Session 11

Question 1

What are the commonest levels of spinal cord injuries?

Answer 1

Half at C6/C7, 30% at C2

In children - C1/C2 due to heavier heads with lax ligaments

Question 2

What are the causes and clinical features of complete cord transection syndrome?

Answer 2

Trauma, infarction, transverse myelitis, abscess, tumour
Spinal shock and autonomic dysfunction with higher lesions
Complete loss of sensation and paralysis below the lesion

Question 3

What is Brown-Sequard syndrome and what are the clinical features?

Answer 3

Unilateral cord injury due to penetrating trauma, tumour, abscess, multiple sclerosis
Ipsilateral loss of motor function, proprioception, vibration and touch
Contralateral loss of pain and temperature sensation

Question 4

What are the causes and clinical features of anterior cord syndrome?

Answer 4

Often results from a flexion injury or due to injury to the anterior spinal artery
Bilateral loss of motor function, pain and temperature sensation below the lesion
Bowel, bladder and sexual dysfunction

Question 5

What are the causes of central cord syndrome?

Answer 5

Hyperextension injury of cervical spine in elderly, hyperflexion injury of cervical spine in younger patients, cervical spine stenosis, syringomyelia (cyst in central canal), central canal ependymoma

Question 6

What are the clinical features of syringomyelia

Answer 6

Loss of motor function and sensitivity to pain and temperature in a cape like distribution - obliteration of spinothalamic fibres decussating in white commissure. Medial fibres are affected first - in the spinothalamic and corticospinal tracts these are the ones supplying the arms
Bladder dysfunction and urinary retention

Question 7

What are the causes and clinical features of posterior cord syndrome?

Answer 7

Rare - spondylosis, spinal stenosis, infections, B12 deficiency (chronic processes), infarction of the paired posterior spinal arteries
Loss of proprioception, vibration, 2 point discrimination and light touch below the lesion

Question 8

What are the long term management options of cord injuries?

Answer 8

Non surgical - intubation (C5 or above), immobilisation for 6 weeks
Surgical - for progressive neurological deficitsor unstable spinal fractures

Question 9

What are the features to assume a spinal injury during initial evaluation?

Answer 9

Head injury present, unconscious/confused, spinal tenderness, weakness, loss of sensation

Question 10

What are the main features of emergency management of spinal injuries?

Answer 10

ABCDE
Rigid C collar, manual stabilisation
Vital sign monitoring
Adress hypoxia, hypotension, hypothermia
Neurological examination
Insert urinary catheter