Traumatic Spinal Cord Injury Flashcards
What are some common etiologies of traumatic spinal cord injury?
Motor vehicle accidents, falls, animal-animal encounters, malicious abuse, penetrating missiles
What are some types of vertebral Column Injury?
Fracture/luxation, acute disc herniation, soft tissue injury, contusion/laceration, nerve root injury, entrapment
What is a primary vs secondary lesion?
Normal - mechanical impact - primary injury (contusion/concussion) and secondary injury (ischemia, neuroinflammation, edema)
What kind of forces can act on the axial skeleton?
Bending (dorsoventral and lateral), Torsional, Shear, Axial loading (compression and tension)
What part of the spine resists bending and axial loading?
Vertebral Body
What part of the spine resists all forces?
Articular facets
What is the most important stabilizer against lateral bending and torsion?
Intervertebral discs
Where are many spinal injuries located region wise?
Cranicervical junction, cervicothoracic junciton, T-L junction and L-S Junction (more in the rear)
What is the goal of treating a traumatic spinal injury?
Don’t make it worse, support the animal
What are the goals of your exam?
Don’t make it worse, establish severity, determine what other injuries are present
After a traumatic spinal injury what should you do when you first asceses the animal?
ABC- airway, breathing and circulation
Evaluate for concurrent injury (Cardiothoracic, appendicular fracture, soft tissue trauma, head traum and urinary tract injury
How should you perform your neurologic exam?
Restrained and in lateral recumbency (Mention, body posture, CN, motor function in all limbs, reflexes in all limbs, perineum and CT, tail, conscious proprioception with deep pain
Tells you stability
How do you grade severity of the spinal injury?
Modified Frankel Score (MFS) - 0-5
0 - normal
1-pain only
2- ambulatory parapersis and ataxia
3- non-ambulatory
4- paraplegia with deep pain preception
5 - paraplegia with absent deep pain
Pain preception = nociception
What is the schiff-sherrington Phenomena/Posture?
extended front limbs and flaccid paralysis hind that can’t be moved normal
Spinal shock (thoracic lumbar lesion)
Decerebrate Posture is?
Extension of all limbs
Brain stem and decreased concsiouness
Decerebellate posture is?
Extension of thoracic and bent hind
Conscious
What is the prognosis for traumatic spinal cord injury?
Cervical: 60-70% good if survive initial injury
T3-L3, L4-S2: 75-80% good with surgery, 60% with conservative
Cervial or thoracolumbar - no deep pain - grave/hopeless - euthanize
How do we immobilize a patient?
Lateral recumbency (plywood, cardboard, stracher, cage, tape, cloth, dont let it prevent ventilation
What does supportive care look like for a spinal injury?
Maintain perfusion - BP and Oxygen
Analgesics
What type of analgesics are needed?
Parental narcotics - Full Mu-opiod agonsit (morphine)
Sedative, anxiolytic, NSAID
How do we image spinal diseases?
Radiograph, CT, MRI
Since radiographs are always indicated in traumatic spinal injury, how should they be taken?
Lateral recumbency
How do you know if the injury is unstable?
Divide vertebrae in 3 compartments
-Disruption of 2/3 compartments = instability and dictates treatment
Can you determine the degree of impairment from radiographs alone?
No, not unless it is a full displacement = poor prognosis
What are indications for advanced imaging like MRI or CT?
No obvious rad lesion, rad lesion doesn’t match clinical localization, surgical therapy indicated and evaluate integrity of the spinal cord
What is treatment of the vertebral column driven by?
Stability and injury severity
If the injury is stable what is the treatment?
cage rest and analgesics for 6 weeks
If the injury is unstable what is treatment?
Surgical or conservative
What are indications for conservative management?
Cervical fracture (death in surgery), Caudal lumbar or lumbosacral fracture with minimal neuro involvement, no significant concurrent injury, intact pain perception, client constrain, external coaptation
How should external coaptation be fulfilled?
Make sure to immobilize high motion segments above and below the level of the lesion
*DONT reduce fracture or luxation before putting a brace on, hard to reduce, labor intensive, multiple material
How do you asses your conservative treatment?
Hospitalize 2-5 days
Check BID (pain, neuro, bladder, tolerance of coaptation)
Recheck weekly next 3 weeks (analgesia)
Repeat rads 4 weeks
What are indications for surgery and what are the goals?
Unstable injury and moderate to secer neurologic signs
Reduce malalignments (decompression)
Rigid fixation
Decompress spinal cord
When is additional decompression necessary?
Displaced fracture or fragment, disc rupture, compressive hematoma, penetrating missile
What are the advantages and disadvantages of surgical treatment?
Advantage: strength against bend and torison, adaptable, no need to remove
Disadvantage: low resistance to bending, implant failure or bone pull out
What are things to strongly consider when thinking about Cervical vertebral trauma?
can lead to death if sever, canal:cord diamteter favorable, low incidence body fracture, high surgical mortality, conservative treatment 75% sucess, delayed referral worsens prognosis
What should you consider with thoracolumbar injury?
surgery if unstable - hard to immobilize, decompensation bad, deficit common with conservative
What should you consider with lumbosacral injury?
Mobile lumbar and imobile sacrum make more stess, nerve roots in caudal equina more injury tolerant than spinal cord, incontinence common
What should you consider with Sacro caudal injury?
tail pull injuries - common in cat, rare dog - traction avulsion S1-S3
Sign: plantigrade with paraparesis, weak/paralyzed, flaccid tail, diminished perineal reflex/anal tine, tail pain, urinary and fecal incontencae
Concurrent injury common
Treat with cage rest, analesic and bladder management, tail amputation internal fixation
***Important presence of tail and perineal sensation, improve in 2 weeks, intact pain sensation urinary function return (75-100%), absence of tail sensation >30 days poor prognosis
What are treatment complications for conservative treatment?
Failure - pain and instability
Coaptation
What are treatment complications for surgical treatment?
technical error, damage to spinal cord, concurrent injure, implant failure or infection
