Spine And Cord Flashcards
What are the high risk factors for spinal cord injury
Over 65
Dangerous mechanism of injury
Parasthesia of the upper or lower limbs
What are the low risk factors for a c-spine injury allowing for ROM testing
No midline spinal tenderness
Ambulatory at any point
Sitting comfortably
Simple rear ended
What does in line immobilisation involve
Collar, scoop, headblocks
What happens to bladder function with a lesion above T12
Empties as it fills
You have afferent fibres to the brain so no conscious awareness of filling and have lost descending control over the urethral sphincter meaning it is constantly relaxed
Spinal reflex is still intact though: stretch transmitted by sensory afferent to synapse of interneurones which synapse of pelvic nerve and cause detrusor contraction
What happens to the bladder with a lesion below T12
Parasympathetic outflow is damaged so no spinal reflex and a paralysed detrusor muscle
Bladder fills, distends and there is overflow incontinence
What is spinal shock?
Muscle flaccidity and diminished reflexes below the level of spinal cord injury lasting1-3 days
What is the cause of priapism
Abrupt loss of sympathetics and unopposed parasympathetics leads to uncontrolled blood flow into the penile sinusoids
Why do UMN lesions lead to spastic paralysis
Lost the many descending inhibitory pathways as well as any voluntary input from corticospinal however still have the reflex arc which is excitatory
What is neurogenic shock
Type of distributive shock due to a lesion above T6.
No output to adrenal glands so no adrenaline.
Loss of sympathetic drive and unopposed vagal activity.
Hypotension + bradycardia + peripheral vasodilation
What is sacral sparing
Some degree of sensation preserved in the sacral dermatomes (even if higher dermatomes are more impaired) is associated with a better outcome
Where do spinal EDH most commonly occur
Cervical region ad anteriorly
What are risk factors for spinal EDH
Burst or compression fracture
Anticoagulated
Spinal spondylosis
Where does the bleeding come from in spinal EDH
Venous (lots of valveless anastamoses)
How does spinal EDH present
Compressive myelopathy
How does cauda equina present
Back pain Lower limb motor weakness Saddle parasthesia Urinary retention Bowel incontinence
What needs to be given to warfarinised patients with INR >2
Prothrombin complex concentrate
What is a facet dislocation
Anterior displacement of one vertebrae on the underlying one
Why do facet dislocations most often occur in the c-spine
The orientation of the facet joints here is far more horizontal than further down the spine where they are more vertical which would make a “jump” harder
C5/C6 is the most common as it’s the junction of mobile to immobile so carries increased strain
What might be damaged in facet dislocations
PLL
Vertebral arteries
Which tracts decussate at the level, which at the medulla and which don’t
At the level: spinothalamic
At the medulla: DCML, corticospinal
Don’t: spinocerebellar
How does Brown Sequrd present
Ipsilateral spastic paralysis and loss of DCML
Contralateral loss of spinothalamic
What can cause anterior cord syndrome and how does it present
ASA thromboembolism, retropulsion of bony fragments
Bilateral loss of motor function and spinothalamics
What can cause posterior cord syndrome and how does it present
PSA damage, B12 deficiency, spinal stenosis
Bilateral loss of DCML
What causes central cord syndrome and how would it present
Hyper-extension injury with inward buckling of ligamentum flavum
Spondylosis (ligamentum flavum compresses)
Cape like distribution of motor and spinothalamic loss
Motor >sensory and arm>leg
