Spinal Cord Injuries - Collins (incomplete)

Question 1

what is the most common population that presents with SCI

Answer 1

50% of acute injuries involve young patients (16-30)
second peak at age 60+
MEN>females

Question 2

what are patients with SCI at higher risk of

Answer 2

more likely to die prematurely by 2-5x

Question 3

what is the most common location of SCI injuries

Answer 3

cervical C5 most common

Question 4

what is the most common manifestation of SCI

Answer 4

incomplete paraplegia

Question 5

what are the most common mechanisms of SCI

Answer 5

MVC
falls
sports-related injuries
violence
secondary to compression (contusion)
complete transection rare

Question 6

what is a complication of SCI

Answer 6

neurologic regulations are worse the higher the level of the injury within the spine

Question 7

what is a primary injury

Answer 7

the initial mechanical insult

Question 8

what is a secondary injury

Answer 8

persistent physiologic insult

Question 9

what is the acute timeline

Answer 9

first 48 hours
cytotoxic, inflammatory, vascular, necrosis, nerve depolarization

Question 10

what is the subacute timeline

Answer 10

48 hours to 14 days
macrophage infiltration and scar initiation

Question 11

what is the intermediate timeline

Answer 11

14 days to 6 months
continued scar formation

Question 12

what is the chronic timeline

Answer 12

6+ months
degeneration of spared components

Question 13

when is the most important time to worry about hypotension s/p SCI

Answer 13

acute phase - compensation for vascular changes

Question 14

what are the role of steroids in SCI

Answer 14

steroids are anti-inflammatory and targeting acute phase but not clinically understood

Question 15

what is the initial treatment for a spine trauma patient

Answer 15

immobilization until cleared

Question 16

what trumps immoblization

Answer 16

treat life-threatening injuries first

Question 17

what is assessed in the initial survey for spinal trauma patients

Answer 17

gross motor/sensory deficits
tenderness - especially midline
step-offs
palpable fluid collections/hematoma
bruising or abrasions/wounds

Question 18

what is assessed later in the ED for spine trauma patients

Answer 18

complete neurological exam including perineal sesation and anal sphincter tone

Question 19

how are spine trauma patients worked up

Answer 19

if they are “walking/talking” and no pain/distracting injuries - dont need imaging

Question 20

what is first line imaging for spinal injuries

Answer 20

book answer: AP and Lateral x-rays + odontoid for c-spine
Practice: CT usually entire spine

Question 21

how are stable fractures typical treated

Answer 21

conservative management usually with brace for immobilization

Question 22

how are unstable fractures typically treated

Answer 22

ORIF, usually fusion procedure

Question 23

does the degree of the SCI correlate with the stability of the fracture

Answer 23

NO, not necessarily correlated

Question 24

what level injury is Neurogenic shock seen most commonly

Answer 24

most often with thoracic level injury

Question 25

what part of the nervous system is disrupted with Neurogenic shock

Answer 25

Sympathetic NS - inability to maintain vascular tone

Question 26

what is the treatment of neurogenic shock

Answer 26

fluid resuscitation and vasopressors

Question 27

what is the resolution timeline of neurogenic shock

Answer 27

24-48 hours

Question 28

what occurs during neurogenic shock

Answer 28

inability to maintain vascular tone
hypotension with BRADYCARDIA and without vasoconstriction

Question 29

what are the SCI patterns

Answer 29

complete, incomplete or transient

Question 30

what is transient SCI

Answer 30

temporary: spinal shock
NOT necessarily neurogenic shock though often co-occurring
spinal cord “stinger”

Question 31

what is the ASIA scale

Answer 31

american spinal injury association system to classify SCI

Question 32

what is the ASIA grading scale

Answer 32

Grade A (complete injury) through E (normal)

Question 33

when is the Bulbocavernossus reflex absent

Answer 33

during Transient SCI

Question 34

when do Transient SCI resolve

Answer 34

24-72 hours - must be resolved to definitively classify SCI

Question 35

What is an incomplete SCI

Answer 35

some degree of neurologic function present distal to injury

Question 36

What is ‘sacral sparing’

Answer 36

voluntary anal sphincter tone, perineal sensation, great toe flexion

BARE MINIMUM

Question 37

what is seen with greater initial function

Answer 37

better prognosis

Question 38

what is the timeline of neurologic improvement following a SCI

Answer 38

up to 12-18 months

Question 39

what are the incomplete SCI patterns

Answer 39

Brown-sequard syndrome
Central Cord syndrome
Anterior cord Syndrome
Posterior Cord Syndrome

Question 40

Ascending

Answer 40

carry information to the brain - sensory

Question 41

descending

Answer 41

carry information from the brain to target tissue/organs- motor

Question 42

what should the SCI patients have for treatment

Answer 42

transfer to specialized SCI injury rehabilitation facility - the earlier the better
shorter overall LOS
lower morbidity and mortality
Extensive PT, assistive technologies/devices
often far away, limited beds and expensive

Question 43

what are common complications for SCI

Answer 43

Gastritis/illeus - NG tube and H2 blockers
Urinary dysfunction - foley or intermittent caths - risks for UTI
Breathing difficulty - “C3,4,5 Keep the diaphragm alive”
Skin Breakdown - reposition every 2 hours, regular inspections, pad pressure points - decreased sensation and loss of motor function
Vascular complications

Question 44

what are the concerns with vascular complications s/p SCI

Answer 44

most common cause of morbidity and mortality
worse the higher the injury
arterial hypotension, orthostatic hypotension
autonomic dysreflexia

Question 45

what is autonomic dysreflexia

Answer 45

rapid increased BP (imbalanced sympathetic SN stimulation)
precipitated by some stimuli below level injury
often bowel and bladder dysfunction