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Flashcards in Final Exam Deck (149)
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1

What is the annual incidence of spinal cord injury in the US?

54/million

2

What is the prevalence of SCI in the US?

245,000 - 353,000 individuals

3

What are the two most common causes of SCI?

- MVA (38.4%)
- Falls (30.5%)

4

Nontraumatic Causes of SCI

- multiple sclerosis
- cervical/lumbar spondylosis
- amyotrophic lateral sclerosis
- primary/metastatic tumors
- infections/osteomyelitis
- vascular insufficiency/AVM
- herniated intervertebral disc
- SCIWORA

5

What age range comprises the highest percentage of SCI?

16 - 30 (58.5%)

6

How is the MOI of SCI different between individuals 0-45 YOA and those 46+?

MVA comprises the highest percentage of individuals age 0-45, while falls greatest cause in individuals over 46

7

What is the mean age of SCI?

42 YOA

8

What is the incidence of SCI in men vs. women?

82% men vs. 19% women

9

What is the breakdown of SCI's by level?

- paraplegia (41.3%); complete = 20% vs. incomplete = 21%
- tetraplegia (58.3%); complete = 14% vs. incomplete = 45%

- C5 = 15.7%
- C6 = 12.7%
- C6 = 12.6%

- T1/2 = 7.6%
- L1 = 4.8%

- Incomplete = 66% vs. complete = 34%

10

What is the system used to classify patients with SCI?

International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)

11

Spinal Cord Classification

- Sensory - dermatome testing
- Motor motor testing

- Neurological level is the most caudal segment with intact sensory and motor bilaterally

12

How is a complete vs. incomplete SCI differentiated?

anal wink test

13

What is required for maximal independent function?

- knowledge
- attitude
- ability

*Often will not be achieved until 18 months post injury or longer

14

What are important treatment concepts for SCI?

- muscle substitution
- momentum
- head-hips relationship

15

What are important options for muscle substitution?

- agonist muscle substitution
- substitution using gravity
- substitution using tension in passive structures
- substitution using fixation of the distal extremity

16

T/F: Zone of partial preservation refers to both complete and incomplete SCI's

False, only complete SCI's

17

What are the 10 muscle groups on the ASIA exam?

- elbow flexors (C5)
- wrist extensors (C6)
- elbow extensors (C7)
- finger flexors (C8)
- finger abductors (T1)

- hip flexors (L2)
- knee extensors (L3)
- ankle dorsiflexors (L4)
- big toe extensors (L5)
- plantarflexors (S1)

18

What are the different ways to classify a SCI?

- skeletal level
- ISNCSCI Impairment Scale: complete vs. incomplete; types of incomplete

19

Vascular Supply of the Spinal Cord

- the anterior aspect of the spinal cord is supplied by the anterior spinal artery and the posterior aspect is supplied by two posterior spinal arteries

- the Vessel of Adamkiewicz is a branch of the abdominal aorta and supplied the spinal cord from T8-L4

20

Instability of the spinal column results when _ column(s) sustain injury

≥2

21

Posterior Spinal Column

comprised of:
- vertebral arch (pedicles and facets)
- supraspinous ligament
- ligamentum flavum

22

Middle Spinal Column

- posterior wall of the vertebral body
- the posterior longitudinal ligament
- posterior disc

23

Anterior Spinal Column

- anterior vertebral body
- anterior longitudinal ligament
- anterior disc

24

Injury to the conus medullaris results in which type of lesion?

upper motor neuron lesion, but may have mixed S/Sx d/t proximity to cauda equina

25

Injury to the cauda equina results in which type of lesion?

lower motor nerve lesion; nerve roots arising from the cauda equina innervate the detrussor muscles of the bladder and voluntary muscles of the external anal sphincter and urethral sphincter

26

Spinal shock after the initial SCI results in what transient effects?

temporary cessation of the following below the injury:
- spinal reflexes
- voluntary motor
- sensory functions
- autonomic control

27

What factors determine the extent of the SCI?

- boney impingement
- vertebral column displacement
- ligamentous injury
- vascular interruption

28

Flexion Injuries

Review in notes

29

Extension Injuries

Review in notes

30

What is meant by "quadruple threat" of injury?

- tissue destruction at the time of injury
- cellular disruption
- death by messenger - apoptosis
- functionless areas in the spine due to scar