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2) Patho 2 > 12) Spinal Cord Injury > Flashcards

12) Spinal Cord Injury Flashcards

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1
Q

What is tetraplegia?

A

Impairment/loss of sensory &/or motor fxn in the C-spine that goes on to affect all limbs, trunk, & possibly respiratory muscles

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2
Q

What is paraplegia?

A

Impairment/loss of sensory &/or motor fxn in the T-, L-, or S-spine that affects the trunk & LE’s

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3
Q

What causes SCI?

A

Trauma causing compression, traction, or transection of the spinal cord

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4
Q

What does trauma to the spinal cord usually cause?

A

Vertebral fx/Dislocation

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5
Q

True or False: The spinal cord needs to be severed for permanent injury to occur.

A

False

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6
Q

When does a flexion/extension load occur & what does it cause?

A
  • Occurs when the neck is flexed
  • Causes significant bone + ligament damage & neuro injury
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7
Q

What does a flexion load injury usually require?

A

Surgical stabilization

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8
Q

What does axial loading cause?

A

Burst injury

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9
Q

What causes a burst injury?

A

Axial loading (diving into a shallow pool)

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10
Q

What causes the neuro damage associated w/burst injuries?

A

Splintering of vertebrae into the spinal cord

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11
Q

True or False:High velocity injuries (GSW, MVA, sports) are associated w/less damage & a better prognosis.

A

True

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12
Q

What infections can cause SCI’s?

A
  • TB
  • HIV
  • Syphillis
  • Transverse Myelitis
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13
Q

Besides infections, what other conditions can cause SCI?

A
  • CA
  • Syringomyelia
  • Spinal stenosis
  • RA
  • DJD
  • Spina bifida
  • Radiation
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14
Q

Syringomyelia

A

Devo of cavity on cord bc of a cyst

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15
Q

True or False: Most of the fxnl limitations seen following SCI aren’t caused by the transection itself.

A

True

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16
Q

When does primary injury occur?

A

W/in 18hrs post-injury

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17
Q

What happens during the primary injury phase?

A

Axonal death bc of direct trauma

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18
Q

W/primary injury, what can occur if the spine remains unstable?

A

Additional traumatic injury

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19
Q

When does 2° occur?

A

In the few wks following initial injury

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20
Q

What processes happen during the 2° injury phase?

A
  • Ischemia
  • Hypoxia
  • Biochem
  • Demyelination
  • Edema & scarring
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21
Q

Why does ischemia & hypoxia occur w/SCI?

A

Vessels get damaged & vasoconstrict + there’s disruption of autonomic regulation of the circulatory system

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22
Q

Why does demyelination occur w/SCI?

A

Damage to oligodendrocytes

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23
Q

What is spinal shock?

A

Occurs immediately after SCI bc abrupt loss of connections btwn the brain & spinal cord.

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24
Q

Sx’s of Spinal Shock

A
  • Areflexia for 24hrs
  • Loss of B&B fxn
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25
Complete SCI
Absence of sensory &/or motor fxn from S4/5
26
Incomplete SCI
Partial loss of sensory &/or motor fxn from S4/5
27
W/an incomplete SCI, where must the pt have sensory & motor fxn?
B&B
28
Zone of Partial Preservation
Dermatomes & mytomes below the level on the injury that remain partially innervated w/a complete SCI
29
What is needed to determine if the injury is complete vs incomplete?
Rectal exam
30
ASIA A
Complete SCI No motor or sensory fxn is left into S4/5
31
ASIA B
Incomplete SCI Sensory fxn into S4/5 is present
32
ASIA C
Incomplete injury Motor fxn is present, but \>50% of key muscles have MMT \<3
33
ASIA D
Incomplete Motor fxn is present & \>50% of key muscles have MMT \>3
34
ASIA E
Normal sensory & motor fxn
35
Neurological Level
Most caudal level of the spinal cord w/normal motor & sensory fxn bilaterally
36
Motor Level
Most caudal, normal, or intact innervated spinal nerve bilaterally or the segment below which motor deficits exist
37
When is a motor level considered to be intact?
If key muscles are 3/5 & level above is 5/5
38
Central Cord Syndrome
Cervical lesion due to hyperextension of the neck causing UE weakness & sometimes B&B dysfxn
39
What is the moston common incomplete SCI?
Central Cord Syndrome
40
Prognosis for central cord syndrome
* 75% regain ability to amb * 50% regain B&B fxn * 25% regain UE fxn
41
Brown-Sequard Syndrome
Lesion that damages a hemisection of the cord * Causes ipsilateral proprioceptive & motor loss + contralateral loss of noci- & thermoception a few levels below the level of injury
42
Prognosis for Brown-Sequard Syndrome
Typically good
43
Anterior Cord Syndrome
Affects anterior 2/3 of spinal cord bc of disrupted anterior spinal artery or flexion injury * Causes loss of noci- & thermoception + motor fxn inferior to the level of injury
44
W/anterior cord syndrome, what fxn's are preserved?
* Proprioception * Light Touch * Deep Pressure
45
Conus Medullaris Syndrome
LMN injury in the conus * Causes LMN deficits of B&B & LE areflexia
46
Cauda Equina Syndrome
LMN injury into the lumbosacral nerve roots w/in the neural canal (below L1)
47
Sx's of Cauda Equina Syndrome
* Areflexic B&B * Saddle Region Anesthesia * Flaccid LE's
48
What comorbidities are associated w/cauda equina syndrome?
* Fx * Amputation * TBI * LOC * Pneumo/Hemothorax * Burns
49
What are the goals of surgical management of SCI?
Align spinal column, spinal canal, & decr pressure on the spinal cord
50
Explain fusion & ORIF
* Done w/anterior approach * For fusion, bone graft is taken from ASIS * Vertebral bodies get wired together * Plates, screws, & rods are inserted
51
Autonomic Dysreflexia
Acute, life-threatening syndrome of controlled massive reflex sympathetic discharge occuring in down to T6 injuries
52
Sx's of Autonomic Dysreflexia
* Severe HA * Sweating superior to injury level * Slow pulse * Goose bumps * Pallor * Blury vision * Extreme HTN (300/160)
53
Is autonomic dysreflexia a medical emergency?
Yes
54
Tx of Autonomic Dysreflexia
* Have p sit up to decr cerebral BP * Try to remove the noxious stim * Seek medical assistance
55
Autonomic Dysfxn
Decr ability to regulate body temp so pt has inability to sweat below their injury if they're complete; Sometimes pt will have excessive sweating
56
Pxn's for pt's w/autonomic dysreflexia
Keep quads cool in hot weather & warm in cold weather
57
What effects on the skeletal system does autonomic dysfxn cause?
* Osteoporosis/Bone demineralization * Incr incidence of pathological fx * Ligamentous changes causing jt instability * DJD
58
Heterotopic Ossification
Abn bone formation in ST & around jt's in the neurologically impaired segments
59
When is the peak incidence for HO?
4-12wks post-SCI
60
Sx's of HO
* Sudden onset of redness & swelling near large jt's * Jt effusion * Decr ROM * Pain
61
How is HO dx'ed?
* Incr serum alkaline phosphatase * 3-phase bone scans
62
Tx for HO
* Meds * ROM after inflammation decr * Splinting for total jt ankylosis \*Forceable stretching & mobes may worse the situation
63
When is surgery for HO most effective?
12-18mo post-onset or when bone is mature
64
Post-op complications of HO
* Delayed wound healing * Excessive bleeding * Infection * Fx * Recurrence
65
What postural deformities are associated w/HO?
* Scoliosis * Kyphosis * PPT
66
Why do SCI pt's get jt contractures?
Bc of loss of antagonist muscle contractions & prolonged sitting/supine positioning
67
68
What effects on the CV system can SCI have?
* Peripheral circulatory clamping of vessels * Circulatory & lymphatic stasis * Venous thrombosis & PE risk * Cardiac muscle atrophy * Unstable HR, BP, & arrhythmia * Orthostatic hypotension * Decr blood & plasma vol * Decr CO
69
Tx for Orthostatic Hypotension
* Abdominal binder * Bilateral LE support stockings * Gradual acclimation to position changes * Reclining w/c * Tilt table * Meds
70
What effects on the GI system can SCI have?
* Paralytic ileus * Abdominal distention--\>Bc of lack of muscular support * B&B dysfn
71
Can women w/SCI normally get pregnant & give birth?
Yes
72
Can men w/SCI have kids?
Yes, but will usually require medical intervention
73
Nociceptive Pain
Pain caused by activation of noci-ceptors in response to (potential) damage to non-neural tissue
74
Neuropathic Pain
Pain arising as a direct consequence of a lesion/disease affecting the somatosensory system
75
Is nociceptive or neuropathic pain more severe?
Neuropathic
76
Characteristics of Neuropathic Pain
* Burning * Pricking * Tingling * Itching * Shock-like * Stabbing * Continuous, Intermittent, Spontaneous * Exaggerated
77
Tx for Neuropathic Pain
* Pharmocologic * Psychologic * Meds
78
What is a mechanical in-exsuffalator?
Vacuum that applies gradual (+) pressure to the AW & then rapidly shifts to (-) pressure to stim a cough
79
ROM Guidelines for the Shoulder
If pt doesn't have active elbow extension, greater than normal elbow extemopms combined w/GH ER is required
80
ROM Guidelines for the Elbow
Full extension is needed for stability
81
ROM Guidelines for the Forearms
Full supination is essential to assist in locking elbows
82
ROM Guidelines for Wrists
* Full wrist flexion & extension must be preserved * If active wrist extension is \<3/5, over stetching may occur & further weaken muscles * May need splints
83
ROM Guidelines for the Neck
Attain ROM through gentle AROM
84
ROM Guidelines for the Fingers
WB activities on hands should be done in a fisted position

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