Test 1 Flashcards
SCI age
most 16-30 yrs: participate in high risk activities
median age 26 yrs
avg age 41
SCI cause
*MVA most common 44% (motorcycle only 7%, die)
Falls 18%
Violence 16%
Sporting, mostly diving 12.7%
SCI gender
Male: Female ration is 4:1
SCI Ethnicity
73.9 Caucasian
caucasian (MVA) > AA (violence) > Hispanic (violence)
leading cause SCI below 45yrs, above 45 yrs
below 45: MVA
above 45: falls
When is SCI most common
July
Saturday
Daytime hours
alcohol or substance abuse plays a role in 17-49% of cases
epidemiology
tetra vs paraplegia/ complete vs incomplete SCI common
Incomplete Tetraplegia (quad): 29.5%—arms, legs, trunk
Complete Paraplegia 27.9%
Incomplete paraplegia: 21.3%
complete tetraplegia (quad): 18.5%
epidemiology
most frequent level SCI
C5
then: C4, C6, T12
what % of pts SCI have complete neuro recovery by discharge?
<1%
what are the most vulnerable areas of the spine levels in SCI?
C5-C7
T4-T7
What ASIA level most likely to be employed?
D
Who is most likely to return to work post SCI? What kind of work?
ASIA D
work fulltime
if return in one yr its the same job
more likely to return to work: younger, male, white, more educated, higher IQ
Rehab
the restoration through personal health services of handicapped individuals to their fullest physical, mental, social, and economic usefulness of which they are capable
including ordinary tx and tx in special rehab
Vertebral Column # vertebrae
7 cervical 12 thoracic 5 Lumbar sacrum and coccyx not considered vertebrae 31 spinal nerves 21 vertebrae
Processes on vertebrae
7 proceses
4 articular
2 transverse
1 spinous
about the dis
central nucleus puplposes surrounded by annulus fibrosis
avascular: bld supply from peiphery adjacent blood vessels
mobility
what is for mobility and stability in spine
muscle attachements and ligaments for stability
articulation of facet joints and IV disc mobility
ALL
anterior longitudinal ligament
anterior vertebral body
atlas to sacrum
limits extension
PLL
posterior body within spinal canal from axis to sacrum, limits flexion
Ligamentum flavum
laminae of adjacent vertebrae,
upright head
ligamentum ncha
extend protub of skull to C7 for head upright
supraspinous infraspinous ligament
btwn spinous pocess
upright head
intertrnsverse ligament
ptween transverese process
limit lateral flexion of spine (rotation?)
dura mater
envelopes roots, ganglia, nerves, dense fibrous tissue, little vascualr supply, protective function
if tumor problem
arachnoid mater:
delicate, cobweblike fine elastic tissue in subarachnoid space
distribute CSF in CNS
Pia Mater
adhere firmly to cord and help hold cord in place
most imp structure between brain and body
spinal cord
where is spinal cord
foramen of first magnum where it is continuous with medulla to level of the first or second lumbar vertebrae
size of spinal cord
45 cm males
42 cm females
1.5 cm wide
weigh 30 grams–light
where are the nerve roots
2 rows of nerve roots emerge from the cord on each of tis 2 sides, the nerve roots join distally to form 31 pairs of spinal nerves. there is one pair of roots per spinal segment, upper roots almost horizontal, others downward oblique
ventral root
anterior, efferent
somatic = motor
have a visceral (sympathetic) portion
originate from ventral and lateral grey
dorsal root
posterior, afferent root
SAME
sensory afferent motor efferent
DAVE
dorsal afferent ventral efferent
how do dorsal and ventral combine
dorsal horn (sensory( and ventral horn (motor) come out of the central grey and join together to form the spinal nerve (31 pairs on each side)
T/F
where does damage to L5 vertebrae cause damage
spinal nerves come out straight around C3, as you go down the nerves travel a little further down each time, the cord ends at L1. damage to L5 vertebrae doesnt mean L5 damage
damage to L5 vertebrae doesnt mean L5 damage
grey area
H shaped area containing cell bodies of neurons
initial axonal segments, terminals of axons that synapse with these neurons
dorsal horn
sensory
ventral horn
motor
lateral horn
visceral
spinal cord white matter
ascending and descending fibers
when fibers performing similar tracts are grouped together they are called tracts
myelenated = white
what happens if posterior cord is damaged?
sensation loss
fasciulus gracilis, fasciculus cuneatue
you can have corticospinal sparing and save motor
you can stull have some sensory from lateral and ventral spinothalamic tracts
lesion to most anterior SC
lose motor from ventral corticospinal tracts as well as sensory from the spinothalamic tracts
anatommical relationships between the spinal cord and ventral vertebral column
Different growth rate of cord and spine. Cord segments are displaced upward from corresponding vertebrae, greater discrepancy occurs as you go down
use spinous processes, add 2 to the number of spinous processes and resulting number is that of underlying spinal cord segment, from C2-T10
Ex: SP C5 over cord segment C7
SP + 2 = # of the underlying segment
Because the cord is shorter than the vertebral column, nerve roots have to travel downwards (caudal), prior to exiting the vertebral canal
Cord Segment–>Vertebral body–>spinous process
Vertebral C6
Vertebral T4
Cord Segment–>Vertebral body–>spinous process (don’t need to memorize this, use the rule): more discrepancy as you go down
- C8–> lower C6/upper C7–>C6
- T6–> lower T3/upper T4–>T3
- T12–>T9–>T8
- L5–> T11–>T10
- S–> T12/L1–>T12
Vascular Supply to the Spinal Cord
the spinal cord is highly vascularized, it needs oxygen/nutrients and with loss of vascularization major damage will occur (trauma, spinal stroke loss of blood supply due to ischemia or hemorrhage)*vascularization is dense because it is important *without the vasculature have extensive cord damage
Anterior spinal artery:
where is it
what does it supply
supplied by intracranial artery and vertebral artery
it is a single solitary trunk, along
anterior fissure to thoracic spine
and it gives rise to sulcal artery which will supply central cord
lateral spinal artery:
where is it
what does it supply
single set of branches from the vertebral artery C2-T2
supplies lateral structures
segmental radicular artery:
where is it
what does it supply
prolongation of anterior spinal artery below T4, intercostal artery from aorta, supply segment bridge to spinal cord
supply nerve root areas
intercostal artery: from where
from aorta
Vessel of Adamkieicz:
what does it supply
supplies the anterior spinal artery between T8-L4. Supplies thoracic, lumbar, and sacral areas,
Terminal artery:
what does it supply
supplies filum terminale
Posterior Spinal Artery:
what is it
what does it supply
supplies the posterior horns and posterior vertebral structures
descends as a pair (unlike the anterior) along the medial edge of the posterior roots,
Centrifugal system
what does it supply
where is it
supply exclusively cord –supply grey matter of the cord
a. arise from the anterior spinal artery and supplies the central region of the cord—mostly grey matter
b. includes most of gray matter and ½ inner, posterior, lateral, and anterior white matter
Centripetal system:
what does it supply?
supply exclusively cord –supply white matter of the cord
—–Supplies part of dorsal horns, posterior column, outer lateral and anterior column
Arise from the anterior and posterior spinal arteries and supplies the peripheral region of the cord. Anterior artery gives rise to pial arteries and travel circumferentially supplies periphery.
Capillary Network:
more dense in grey or white matter?
more dense in the grey matter than in the white matter. This suggests that grey matter is more important needs more vascular supply, when there is ischemia to cord itself the grey matter cells die more quickly than the white matter cells
