Classification and Prognosis

Question 1

2 ascending tracts

Answer 1

Dorsal columns (fasciculus cuneatus, fasciculus gracilis)
Spinothalamic tract

Question 2

1 descending tract

Answer 2

Corticospinal tract

Question 3

The dorsal column is organized in what order? (From medial to lateral)

Answer 3

Sacral, lumbar, thoracic, cervical

Question 4

The corticospinal tract and spinothalamic tract are organized in what order? (From medial to lateral)

Answer 4

Cervical, thoracic, lumbar, sacral

Question 5

Effects of a spinal cord injury on

1. Dorsal columns
2. Spinothalamic tract
3. Corticospinal tract

Answer 5

1. Ipsilateral sensory dysfunction
2. Contralateral sensory dysfunction
3. Ipsilateral motor dysfunction

Question 6

What does
1. Dorsal column
2. Spinothalamic
measure?
3. Corticospinal

Answer 6

1. Proprioception, vibration
2. Pain, temperature
3. Fine motor control

Question 7

Where does
1. Dorsal columns
2. Spinothalamic
3. Corticospinal
cross?

Answer 7

1. Medulla
2. Spinal cord level
3. Medulla

Question 8

Sensation grading

Answer 8

2 is normal
1 is present but not normal
0 is absent

Question 9

Motor grading

Answer 9

5 Normal power
4 Some resistance
3 Full range against gravity but not resistance
2 Full range without gravity
1 Flicker or not FULL range without gravity
0 No contraction

Question 10

Tetraplegia definition

Answer 10

Partial or complete loss of sensory and/or motor function of arms and typically trunk and legs
If it involves the arms, you’re in the tetraplegia range

Question 11

Paraplegia

Answer 11

No involvement of the upper extremities

Question 12

Complete spinal cord injury

Answer 12

No sensory or motor function is preserved in sacral segments (S4-5)
Digital rectal exam is key for determining

Question 13

Incomplete spinal cord injury

Answer 13

Some sensory and/or motor function in sacral segments (S4-5)

Question 14

When is prognosis best assessed?

Answer 14

On the exam 3-7 days after the initial injury, not the initial exam
Assuming they’re out of spinal shock

Question 15

What’s the general prognosis for complete spinal cord injuries

Answer 15

There is a 45-90% chance of functional recovery in the myotome below the one that was injured

Question 16

Prognosis for an incomplete SCI

Answer 16

Variable (much better than complete)
Potential for community ambulation
Most recovery happens in the first few months, but can continue to make gains after 2 years

Question 17

4 incomplete spinal cord injury syndromes

Answer 17

Central cord syndrome
Brown-Sequard syndrome
Anterior cord syndrome
Cauda Equina syndrome

Question 18

Central Cord Syndrome

Answer 18

Most common
Upper extremities are more involved than the lower
Possible bladder/bowel involvement
Typically from hyperextension of the neck - causes damage to the center of the cord

Question 19

Central cord syndrome prognosis

Answer 19

Some neurological improvement

But can be left with poor hand function which can significantly impact function

Question 20

Brown Sequard syndrome

Answer 20

Pure syndrome is clinically rare
Mostly seen with penetrating injuries
Good prognosis
One half of the spinal cord is injured, so you get loss of pain/temp/light touch on the opposite side, and loss of motor function and vibtration/position/deep touch on the same side

Question 21

Anterior cord syndrome

Answer 21

Problem with the anterior spinal artery, so the anterior 2/3 of the cord gets damaged
Will see motor, pain, temperature deficits
Proprioception and light touch are relatively preserved
Often bladder dysfunction

Question 22

Prognosis for anterior cord syndrome

Answer 22

Poor motor return

Worst prognosis of the syndromes

Question 23

Cauda Equina Syndrome

Answer 23

Often come in with lower back pain, MUST screen
Disc protruding can causes the nerve roots in the sacrum to become pinched
Various presentations
Its a lower motor injury
Signs: saddle anesthesia, new urinary dysfunction, new sexual dysfunction, bowel dysfunction, pain/weakness in legs, loss of ankle reflex

Question 24

Cauda Equina Prognosis

Answer 24

Variable (dependent on degree of initial injury and time for treatment)
Lower motor neuron injury so there is a potential for nerve regrowth (1 inch a month for 18 months)
Lower motor bowel/bladder dysfunction and sexual dysfunction can be prolonged