Spinal Symposium Flashcards
What are the most common causes of spinal cord injuries
- Fall
- RTA
- Sport
- Knocked over/collision/lifting
- Trauma
- Sharp trauma/assault
Describe the features of a complete spinal injury
- No motor or sensory function distal to the lesion
- No anal squeeze
- No sacral sensation
- AISA grade A
- No chance of recovery
Describe the features of an incomplete spinal injury
- Some function is present below site of injury
- More favourable prognosis overall
What are the different patterns of injury in spinal cord injuries?
- Tetraplegia/quadriplegia
- Paraplegia
- Central cord syndrome
- Anterior cord syndrome
- Brown-Sequard syndrome
Describe the features of tetraplegia
- 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
- Above C5 - respiratory failure due to loss of innervation of the diaphragm
- Spasticity (increased muscle tone)
Describe the features of paraplegia
- Partial or total loss of use of the lower limbs
- Impairment or loss of motor/sensory function on thoracic, lumbar or sacral segments of the spinal cord
- Arm function spared
- Possible impairment of function in the trunk
- Bladder/bowel function affected
- Spasticity if injury above L1
Describe the features of central cord syndrome
- Older patients
- Hyperextension injury
- Centrally cervical tracts more involved
- Weakness of arms > legs
- Perianal sensation and lower extremity power preserved
Describe the features of anterior cord syndrome
- Hyperflexion injury
- Anterior compression fracture
- Damaged anterior spinal artery
- Fine touch and proprioception preserved
- Profound weakness
Describe the features of Brown-Sequard syndrome
- Hemi-section of the cord
- Penetrating injuries
- Paralysis on affected side
- Loss of proprioception and fine discrimination
- Pain and temperature loss on the opposite side below the lesion
How can spinal cord injuries be managed?
- Prevention of a secondary insult
- ABCD and ATLS
- Treat spinal or neurogenic shock
- Assess neurological function including PR and perianal sensation
- Log rolling
What are the features of spinal shock?
- Transient depression of cord function below level of injury
- Flaccid paralysis
- Areflexia
- Lasts several hours to days
What are the features of neurogenic shock?
- Hypotension
- Bradycardia
- Hypothermia
- Injuries above T6
- Secondary to disruption of sympathetic outflow
What imaging should be done for a SCI?
- XR
- CT
- MRI: if neurological deficit or child
When should surgical fixation be used?
Unstable fractures
What is the long term management of SCI?
- SCI Unit
- Physio
- OT
- Psychological support
- Urological/sexual counselling
What are the features of nerve root pain?
- Limb pain worse than back pain
- Pain in a nerve root distribution
- Root tension and compression signs
- Dermatomes and myotomes
How can nerve root pain be managed?
- Most will settle within 3 months
- Physio
- Strong analgesia
- Referral after 12 weeks
- MRI
What are the different types of disc problems?
- Bulge
- Protrusion
- Extrusion
- Sequestration (dessicated disc material free in the canal)
How is cauda equina syndrome managed?
- SURGICAL EMERGENCY
- Admission, urgent MRI scna and emergency operation within 48 hrs
What happens if cauda equina syndrome is left untreated for too long?
Permanent bladder and anal sphincter and incontinence
What is the aetiology of cauda equina syndrome?
- Central lumber disc prolapse
- Tumours
- Trauma
- Infection
- Iatrogenic
What are the clinical features of cauda equina syndrome?
- Injury or precipitating event
- Bilateral buttock and leg pain + varying dysaesthesiae + weakness
- Bowel or bladder dysfunction
- PR exam: saddle anaesthesia, loss of anal tone and anal reflex
Which investigation should be done for cauda equina syndrome?
- MRI
- If contraindicated then lumbar CT myelogram
What are the features of cervical and lumbar spondylosis?
- Degenerative change at facet joints, discs, ligaments etc.
- If severe can compress whole cord - causes myelopathy
- UMN signs in limbs (increased tone, brisk reflexes etc.)
What are the features of spinal claudication?
- Usually bilateral
- Sensory dysaesthesiae
- Poss weakness
- Takes several minutes to ease after stopping
- Worse walking downhill
How can lateral recess stenosis be treated>
- Non operative
- Nerve root injection
- Epidural injection
- Surgery
How can central stenosis be treated?
- Non-operative
- Epidural steroid injection
- Surgery
How can foraminal stenosis be treated?
- Non-operative
- Nerve root injection
- Epidural injection
- Surgery
