TSCI Flashcards
4 stable spine fractures
Mild anterior subluxation
Simple burst (1 column fx)
Simple wedge
Clay shoveler’s
5 unstable spine fractures
Flexion teardrop
Jefferson fx
Hangman fx
Dens (type III, II)
Complex burst fracture
leading cause of TSCI for under 65 w/ significant trauma
MVA
leading cause of TSCI for people over 65 w/ minor trauma
falls
- immediate transient loss of all neurological function below injury level that lasts several hrs to several days/wks d/t K+ loss from damaged cells
- flaccid paralysis followed by spasic paresis
- loss of reflexes below SCI but later recover
- bowel & bladder involved; priapism
spinal shock
high cervical and thoracic (above T6) injury can cause what kind of shock
neurogenic shock
- disruption of sympathetic outflow from T1-L2 typically 4-6hrs after injury with cord lesions above T6
- can last 48hrs-several days
- loss of vasomotor tone (peripheral blood pooling & less preload)
neurogenic shock
3 classic signs of neurogenic shock & how its treated
- hypotension, bradycardia, hypothermia
- tx– fluid & pressors; atropine
what is autonomic dysreflexia (4)
- life threatening
- usually later complication of lesions above T6 where SBP rises over 250, tachycardia, urticaria, flushing, diaphoresis, reflex brady, throbbing HA
- can lead to stroke or seizure
- bladder distention, UTI, fecal impaction, skin lesions
3 signs of poor prognosis for recovery of SCI
- arrived in shock
- cannot breath
- complete injury
what is complete impairment according to ASIA scale
no motor or sensory function is preserved in S4-S5
difference between incomplete B, C, & D impairments in ASIA scale
- B= sacral sensory sparing
- C= motor preserved below & majority have muscle grade less than 3
- D= motor preserved below & at least half have muscle grade above 3
what type of SCI
- paralysis
- persistence beyond 24 hrs– no distal function recovery
complete SCI
* complete and irreversible loss of motor/sensory function below level of injury
how long does it take to see the extent of injury with incomplete SCIs
6-8 wks (after shock, swelling, and fluid subsides)
- mixed loss
- can be extremeley variable in each person
incomplete SCI– damage that is not absolute
with complete SCI
injuries above what level causes tetraplagia?
above C5
with complete SCI
injuries at and below what level causes paraplegia
at or below T1
what is anterior cord syndrome (2)
- direct trauma to anterior spinal cord (hyperflexion or flexion/rotation injury) or anterior spinal artery infarct causing ischemia
- retropulsed disc or bone; compression fracture
3 expected impairments from anterior cord syndrome
- impairment with pain & temp below level (spinothalamaic tracts)
- variable loss of motor function (corticospinal tracts
- can be para or tetraplegic with only few recovering motor function
what is central cord syndrome & expected population(3)
- usually at cervical region; hyperextension with osteophytic spurs
- often in elderly ppl w/ cervical spondylosis and spinal stenosis; surgical decompression
- in young d/t sporting events
3 expected impairments from central cord syndrome
- weakness w/ hand dexterity; neuropathic pain in hands
- loss of function in arms
- myelopathic symptoms
define posterior cord syndome
hyperextension injuries or posterior spinal artery infarct that involves dorsal column pathways
expected impairment with posterior cord syndrome (2)
- difficulty in coordinated limb movement (ataxic gait), proprioception & vibration
- overall strength & sense of pain perserved!!
findings with brown-sequard syndrome (3)
- ipisilateral hemiplegia, loss of fine tough, proprioception, vibrations (dorsal columns)
- contralateral absent pain & temp (lateral spinothalamic tract)
- most regain bowel & bladder function and ambulatory capacity
- d/t bony compression or disc protrusions in lumbar or sacral region
- bowel/bladder sphincter disturbance
- back pain; saddle anesthesia
- bilateral LE motor weakness and sensory loss
- no achilles reflex
cauda equina syndrome
better prognosis than Conus medullaris
3 leading causes of SCI mortality
- pneumonia
- septiciemia
- heart dz
when should you start steroids?
high dose w/in 8 hrs of injury if there is any sign of motor or sensory neuro deficit (solumedrol)
helps recover function and decrease edema/K+ depletion
Lesions above what level will cause partial or complete diaphragmatic paralysis
C5
C1-C3 will always need respiratory support
3 indications for spinal surgery
- significant cord compression w/ neuro deficits
- unstable fracture or dislocatin
- instable spine
3 groups that should be treated as having an SCI till proven otherwise
- significant trauma victims
- loss of consciousness
- spine symptoms (neck pain/tenderness, extremity tingling, numbness or weakness)
if there is evidence of compression, what should be done & how fast?
urgent decompression w/in 2 hrs for best chance of return to function
what other imaging should be done on patients with documented traumatic cervical fractures
thoracic & lumbar xrays
diagnostic imaging for unstable ligamentous injuries
MRI, flexion/exension films
4 indications that cervical collar is NEEDED
- altered mental status or intoxicated
- neuro deficit
- suspected extremity fracture
- spine pain/tenderness
if they meet this criteria they should also be getting imaging
what group needs radiographica clearance of the ENTIRE spine (not just cervical)?
unconscious people who can’t be assessed clinically
if awake & asymp (see below), what should you do?
asymp– no neck pain, normal neuro exam, no injury distractinf from eval
also cooperative & NOT drunk; can do ROM
- No radiographic evaluation & stop immobilization
if awake & symptomatic, what imaging is indicated?
high quality CT or 3-view C-spine series (supplement CT later)
what should you do if..
awake with neck pain/tenderness + CT or 3-view series are normal? (3)
- continue immobilization until asymptomatic
- stop immobilization if normal flexion/extension radiograph OR normal MRI w/in 48 hrs of injury
- stop immobilization at physician discretion
in an obtunded/unevaluable patient with high clinical suspicion but normal CT, what do you do?
consult physician
