Trauma

Question 1

Commonest groups for non trauma spinal cord injury

Answer 1

Older patients and females

Question 2

Distribution of pathology along the cord in non trauma SCI

Answer 2

Equally amongst cervical thoracic and lumbar sacral

Question 3

What proportion of non traumatic injuries are complete?

Answer 3

40%

60% are incomplete

Question 4

What percentage of non trauma SCI result in paraplegia and quadriplegia respectively

Answer 4

75% paraplegia

25% quadriplegia

Question 5

What proportion of SCI are traumatic

Answer 5

Two thirds

One third non trauma

Question 6

Typical population of trauma SCI

Answer 6

Younger men

Question 7

What proportion of trauma SCI is incomplete

Answer 7

90% incomplete

10% complete

Question 8

What percentage of traumatic SCI are paraplegic and quadriplegia respectively

Answer 8

Para 50%

Quad 50%

Question 9

What is the distribution of affected areas in traumatic SCI

Answer 9

Cervical 50%
Thoracic 40%
Lumbar sacral 10%

Question 10

Name the five mechanisms of traumatic SCI

Answer 10

Flexion - falls, cars, ligament damage and bilateral dislocation
Rotation - passenger in a car, side impact, unilateral fracture dislocation
Extension - older, OA, spondylitis, central cord syndrome
Compression - burst fractures, usually minor damage
Direct - high energy blow to column

Question 11

What is the ASIA criteria for SCI

Answer 11

A - complete motor and sensory
B - incomplete sensory only
c - incomplete motor grade less than 3
D incomplete motor grade more than 3
E normal function

Question 12

ASIA class A

Answer 12

Complete motor and sensory

Question 13

Asia class b

Answer 13

Incomplete sensory only

Question 14

Asia grade c

Answer 14

Incomplete motor grade less than 3

Question 15

Asia grade d

Answer 15

Incomplete motor more than 3

Question 16

Asia E

Answer 16

Normal

Question 17

Features of anterior cord lesion

Answer 17

Damage to anterior spinal artery or vertebral bodies

Loss of motor, loss of pin prick

Touch and proprioception preserved

Muscle recovery poor

Question 18

Features of posterior cord injury

Answer 18

Uncommon

Loss of light touch proprioception, vibration, pain and temperature

Some motor preservation

Proprioception loss causes poor functional recovery

Question 19

Features of central cord syndrome

Answer 19

Cervical mostly
Weakness with arms worse than legs and sacral sparing

Recovery sequence lower limb, bladder and bowel, proximal upper, distal upper

Question 20

Feature of brown sequard SCI

Answer 20

Hemisection so;

Ipsilateral sensation loss above the lesion
Ipsilateral flaccid paralysis
Ipsilateral loss of vibration and proprioception below the lesion
Contralateral loss of pain and temperature below

Question 21

Cauda equine features

Answer 21

Lower motor neurone lesion

Flaccid lower limbs
Atomic bladder bowel
No sacral reflexes
Variable sensation loss

Question 22

Conus medullaris SCI features

Answer 22

Lies at L1 supplies L4 - S1
Associated with L1-2 injury

Mixed upper (conus) and lower (nerve root) lesion