Spinal Symposium: Spinal Anatomy and Injury

Question 1

RECAP- does the vertebral foramen, where the spinal cord passes down, increase with size going downwards or decrease?

Answer 1

Decreases with size as moves inferiorly

Question 2

RECAP- which section of the vertebral column has a foramen for the vertebral artery?

Answer 2

Cervical region

Question 3

RECAP- to which section of the vertebral column do ribs attach?

Answer 3

Thoracic region

Question 4

RECAP-curvature of spine at cervical and lumbar regions?

Answer 4

Lordosis

Question 5

RECAP- curvature of the spine at the thoracic and sacral regions?

Answer 5

Kyphosis

Question 6

Where does the C1 nerve arise in relation to the C1 vertebra?

Answer 6

Above the C1 vertebra

Question 7

Where does the C8 nerve root emerge?

Answer 7

Between vertebrae of C7 and T1

Question 8

Where does the C5 nerve root emerge in relation to the C5 vertebra?

Answer 8

Between C4 and C5

Question 9

Where does the L3 nerve root emerge in relation to the L3 vertebra?

Answer 9

Between L3 and L4

->so cervical is the vertebrae before and the actual vertebrae and lumbar is the actual vertebrae and one below if that makes sense

Question 10

Dermatome?

Answer 10

An area of skin supplied by a single spinal nerve

Question 11

Myotome?

Answer 11

Group of muscles innervated by a single spinal nerve

Question 12

Where is the C7 dermatome?

Answer 12

Middle finger

->C5 badge area, C6 thumb, C8 little finger, etc

Question 13

Where is T10 dermatome?

Answer 13

Around umbilical area

Question 14

Which dermatomes supply the groin area?

Answer 14

T12 and L1

Question 15

In terms of myotomes- which muscle does C5 innervate and what is the associated action?

Answer 15

Deltoid muscle- shoulder abduction

Question 16

In terms of myotomes- which muscle does C6 innervate and what is the associated action?

Answer 16

Biceps- elbow flexion and wrist extension

Question 17

In terms of myotomes- which muscle does C7 innervate and what is the associated action?

Answer 17

Triceps- elbow extensors

Question 18

In terms of myotomes- which muscle does C8 innervate and what is the associated action?

Answer 18

Flexor digitorum supericialis and profundus- finger flexors

Question 19

In terms of myotomes- which muscle does T1 innervate and what is the associated action?

Answer 19

Interossei- finger abduction

Question 20

In terms of myotomes- which muscle does L2 innervate and what is the associated action?

Answer 20

Iliopsoas- hip flexion

Question 21

In terms of myotomes- which muscle does L3/4 innervate and what is the associated action?

Answer 21

Quadriceps- knee extension

Question 22

In terms of myotomes- which muscle does L5 innervate and what is the associated action?

Answer 22

Extensor hallicus longus- big toe extensor

Question 23

In terms of myotomes- which muscle does S1 innervate and what is the associated action?

Answer 23

Gastroc- ankle planarflexor

Question 24

Who tends to get spinal cord injuries?

Answer 24

Male > female
Peak 20-29 years

->young men in RTA or falling from buildings x

Question 25

What are the most common causes of spinal cord injuries?

Answer 25

Falls RTAs Sport Knocked over/collision Trauma Sharp trauma/assault

Question 26

Two main groups of spinal cord injuries?

Answer 26

Complete and incomplete

Question 27

Difference between incomplete and complete spinal cord injuries?

Answer 27

Complete- no motor or sensory function distal to lesion. No chance of recovery. Incomplete- some function present, more favourable prognosis

Question 28

List the features of a complete spinal cord injury.

Answer 28

No motor or sensory function distal to the lesion No anal tone No sacral sensation

Question 29

Why can't a complete/incomplete spinal cord injury be determined acutely?

Answer 29

Patient may be in spinal shock meaning the spinal cord does not work so examination initially unreliable

Question 30

Which classification is used for the severity of spinal cord injuries?

Answer 30

ASIA classification -> A-E, A most severe (complete SCI) to E (normal motor and sensory function)

Question 31

Are ASIA classified SCI's complete or incomplete?

Answer 31

All three incomplete

Question 32

Tetraplegia/quadraplegia?

Answer 32

Partial or total loss of use of all four limbs and the trunk

Question 33

Paraplegia?

Answer 33

Affects lower limbs predominantly suggesting that injury level is below innovation of arms

Question 34

In tetraplegia/quadriplegia, what kind of motor/sensory loss is there?

Answer 34

Loss of motor/sensory function in cervical segments of the spinal cord

Question 35

RECAP- nerve supply to diaphragm?

Answer 35

Phrenic nerve- C3,4,5 keeps the diaphragm alive :)

Question 36

Spasticity?

Answer 36

Increased muscle tone

Question 37

Is spasticity seen in UML or LML?

Answer 37

Upper motor lesions

Question 38

Features of paraplegia?

Answer 38

Arm function spared Possible impairment of trunk function

Question 39

In paraplegia, what kind of motor/sensory loss is there?

Answer 39

Impairment or loss of motor/sensory function in the thoracic, lumbar or sacral region

Question 40

What happens to bowel and bladder function in paraplegia and quadriplegia?

Answer 40

Impaired in both

Question 41

What are the three partial cord syndromes?

Answer 41

Central cord syndrome Anterior cord syndrome Brwon-Sequard syndrome

Question 42

Which age group tends to get central cord syndrome?

Answer 42

Elderly

Question 43

When movement usually causes central cord syndrome?

Answer 43

Hyperextension

Question 44

Features of central cord syndrome?

Answer 44

Weakness of arms > legs Power normal Perianal sensation and lower extremity power presevered

Question 45

When movement usually causes anterior cord syndrome?

Answer 45

Hyperflexion

Question 46

Features of anterior cord syndrome?

Answer 46

Loss of sensation and pain Fine touch and proprioception preserved

Question 47

Brown-Sequard syndrome?

Answer 47

Hemi-section of the cord

Question 48

What tends to cause Brown-Sequard syndrome?

Answer 48

Penetrating injuries e.g. stabbing

Question 49

Features of Brown-Sequard syndrome?

Answer 49

Paralysis on affected side Loss of proprioception and fine touch Pain and temperature loss on opposite side below lesion

Question 50

What are the principles of management for any patient with a SCI?

Answer 50

Want to minimise secondary damage Involves ABCD management- A before B before C before D

Question 51

A for ABCD management of spinal cord injuries?

Answer 51

Airways- cervical spine control using spinal cord immobilisation collar. Intubation and oxygen.

Question 52

B for ABCD management of spinal cord injuries?

Answer 52

Breathing- ventilation and oxygenation Management of any chest injuries to maximise oxygenation of blood

Question 53

C for ABCD management of spinal cord injuries?

Answer 53

Circulation- IV fluids Consider Neurogenic shock (low BP and HR, loss of sympathetic tone) Sometimes vasopressors given to maximise blood supply and improve circulation

Question 54

When can spinal shock occur?

Answer 54

After SCI and can last several hours to days after an injury

Question 55

What is spinal shock?

Answer 55

Transient depression of cord function below the level of injury

Question 56

When does neurogenic shock occur?

Answer 56

Secondary to the disruption of sympathetic outflow

Question 57

Features of neurogenic shock?

Answer 57

Hypotension Bradycardia Hypothermia

Question 58

Above what level of the spinal cord do injuries cause neurogenic shock?

Answer 58

Above T6

Question 59

If examining a patient with spinal shock, what would be noted?

Answer 59

Flaccid paralysis Absence of reflexes

Question 60

D for ABCD management of spinal cord injuries?

Answer 60

Disability- using GCS to assess cognition Assessing neurological function, including PR and perianal sensation

Question 61

What is meant by log rolling a paient?

Answer 61

Using at least four members of staff to roll the patient while keeping them immobilised until the injury can be evaluated clinically and radiologically Allows for inspection of vertebrae and assessment of PR and perianal sensation

Question 62

Imaging for SCI?

Answer 62

X-rays CT- for bony anatomy MRI- if neurological deficit or children

Question 63

Okay so which investigation if there is neurological deficit as a result of SCI?

Answer 63

MRI

Question 64

Which SCIs are managed via surgery?

Answer 64

Unstable fractures

Question 65

How are SCIs usually treated using operation?

Answer 65

Surgical fixation, usually with pedicle screws

Question 66

Long term management of SCI?

Answer 66

Spinal cord Injury Unit- team of specialists for advice and help Physiotherapist Occupational therapist Psychological support Urological/sexual counselling

Question 67

Differences between neurogenic claudication and vascular claudication?

Answer 67

Neurogenic- patient should be able to walk up hills, cycle a bike or push a trolley but may have problems coming down a hill or lying flat. May be complaints of backache too. Pain can take a while to go. Vascular- struggling walking uphill, pain goes after rest

Question 68

Which type of claudication is often bilateral?

Answer 68

Neurogenic