spinal symposium Flashcards
dermatome
area of skin mainly supplied by single spinal nerve
myotome
group of muscles a spingle spinal nerve innervates
types of spinal injuries
fracture
spinal cord injury
complete spinal cord injury
no motor or sensory function distal to lesion no anal squeeze no sacral sensation ASIA grade A no chance recovery
incomplete SCI
some function present below site of injury
more favourable prognosis
ASIA classification: Grade A
complete
no sensory or motor function preserved in sacral segments S4-S5
ASIA classification: Grade B
incomplete
sensory but not motor function preserved below neurologic level and extending through sacral segments S4-S5
ASIA classification: Grade C
incomplete
motor function preserved below neurologic level
majority of key muscles have a grade < 3
ASIA classification: Grade D
incomplete
motor function preserved below neurologic level
majority key muscles grade > 3
ASIA classification: Grade E
normal motor and sensory function
tetraplegia/quadraplegia
partial or total loss of use of all 4 limbs and trunk
loss of motor/sensory function in cervical segments spinal cord
spasticity
increased muscle tone
UMN lesion
paraplegia
partial or total loss of use of lower limbs
impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments spinal cord
arm function spared
partial cord syndromes
central cord syndrome
anterior cord syndrome
brown-sequard syndrome
central cord syndrome
impinges onto parts corticospinal tracts
centrally cervical tracts more invovled
weakness arms > legs
perianal sensation and lower extremity power preserved
anterior cord syndrome
hyperflexion injury, anterior compression fracture, damage anterior spinal a.
fine touch and proprioception preserved (dorsal coloumns ok)
corticospinal (motor) and spinothalamic (pain) tracts damaged –> profound weakness
brown-sequard syndrome
hemi-section of cord
penetrating injuries
paralysis on affected side (corticospinal)
loss proprioception + fine discrimination (dorsal)
pain and temp loss on opposite side below lesion (spinothalamic)
key to management of SCI patient
prevent a secondary insult
ABCD: A
airway - c spine control
ABCD: B
breathing
- ventilation + oxygenation
- concomitant chest injuries
ABCD: C
circulation
- IV fluids + access
- consider neurogenic shock
- vasopressors
spinal shock
transient depression of cord function below level injury
flaccid paralysus
arreflexia
lasts several hrs to days post injury
neurogenic shock
hypotension bradycardia hypothermia injuries above T6 secondary to disruption sympathetic outflow
ABCD: D
disability
assess neurological function
incl PR and perianal sensation
investifations SCI
X-ray
CT
MRI
surgical fixation
unstable fractures
long term management SCI
spinal cord injury unit physiotherapy OT psychological support urological/sexual counselling
type of joint is intervertebral disc
secondary cartilagenous joint
normal ageing processes to IV discs
decreased water contents disc
disc space narrowing
degenerative changes x-ray
degenerative changes in facet joints
aggravated by smoking, weight gain etc.
pathological processes IV discs
- tearing annulus fibrosis and protrusion of nucleus
- nerve root compression by osteophytes
- central spinal stenosis
nerve root pain
limb pain worse than back pain
pain in nerve root distribution - radicular
root tension and root compression signs
IV disc problems: bulge
common
majority asymptomatic
nucleus contained, annulus slightly bulging
IV disc problems: protrusion
annulus weakened but still intact
nucleus elongated and moved out place, hasn’t breached annulus
IV disc problems: extrusion
nucleus through annulus but still in continuity
annulus ruptured
IV disc problems: sequestration
dessicated disc material free in canal
cervical disc prolapse
mostly C5/6
thoracic disc prolapse
<12% IVD prolapses
most T11/T12
lumbar disc prolapses
L4/5 then L5/S1 then L3/4
most posterolateral: pos longitudinal leg weakness, sciatica
central disc may give pain in both legs or back pain only
cauda equina syndrome
compression of cauda equina
sacral nerve roots compressed
cauda equina causes
central lumbar disc prolapse spinal stenosis trauma tumour - 1ry, 2ry haematoma infection - epidural abscess iatrogenic: spinal surgery
cauda equina classic triad
saddle anaesthesia
bilateral leg weakness
urinary/faecal incontinence/sexual dysfunction
cauda equina other features
poor anal tone
back pain and radicular pain
LMN signs: hypotonia, hyporeflexia
cauda equina investigations
urgent MRI
if contraindicated lumbar CT myelogram
cauda equina Rx
surgery within 48hrs: decompression - laminectomy
cervical + lumbar spondylosis
OA
degenerative changes to facet joints, IV discs and ligaments
if severe can compress cord causing myelopathy
cervical spondylosis features
axial neck pain
neurological complications: compression, cervical spondylotic radiculopathy
cervical spondylosis: cervical spondylotic radiculopathy
arm pain, sensory loss and weakness down nerve root supply
distinguish spinal claudication from vasuclar claudication
usually bilateral sensory dysthesiae possible weakness several mins to ease after walking worse walking downhill
spinal stenosis classifications
lateral recess stenosis
central stenosis
foraminal stenosis
spinal stenosis features
back pain
activity relation pain
leg numbess/paraethesiae
pain radiating down legs
spinal stenosis Rx: lateral recess stenosis
nerve root steroid injection
epidural steroid injection
surgery
spinal stenosis Rx: central stenosis
epidural steroid injection
surgery
spinal stenosis Rx: foraminal stenosis
nerve root steroid injection
epidural injection
surgery
spondilolothesis
one vertebrae translated onto another
causes: degenerative, fractures, trauma, infection
