Spinal Symposium Flashcards
In what populations are spinal cord injuries most common?
M>F
Peak incidence 20-29
Associated with high energy mechanisms
How are spinal cord injuries classified?
Complete- no motor or sensory function distal to lesion, no anal squeeze, no sacral sensation, no chance of recovery
Incomplete- some function present distal to lesion, more favourable prognosis
What are the characteristics of tetraplegia/quadriplegia?
Partial or total loss of use of all four limbs and trunk
Loss of motor/sensory function in cervical segments of spinal cord
Result of cervical fracture
Respiratory failure common due to loss of innervation of diaphragm
Spasticity common (increased muscle tone, UMN lesion, injuries above L1)
What are the characteristics of 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
Arm function is spared but there is potential for impairment of trunk function
Due to thoracic or lumbar fractures
Can have associated chest wall or abdominal injuries
Spasticity if injury of spinal cord (ie above L1)
Bladder/bowel function affected
What are the characteristics of central cord syndrome?
Incomplete injury
Older patients
Hyperextension injury
Weakness of arms more prominent than weakness of legs
Perianal function and lower extremity power preserved
What are the characteristics of anterior cord syndrome?
Incomplete injury Hyperflexion injury Anterior compression fracture Damaged anterior spinal artery Fine touch and proprioception preserved Profound weakness present
What are the characteristics of Brown-Sequard syndrome?
Incomplete injury
Hemi-section of cord affected
Caused by penetrating injuries
Paralysis on affected side
Loss of proprioception and fine discrimination
Pain and temperature loss on opposite side below lesion
What are the features of spinal shock?
Transient depression of cord function below level of injury
Flaccid paralysis
Areflexia
Lasts several hours to days following injury
What are the features of neurogenic shock?
Hypotension Bradycardia Hypothermia Injuries above T6 Secondary to disruption of sympathetic outflow
What imaging can be done in spinal fractures?
X-ray
CT
MRI if neurological deficit or children
What are the features of nerve root pain?
Fairly common
Limb pain more prominent than back pain in those affected.
Pain is usually present in a nerve root distribution with root tension and compression signs present.
Most cases will settle in ~3 months with physiotherapy and strong analgesia.
If present for >12 weeks then a referral should be made
MRI can be useful in ruling out other causes
How are disc prolapses classified?
Bulge- common, majority asymptomatic
Protrusion- annulus weakened but still intact
Extrusion- protruding through annulus but still in continuity
Sequestration- dessicated disc material free in canal
Which vertebra from each region is most commonly affected by disc prolapse?
Cervical- C5/6
Thoracic- T8-12
Lumbar- 4/5
What is the classical triad of cauda equina?
Saddle anaesthesia
Bilateral sciatica
Bladder/bowel problems
What are the possible causes of cauda equina syndrome?
Central lumbar disc prolapse (Most common) Tumours Trauma Infection Iatrogenic
