Spinal Symposium - Pt 1 Flashcards
What is a dermatome?
Area of skin that is mainly supplied by a single spinal nerve
What is a myotome?
Group of muscles that a single spinal nerve innervates
What are the myotomes of the upper limb?
C5 - shoulder abduction
C6 - elbow flexion
C7 - elbow extensors
C8 - long finger flexors
T1 - finger abduction
What are the myotomes of the lower limbs?
L2 - hip flexion
L3,4 - knee extension
L4 - ankle dorsiflexion
L5 - big toe extension
S1 - ankle plantar flexion
How man people with a fracture/ dislocation have a SCI (spinal cord injury)?
15%
Majority of people with a SCI will have an accompanying column injury
What is the incidence of spinal cord injuries?
1000 SCI/ year in the UK
Males > females
Peak is 20-29 years old
What are the most common causes of spinal cord injury?
Road traffic accidents, sport + recreational activities and falls
What is a complete SCI?
No motor or sensory function distal to lesion
No anal squeeze and sacral sensation
ASIA grade A
No chance of recovery
What is an incomplete SCI?
Some function is present below site of injury
More favourable prognosis overall
What is ASIA classification?
A - complete
B - incomplete. Sensory but not motor is preserved.
C - incomplete. Motor function preserved with key muscle grade under 3
D - incomplete. Motor function preserved with key muscle grade over 3
E - normal motor and sensory function
Describe tetraplegia
Quadriplegia
Partial or total loss of use of all four limbs and the trunk
Loss of motor/ sensory function in cervical segments of spinal cord
What causes tetraplegia?
Cervical fracture - resp. failure due to loss of innervation of diaphragm from phrenic nerve
Spasticity
What is spasticity?
Increased muscle tone
UMN lesion
Spinal cord and above
Injuries above L1
What is paraplegia?
Partial or total loss of use of lower limbs
Arm function spared
Possible impairment of function of trunk
Impairment or loss of motor/ sensory function in thorax, lumbar or sacral regions
What causes paraplegia?
Thoracic/ lumbar fractures
Associated with chest or abdominal injuries
What is the symptoms with paraplegia?
Spasticity if injury of spinal cord
Bladder/ bowel function affected
What are some partial cord syndromes?
Central cord syndrome
Anterior cord syndrome
Brown-Sequard syndrome
What is the signs of central cord syndrome?
Central tracts more involved
Weakness of arms > legs
Perianal sensation and lower extremity power preserved
What is central cord syndrome causes?
Hyperextension injury
Older patients - arthritic neck
Describe Brown-Sequard Syndrome
Hemi-section of the cord
Penetrating injuries
Paralysis on affected side, loss of proprioception and fine discrimination, and pain + temp. loss on oppisite side
What is the key to management of SCI?
Prevent secondary insult - particularly in patients with an incomplete injury
ABCD and ATLS
What is a secondary injury of SCI?
Acute pathophysiologic processes
Neuroprotective interventions - stabilisation, ATLS resus, pharmacological agents and surgical care
What is ABCD of management?
Airway
Breathing
Circulation - IV fluids and consider neurogenic shock
Disability - assess neurological function
What is spinal shock?
Transient depression of cord function below level of injury
Flaccid paralysis, areflexia and lasts several hours to days after injury
What is neurogenic shock?
Hypotension, bradycardia and hypothermia
Injuries above T6
Secondary to disruption of sympathetic outflow
What imaging is required for SCI?
X-rays
CT scanning - bony anatomy
MRI - neurological deficit or children
Describe surgical fixation
For unstable fractures
Vast majority fixed from posterior
Pedicle screws preferred method
What is the long term management of SCI?
Spinal cord injury unit
Physio
Occupational therapy
Psychological support
Urological/ sexual counselling
