor neuron lesion
• Spinal cord and above (CNS)
• Injuries above L1

Question 20

Difference between a complete and an incomplete SCI?

Answer 20

Complete

• no motor/ sensory function distal to lesion
• no anal squeeze
• no sacral sensation
• ASIA grade A
• No chance of recovery

Incomplete

• Some function present below the site of injury
• more favourable prognosis overall