Traumatic Spinal Cord Injury Flashcards
most frequent causes of traumatic SCI:
- MVA (38%)
- Falls (30.5%)
- Acts of violence (primarily gun shot wounds; stabbings)
- Sports/Recreational injuries 9%
- Other
Partial or complete paralysis of all 4 extremities & trunk,
including respiratory muscles, and results from lesions of cervical cord. Approx 56% of patients with SCI:
Tetraplegia
Partial or complete paralysis of all or part of trunk & both LE’s and results from lesions of thoracic or lumbar cord or cauda equina. Approx 43% of patients with SCI
Paraplegia
results from lesions of thoracic or lumbar cord or cauda equina
paraplegia
Results from lesions of cervical cord
tetraplegia
Which is currently the most frequent SCI?
Followed by?
- Incomplete tetraplegia
- Followed by incomplete paraplegia
- Complete paraplegia
- Complete tetraplegia
ASIA
American Spinal Injury Association
- developed in 1992
- revised periodicaly
- improve accuracy and reliability of SCI examination
What is NEUROLOGICAL LEVEL (NLI), MOTOR LEVEL, SENSORY KEVEL and SKELETAL LEVEL of injury?
- NL: Refers to the most caudal segment of (3 or greater) muscle function strength, provided there is normal (intact) sensory and motor function rostrally respectively
- SKL: the greatest vertebral damage is found on a radigraph.
-
ML: grade of at least 3/5 AND key muscle functions above that level are intact (grade of
5/5) - Sensory level = most caudal, intact dermatome for both pinprick and light touch sensation
How is a complete SCI determined?
Determined by anal sensation and voluntary external anal sphincter contraction
Collection of muscle fibers innervated by the motor axons within each segmental nerve root
MYOTOME
preservation of some sensory or motor function below the neurological level of the lesion including sensory &/or motor function at S4 & S5
incomplete SCI
(S4 and S5) no sensory or motor function in the lowest sacral segments
complete SCI
complete SCI caused by?
- complete transection of cord
- severe compression of cord
- extensive vascular impairment
incomplete SCI injury cause by?
- contusions: pressure on cord from displaced bone &/or soft tissue or from swelling within spinal canal
- partial transection of cord
Zone of partial preservation (ZPP):
- Determined in complete SCI only
- Intact motor &/or sensory function below the neurological level but NO S4 & S5 motor or sensory function
- Lowest dermatome or myotome on each side with some preservation/innervation
ASIA Impairment Scale:
- A = Complete: No motor or sensory function preserved in the lowest sacral segments
- B = sensory incomplete: Sensory but not motor function preserved in the lowest sacral segments
- C = motor incomplete: Motor function present below the injury but more than half key muscles are <3/5
- D = motor incomplete: Motor function present below the injury but at least half key muscles are >3/5
- E = normal: Motor and sensory function normal, only assigned if initial deficit is present
- F Some patterns of spinal cord injury have special names.
Incomplete (SCI) Clinical Syndromes:
- Brown-Sequard Syndrome
- Anterior Cord syndrome
- Central Cord Syndrome
- Posterior Cord Syndrome
- Cauda Equina Injuries
Which incomplete SCI is usually caused by stab wounds?
Brown-Sequard Syndrome
What is Brown-Sequard Syndrome?
Hemisection of spinal cord
Clinical features of Brown-Sequard Syndrome
- Ipsilateral: paralysis, loss of sensation in dermatome segment corresponding to level of lesion, abnormal reflexes, clonus, positive babinski, loss of proprioception, kinesthesia, and vibration
- Contralateral loss of pain & temperature several dermatomes below level of the lesion
What is anterior cord syndrome?
Clinical Feautures?
- Flexion injuries of CS
- Damage to SC or ASA
- usually due to compression of anterior cord: fracture, dislocation, cervical disc protrusion
-
Clinical features:
- loss of motor function below level of lesion
- loss of pain & temperature below level of the lesion
What is Central Cord Syndrome?
- hyperextension injuries of cervical spine
- could be congenital or degenerative narrowing of spinal canal: compressive forces lead to hemorrhage & edema
- UE’s more involved than LE’s
- varying degress of sensory loss
- motor loss more severe
- complete preservation of sacral tracts
- can ambulate
What is posterior cord syndrome?
- rare
- posterior columns affected
- loss of proprioception, two-point discrimination,
graphesthesia, sterognosis below level of the lesion - wide-based steppage gait pattern typical
- preservation of motor, pain & light touch
What is cauda equina injuries?
- Usually incomplete
- LMN’s lesion
- potential to regenerate, but reinnervation is not common
4 most common types of forces in SCI
- flexion
- compression
- hyperextension
- flexion-rotation
some areas of spine more susceptible to injury:
- cervical area = C5 - C7
- thoracolumbar area = T12 - L2
least common mechanism of injury in SCI
Distraction: traction force in cervical spine where head is pulled away from body
True or false:
shearing forces do not create SCI
false
Which is the most common mechanism of SCI?
flexion
what type of fx is associated with flexion SCI?
- *wedge fracture** of anterior vertebral body
- high % occur from C4-C7 & T12-L2*
what is the casue of compression SCI?
- vertical or axial blow to head (diving, falling objects, surfing)
- closely associated with flexion injuries
what is the casue of flexion-rotation SCI?
- posterior to anterior force directed at rotated spine ( rear end collision with passenger rotated toward driver)
what is the casue of hyperextension SCI?
- strong posterior force (rear end collision)
- falls with chin striking stationary object (often seen in elderly population)
Clinical Manifestations of SCI:
- Spinal shock: Period of areflexia
- Motor & sensory impairments: partial or complete bellow
- Autonomic Dysreflexia: elevation of BP, medical emergency
- Postural Hypotension
- Impaired temperature control: autonomic dysfunction
- Pulmonary impairment: tetraplegia, C1-C3 phrenic nerve
- Spasticity: bellow level of lesion
- Bladder & bowel dysfunction
- Sexual dysfunction
- Secondary impairments & complications: pressure sores, DVT
What is heterotopic (ectopic) ossification?
Abnormal bone growth in soft tissue below level of lesion
gradual increase in spasticity seen during __________
post SCI
1st 6 months
C1-C3 SCI may cause:
severe to mild impairment of respiratory function due to paralysis of respiratory muscles (phrenic nerve)
SCI autonomic (sympathetic) dysfunction can result in
- loss of internal thermoregulatory response
- compensatory diaphoresis above level of lesion
- no vaso dilatation/constriction is response to heat/cold
Incomplete SCI autonomic (sympathetic) dysfunction can result in:
spotty areas of localized sweating below level of lesion
Pathological autonomic reflex resulting in elevation of blood pressure
Autonomic Dysreflexia (Hyperreflexia)
medical emergency
what is the most common cause of Autonomic Dysreflexia?
bladder distention (urinary retention)
Most commont symptoms of autonomic dysreflexia:
- headache
- profuse sweating
- flushing
- hypertension (elevated BP)
(slide 47 of SCI for more)
Intervention in autonomic dysreflexia:
- 1st check catheter and tubing
- position pt in sitting position (lower BP)
- look for irritating stimuli: tight clothing etc.
- obtain medical assistance
what is the 1st indicator of spinal shock
+ bulbocavernosus reflex
Period of areflexia immediately following SCI, absence of all reflex activity, flaccidity & loss of sensation below level of lesion, lasts for several hours to several weeks and usually subsides within 24 hours.
Spinal shock
SCI postural hypotension intervention includes:
- elevation of head from the bed
- tilt table
- compressive agents
- abdominal binder
- drug therapy
which is the most frequent neurological category of SCI?
incomplete tetraplegia
