Flashcards in 18 - Spinal Cord Injury Deck (35):
Describe the epidemiology of spinal cord injuries
- About 273,000 people living with SCI
- Ave age 42 (up from 28 in 70’s)
- 80% male
- Length of stay inpatient in 70’s was 24 days, now 11 days
What are the common causes of spinal cord injuries?
- MVC (low impact/lap restraint)
- Falls (1/4 falls greater or equal to 1 story)
Notes – falls increasing and sports decreasing
What are the two types of spinal cord injuries?
Describe a LMN injury
- Decreased reflexes
- Decreased tone
- Muscle atrophy
Describe an UMN injury
- Increased tone
- Increased reflexes
What are spinal cord syndromes?
- Anterior cord
- Central cord
- Cauda equina
Describe anterior cord
Anterior cord – paralysis below lesion with loss of pain/temp (posterior columns spared)
Describe central cord
Central cord – corticospinal tract injury; worse upper extremities than lower; some loss pain/temp
Describe Brown Sequard
Brown-sequard – ipsilateral paresis, loss of vibration and proprioception; contralateral loss pain and temp
Describe cauda equina
- Cauda equina – from peripheral nerve injury; motor/sensory loss LE; bowel bladder dysfunction; saddle anesthesia
- This is an emergency
Describe spinal shock
- Common in c-spine
- Concussion to spine
- Flaccid paralysis, areflexia, loss sphincter tone, priapism, incontinence
- Resolves in 24 hours
Describe neurogenic shock
- Loss of sympathetic tone
- Hypotensive + bradycardia (instead of tachycardia)
- Flushed, dry, warm
- Urinary retention
- More common in injuries above T6
What is the "prehospital" care in a spinal cord injry?
Describe hospital care suspected spine injury
Life threatening injuries get priority
GET THEM OFF THE BOARD***
Decide proper imaging – if suspect injury get CT (some have MRI)
Describe C spine injuries
- 5-10% of unconscious MVCs or falls have major c-spine injury
- Most fatal at c1 or c2
- 1/3 at c2
- ½ at c6 or 7
What does it mean to "clear" a C spine?
- No bony tenderness
- No neuro deficits
- No intox
- No altered level of consciousness
- No distracting injuries
This criteria is 99% sensitive; 12% specific
What are the Canadian C-spine rules?
- From the makers of the Ottawa Ankle Rules:
- Too many xrays from nexus
- 100% sensitive, 42% specific
What does trauma.org say about a c spine injury?
No asymptomatic patient in literature has had unstable fracture or suffered neurological damage.
On the other hand...
On the other hand, an intubated trauma patient has an incidence of 10% - likely to miss on xrays (get the CT scan)
Describe an unstable injury
2 columns disrupted (anterior, middle, posterior)
Describe preveterbral edema
If prevetebral space is widened, hematoma often secondary to fx.
WHat is Hangman's fracture?
Not testing this
- Typically occurs with hyperextension of neck
- Line through pedicles
- Many survive
- In hanging death more likely from asphyxia
What is a tear drop?
- Flexion mechanism is stable (nutcracker) but extension is avulsion and is unstable
- Unstable because so much force to do this the ligaments have been disrupted
What is a Jefferson's fracture?
- Burst Fx of C1
- Lots of preveterbral edema
What is Clay Schoveler's?
- Flexion results in oblique fracture of spinous process
- Often C7 or T1
What do you need to remember a lower spinal injury?
Back boards hurt, cause ulcers, get off ASAP
Describe an L spine injury
Very common with calcaneal fractures
Transverse fractures of L1 associated with renal injury
What is spondololithiasis?
Slippage of superior body in relation to one below.
Often asymptomatic until severe
What is spondlolysis?
- Defect in pars articularis; see scotty dog in oblique view
- Not acute, but can cause pain
- Usually genetic but can be microtrauma
What is a chance fracture?
- Horizontal fx through spinous process, lamina, pedicle and vertebral body
- 50% have organ involvement
- MVCs (seatbelt) and falls
What can spinal stenosis cause?
Lower limb numbness and pain - clinically relevant for us
What is the long term life expectancy of spinal cord injuries
Life expectancy of SCI is decreased by 15 to 20 year
Cause of death usually PE, infection (used to be renal failure)
Describe a calcaneal fracture
- 10% of calcaneal fractures have associated lumbar (jump out of window)
- 26% of calcaneal fractures have other injury
- Check UA (urine analysis) if suspicious of bleeding or organ damage
What are the clinically relevant things you will see in your podiatric office in long term spinal cord injury patients?
- Increased fractures…how to treat?
- Hypertrophic skin changes – higher lesion/longer injury
- Hypertrophic nail changes – higher the lesion/longer injury
- Pressure ulcers