U11W4: spinal cord injury Flashcards
How many spinal nerves are there?
Consists of 31 spinal nerves.
What are the four main functions of the vertebral column?
Protection - the spinal cord within the spinal canal
Support - the weight of the body
Axis - central axis of the body
Movement - posture and movement, origin and insertion point of muscles
What makes up the vertebral column?
Bony vertebrae that are linked by atricular synovial joints and the fibrouscartilogenous intervertebral disks
There are 7 cervical vertebrae
there are 12 thoracic vertebrae
There are 5 lumbar vertebrae
There are 5 fused sacral vertebrae
There are 4 fused coccyx
What are the key features of the vertebrae?
Can you lable them in this image?
The vertebral body (weight bearing)
The vertebral arch:
- spinous process
- transverse process
- pedicles (green)
- lamina (purple)
- articular processes (sup in yellow)
What are the unique features of the cervical vertebrae?
Triangular foramen
Bifid spinous process (except C7 and C1)
Transverse formaine for vertebral arteries
Triangluar vertebrael foramen
What are some unique features of thoracid vertebrae?
Demi facets for head of rib
Costal facests on transverse process for shaft of rib
Spinous process if obliquely inferiorly.
Circular vertebral foramen
What are the key features of the lumbar vertebrae?
Largest vertebrae
Kidney bean shaped vertebral body
Triangluar shapes vertebral foramen
Position of spinous process allows needle access between the vertebrae as do not extend inferioly past the level of the vertebral body.
What are the different ligaments supporting the vertebral column?
Left to right
Anterior longitufinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Interspinal ligament
Supraspinous ligament
What are the key features of the spinal cord?
Spinal cord is surrounded by three layers the innermost pia mater, archnoid mater and the dura mater.
L1 - conus medullaris - end of spinal cord
Continues are the cauda equina - lower motor neurons
The filum terminale is a fibrous continuation of the spinal cord that fuses with the coccyx - contains the remnants of the meningeal layers and helps fixate the spinal cord.
What is a burst fracture?
When a vertebra is crushed in all directions due to a significant trauma that crushes the bone such as motor vehicle accident or severe fall. - high energy axial loading spinal trauma.
Includes the vertebral body endplate and cortex.
Frequently includes retropulsion of fragments into the spinal canal
More severe than compression fracture
Incomplete - one endplate or complete both endplates
How do vertebral burst fractures normally present?
Often after a high energy axial trauma
Back pain or lower limb neurological deficit.
What vertebral level of burst fractures most likely?
T9-L5
What are the key radiographic features of a burst fracture?
Loss of vertebral height on lateral views.
Interpedicular widening
Bone fragment retropulsion into the spinal canal.
Burst vertebral body
How is a burst fracture different to a wedge fracture?
Burst - bursting of whole vertebral body cortex and one or both endplats
Wedge fracture - posterior body cortex often remains intact, often hyperflexion injuries, anterior section often collapses - one fragment may disconnect or front just remains squished.
How is a burst fracture different to a compression fracture?
Burst is often thought of as a severe compression fracture
Compression tends not to have a retropulsion of fragments into the spinal canal.
Compression tends to mainly affect the anterior vertebral body and has little risk of affecting the spinal nerves or cord, considered stable
What are the key features of a complete spinal lesion?
Loss of bilateral motor function
Complete loss of sensation below the level of the lesions
May be quadriplegic (all four limbs typically cervical in origin) or paraplegic (lower body only - thoracic, lumbar or sacral in origin)
What are the key features of an incomplete spinal lesion?
What are the different types?
Partial damage to the spinal cord means some function is retained and others are lost
Can be classified as:
Anterior cord syndrome (damage to CS and ST)
Central cord syndrome - often in cervical region and damages ST and CS
Posterior cord syndrome - damage to DCML
What are the different dermatomes of the body?
Use images from google to check your understanding of this - no goot one image.
What are the different features of E.coli that can be tested for?
Normally a stool test
Gram stain - gram negative rods.
Catalse positive - foams when hydrogen peroxide added as catalses conversion to water and oxygen
Coagulase negative - will not coagulated rabbit plasma
Oxidase negative - absence of colouration or light pink when DMPD is added.
What clinical assessments may be used for a spinal cord injury?
Upper/lower limb neurological examination - includes testing for motor, range of motion, sensation and reflexes
Spine examination
GAIT examination
Romberg test (balance)
Imaging techniques - such as an X-ray or CT
Respiratory function - to identify paralysis of the respiratory muscles
Assessment of Pain - visual analogue scale
Assessment of activity - often the spinal cord independence measure
How can myelograms be used to diagnose spinal cord injuries?
Contrast material is injected into the space around the spinal cord and nerve routes (often the subarachnoid space)
Use real time x-ray often fluroscopy
Allows to view the anatomy of the structures.
How is Transcranial magentic stimulation used to diagnose spinal cord injuries?
Neurophysiological examination
Aims to detect parts of the corticospinal tract that remain functional
Uses magnetic fields to stimulate neurons in the brain - then looking for muscle twitches or electrical activity in the eriphery to decide of the tract is functional and if information has been passed down the corticospinal tract.
Regulation od blood pressure**
What is an ionotrope?
What are the different types?
Substances that affect the contractility of the heart
Positivie inotropes - increase contractility
Negative ionotropes - decrease contractility.
What are the different types of adrenergic receptors?
Alpha 1
Alpha 2
Beta 1
Beta 2
There is also a beta 3 but this is less important
What type of receptors are adrenergic receptors?
GCPRs.