Spine Disorders

Question 1

What things can cause damage to the spinal cord?

Answer 1

• Fracture in vertebrae
• Tumour
• Infection
• Trauma
• Herniated disc

Question 2

How would a patient present with a high cervical injury?

Answer 2

Motor
- Spastic quadriplegia

Sensory
- anaesthesia at level corresponding with injury and below (four limbs + trunk)

Bowel + Bladder

• Central-type impairment
• Urinary retention
• Severe constipation
• Can lead to recurrent UTIs and ileus

Breathing

• intercostal muscles impaired, diaphragm partly impaired + fatigues easily
• breathing support needed

Very high chance of death

Question 3

How would a patient present with lower cervical injury?

Answer 3

• Injury at cervical enlargement (C5-T1)

Motor

• flaccid (decreased tone) paralysis of upper limbs
• spastic (increased tone) paralysis in lower limbs

Sensory

• sensation lost from level of injury down
• some sensation in arms

Breathing

• intercostals not working, diaphragm intact
• no breathing support

Bladder + bowels

• Central-type impairment
• Urinary retention + constipation

Question 4

How would a patient present with thoracic injury?

Answer 4

• T2-T12, below cervical enlargement, above lumbar enlargement

Motor

• spastic paralysis of lower limbs
• Intact upper limbs (can move themselves about in wheelchair)

Sensory
- anaesthesia below level of injury

Breathing
- intercostals not working, breathe with diaphragm

Bowel + bladder

• central-type disturbance
• urinary retention + constipation

Question 5

How would a patient present with complete lumbar injury?

Answer 5

• Lumbar enlargement injury L1-S1

Motor

• intact upper limbs
• lower flaccid paralysis

Sensory
- anaesthesia below level of injury (below inguinal folds L1-L2)

Breathing
- normal as intercostals not affected

Bowel + bladder
- central-type impairment

Question 6

How would a patient present with complete conus medullaris injury?

Answer 6

• S2
• cauda equina syndrome

Motor

• flaccid paralysis of lower limbs or weakness
• upper limbs intact

Sensory
- saddle anaesthesia and lower limb anaesthesia

Breathing
- normal

Bowel + bladder

• peripheral-type impairment (below conus)
• urinary incontinence, leaking faeces + urine

Question 7

What is Brown-Sequard syndrome?

Answer 7

Hemi-paraplegia on one side + hemianesthesia on other side due to injury to one side of spinal cord

E.g. L hemi-spinal cord lesion at T11

• spastic paralysis ipsilaterally (L leg)
• proprioception + deep sensation loss (L leg)
• pain + temp anaesthesia contralaterally (R leg)
• central-type impairment of LL
• upper limbs not affected