Trauma Flashcards
Commonest groups for non trauma spinal cord injury
Older patients and females
Distribution of pathology along the cord in non trauma SCI
Equally amongst cervical thoracic and lumbar sacral
What proportion of non traumatic injuries are complete?
40%
60% are incomplete
What percentage of non trauma SCI result in paraplegia and quadriplegia respectively
75% paraplegia
25% quadriplegia
What proportion of SCI are traumatic
Two thirds
One third non trauma
Typical population of trauma SCI
Younger men
What proportion of trauma SCI is incomplete
90% incomplete
10% complete
What percentage of traumatic SCI are paraplegic and quadriplegia respectively
Para 50%
Quad 50%
What is the distribution of affected areas in traumatic SCI
Cervical 50%
Thoracic 40%
Lumbar sacral 10%
Name the five mechanisms of traumatic SCI
Flexion - falls, cars, ligament damage and bilateral dislocation
Rotation - passenger in a car, side impact, unilateral fracture dislocation
Extension - older, OA, spondylitis, central cord syndrome
Compression - burst fractures, usually minor damage
Direct - high energy blow to column
What is the ASIA criteria for SCI
A - complete motor and sensory B - incomplete sensory only c - incomplete motor grade less than 3 D incomplete motor grade more than 3 E normal function
ASIA class A
Complete motor and sensory
Asia class b
Incomplete sensory only
Asia grade c
Incomplete motor grade less than 3
Asia grade d
Incomplete motor more than 3
Asia E
Normal
Features of anterior cord lesion
Damage to anterior spinal artery or vertebral bodies
Loss of motor, loss of pin prick
Touch and proprioception preserved
Muscle recovery poor
Features of posterior cord injury
Uncommon
Loss of light touch proprioception, vibration, pain and temperature
Some motor preservation
Proprioception loss causes poor functional recovery
Features of central cord syndrome
Cervical mostly
Weakness with arms worse than legs and sacral sparing
Recovery sequence lower limb, bladder and bowel, proximal upper, distal upper
Feature of brown sequard SCI
Hemisection so;
Ipsilateral sensation loss above the lesion
Ipsilateral flaccid paralysis
Ipsilateral loss of vibration and proprioception below the lesion
Contralateral loss of pain and temperature below
Cauda equine features
Lower motor neurone lesion
Flaccid lower limbs
Atomic bladder bowel
No sacral reflexes
Variable sensation loss
Conus medullaris SCI features
Lies at L1 supplies L4 - S1
Associated with L1-2 injury
Mixed upper (conus) and lower (nerve root) lesion
