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Flashcards in SC injuries Deck (34):
1

SCIs

MVAs>falls>violence>unk>sports

2

slide 4

know bolded
also slide 6 low right pic

3

compression fx

vertebral body

4

herniated disc..needs

laminectomy

5

anterior vertebral column should be

nice and smooth

6

complete SCI

The complete absence of sensory and motor function below the level of injury.
This includes loss of function to the level of the lowest sacral segment

7

incomplete SCI

Sensory, motor, or both functions are partially present below the neurologic level of injury.

may consist only of sacral sensation at the anal mucocutaneous junction or voluntary contraction of the external anal sphincter upon digital examination

Anterior Cord Syn, Central Cord Syn, Brown-Sequard

8

spinal shock

The temporary loss or depression of spinal reflex activity that occurs below a complete or incomplete spinal cord injury (unknown duration)

The lower the spinal cord injury, the more likely that all distal reflexes will be absent.

Loss of neurologic function that occurs with spinal shock can cause an incomplete spinal cord injury but mimics a complete cord injury.

9

spinal shock 2

first reflex to return ?
duration ?

Therefore, cord lesions cannot be deemed complete until spinal shock has resolved.

The bulbocavernosus reflex is among the first to return as spinal shock resolves.
The duration of spinal shock is variable; it generally persists for days to weeks

10

SC syndromes

Anterior Cord Syndrome-

Central Cord Syndrome

Brown-Sequard (Hemisection

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anterior cord syndrome from...

Corticospinal pathway
Spinothalamic pathway
Preservation of posterior column function

12

anterior cord syndrome

It is characterized by

loss of motor function below the level of injury

loss of sensations carried by the anterior columns of the spinal cord (pain and temperature)

preservation of sensations carried by the posterior columns (fine touch and proprioception)

13

anterior cord causes

Contusion of the cord or bony-injury
Flexion of cervical spine
Thrombosis of anterior spinal artery
Leads to ischemic injury
Extrinsic masses

14

anterior cord px

Overall is poor
Functional recovery has been and is still very minimal

*Anterior spinal artery syndrome is the most common form of spinal cord infarction*

15

central cord from damage to

Corticospinal pathway
Spinothalamic pathway
Preservation of posterior column function

16

Central Cord Syndrome

Decreased: (not loss)
Motor function, pain and
to a lessor extent temperature
sensation ; greater in upper than
lower extremities (more deficit in uppers)

17

Central Cord Syndrome causes

Usually in older patients with pre-existing cervical spondylosis who sustain a hyperextension injury
Thrombosis of anterior spinal artery
Leads to ischemic injury
Extrinsic masses

18

Central Cord Syndrome ps

Good for recovery of function
However, most do not recover fine motor use of the upper extremities

the most common form of cervical spinal cord injury*

19

Brown-Sequard Syndrome

Results from hemisection of the spinal cord:

Patients will exhibit:
Ipsilateral loss of:
Motor function
Proprioception
Vibratory sensation

Contralateral loss of:
Pain and temperature sensation

20

Brown-Sequard Syndrome causes

Most common cause is penetrating trauma (GSW)
Disk protrusion
Hematomas
Bone injury
Tumors

21

Brown-Sequard Syndrome px

Best prognosis for recovery of all the incomplete cord syndromes

22

radicular pain

Typically more local and follows a dermatome or myotome pattern
i.e. older person with neck pain, not nec. a SC problem directly, spasm when studying-peripheral issue

23

Clinical Approach to Spinal Cord Trauma/Injury : First and foremost ā€“

You must assume there is a spinal cord injury until proven otherwise

A-B-Cā€™s are top priority but with assumption of cervical spine injury
(log roll-as a unit)

24

Clinical Approach to Spinal Cord Trauma/Injury

good detailed hx
increase or decrease your suspicion for a spinal cord injury (SCI)??
reliable history?

25

then focus neurological hx

Mechanism of injury
Loss of consciousness
Neurologic complaints

26

neuro exam

Vital signs
Level of consciousness (AVPU)
Glasgow Coma Scale
Pupil evaluation
Cranial Nerves
Motor assessment
Sensory assessment
Reflexes

27

C6 or higher

quadriplegic

28

T6 or lower

paraplegic
in btw??

29

once suspect injury, confirm w.

Plain Radiographs

CT scans-bony details, more radiation

MRIs

30

Plain Radiographs

Advantages:
Quick and easy to get
Rapid turnaround on viewing/interpretation

Disadvantages:
Limited compared to other modalities
Patient disorders limit utility of studies

31

CT

Advantages:
Give much more information than radiographs
More sensitive than plain films
Great for detecting blood

Disadvantages:
Patient must be stable enough to have study
Much more radiation than plain films
Usually require interpretation by radiologist
Cannot give any info on spinal cord
better for bony detail than soft tissue

32

MRIs

Advantages:
Gives a lot of information about bones, cord, vasculature
More sensitive than CT scans
Great for detecting spinal cord injury, ischemia
No radiation

Disadvantages:
Patient must be stable enough to have study
Studies require a lot more time to complete
Requires interpretation by radiologist
Patients with metal cannot have study

33

dx modality determined by History and Physical Exam

GCS, Mental status, Intoxicants?
Patient status (stable vs unstable)
Capabilities of facility (keep vs transfer)

34

(after H&P) Diagnostic modality used will be determined by:

Balance need for information with Do No Harm!
If a patient disposition can be made with a plain film or no imaging than that is the route to go.