Spinal Symposium: Spinal Anatomy and Injury Flashcards
RECAP- does the vertebral foramen, where the spinal cord passes down, increase with size going downwards or decrease?
Decreases with size as moves inferiorly
RECAP- which section of the vertebral column has a foramen for the vertebral artery?
Cervical region
RECAP- to which section of the vertebral column do ribs attach?
Thoracic region
RECAP-curvature of spine at cervical and lumbar regions?
Lordosis
RECAP- curvature of the spine at the thoracic and sacral regions?
Kyphosis
Where does the C1 nerve arise in relation to the C1 vertebra?
Above the C1 vertebra
Where does the C8 nerve root emerge?
Between vertebrae of C7 and T1
Where does the C5 nerve root emerge in relation to the C5 vertebra?
Between C4 and C5
Where does the L3 nerve root emerge in relation to the L3 vertebra?
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
Dermatome?
An area of skin supplied by a single spinal nerve
Myotome?
Group of muscles innervated by a single spinal nerve
Where is the C7 dermatome?
Middle finger
->C5 badge area, C6 thumb, C8 little finger, etc
Where is T10 dermatome?
Around umbilical area
Which dermatomes supply the groin area?
T12 and L1
In terms of myotomes- which muscle does C5 innervate and what is the associated action?
Deltoid muscle- shoulder abduction
In terms of myotomes- which muscle does C6 innervate and what is the associated action?
Biceps- elbow flexion and wrist extension
In terms of myotomes- which muscle does C7 innervate and what is the associated action?
Triceps- elbow extensors
In terms of myotomes- which muscle does C8 innervate and what is the associated action?
Flexor digitorum supericialis and profundus- finger flexors
In terms of myotomes- which muscle does T1 innervate and what is the associated action?
Interossei- finger abduction
In terms of myotomes- which muscle does L2 innervate and what is the associated action?
Iliopsoas- hip flexion
In terms of myotomes- which muscle does L3/4 innervate and what is the associated action?
Quadriceps- knee extension
In terms of myotomes- which muscle does L5 innervate and what is the associated action?
Extensor hallicus longus- big toe extensor
In terms of myotomes- which muscle does S1 innervate and what is the associated action?
Gastroc- ankle planarflexor
Who tends to get spinal cord injuries?
Male > female
Peak 20-29 years
->young men in RTA or falling from buildings x
What are the most common causes of spinal cord injuries?
Falls
RTAs
Sport
Knocked over/collision
Trauma
Sharp trauma/assault
Two main groups of spinal cord injuries?
Complete and incomplete
Difference between incomplete and complete spinal cord injuries?
Complete- no motor or sensory function distal to lesion. No chance of recovery.
Incomplete- some function present, more favourable prognosis
List the features of a complete spinal cord injury.
No motor or sensory function distal to the lesion
No anal tone
No sacral sensation
Why can’t a complete/incomplete spinal cord injury be determined acutely?
Patient may be in spinal shock meaning the spinal cord does not work so examination initially unreliable
Which classification is used for the severity of spinal cord injuries?
ASIA classification
-> A-E, A most severe (complete SCI) to E (normal motor and sensory function)
Are ASIA classified SCI’s complete or incomplete?
All three incomplete
Tetraplegia/quadraplegia?
Partial or total loss of use of all four limbs and the trunk
Paraplegia?
Affects lower limbs predominantly suggesting that injury level is below innovation of arms
In tetraplegia/quadriplegia, what kind of motor/sensory loss is there?
Loss of motor/sensory function in cervical segments of the spinal cord
RECAP- nerve supply to diaphragm?
Phrenic nerve- C3,4,5 keeps the diaphragm alive :)
Spasticity?
Increased muscle tone
Is spasticity seen in UML or LML?
Upper motor lesions
Features of paraplegia?
Arm function spared
Possible impairment of trunk function
In paraplegia, what kind of motor/sensory loss is there?
Impairment or loss of motor/sensory function in the thoracic, lumbar or sacral region
What happens to bowel and bladder function in paraplegia and quadriplegia?
Impaired in both
What are the three partial cord syndromes?
Central cord syndrome
Anterior cord syndrome
Brwon-Sequard syndrome
Which age group tends to get central cord syndrome?
Elderly
When movement usually causes central cord syndrome?
Hyperextension
Features of central cord syndrome?
Weakness of arms > legs
Power normal
Perianal sensation and lower extremity power presevered
When movement usually causes anterior cord syndrome?
Hyperflexion
Features of anterior cord syndrome?
Loss of sensation and pain
Fine touch and proprioception preserved
Brown-Sequard syndrome?
Hemi-section of the cord
What tends to cause Brown-Sequard syndrome?
Penetrating injuries e.g. stabbing
Features of Brown-Sequard syndrome?
Paralysis on affected side
Loss of proprioception and fine touch
Pain and temperature loss on opposite side below lesion
What are the principles of management for any patient with a SCI?
Want to minimise secondary damage
Involves ABCD management- A before B before C before D
A for ABCD management of spinal cord injuries?
Airways- cervical spine control using spinal cord immobilisation collar. Intubation and oxygen.
B for ABCD management of spinal cord injuries?
Breathing- ventilation and oxygenation
Management of any chest injuries to maximise oxygenation of blood
C for ABCD management of spinal cord injuries?
Circulation- IV fluids
Consider Neurogenic shock (low BP and HR, loss of sympathetic tone)
Sometimes vasopressors given to maximise blood supply and improve circulation
When can spinal shock occur?
After SCI and can last several hours to days after an injury
What is spinal shock?
Transient depression of cord function below the level of injury
When does neurogenic shock occur?
Secondary to the disruption of sympathetic outflow
Features of neurogenic shock?
Hypotension
Bradycardia
Hypothermia
Above what level of the spinal cord do injuries cause neurogenic shock?
Above T6
If examining a patient with spinal shock, what would be noted?
Flaccid paralysis
Absence of reflexes
D for ABCD management of spinal cord injuries?
Disability- using GCS to assess cognition
Assessing neurological function, including PR and perianal sensation
What is meant by log rolling a paient?
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
Imaging for SCI?
X-rays
CT- for bony anatomy
MRI- if neurological deficit or children
Okay so which investigation if there is neurological deficit as a result of SCI?
MRI
Which SCIs are managed via surgery?
Unstable fractures
How are SCIs usually treated using operation?
Surgical fixation, usually with pedicle screws
Long term management of SCI?
Spinal cord Injury Unit- team of specialists for advice and help
Physiotherapist
Occupational therapist
Psychological support
Urological/sexual counselling
Differences between neurogenic claudication and vascular claudication?
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
Which type of claudication is often bilateral?
Neurogenic
