Trigeminal Cervical Thoracic Lumbar Sacral

Pain and temp Cross 1-2 levels above entry

Spinothalamic tracts (lateral columns) Pain (pinprick) Temperature Light touch From opposite side of body\ \

Light touch Pressure Joint position (proprioception) and vibration same side of body Same level entry

MOST SERIOUS Cause trauma Damage ALL tracts on BOTH SIDES Results total loss of fxn on BOTH SIDES Initially areflexia Becomes hyperreflexia, spasticity, pos. plantar reflex

Loss of motor and sensory after trauma total lack of fxn Absent reflexes and flaccid paralysis lasts a week to several months End of spinal shock signaled by muscular spasticity reflex bladder emptying hyperreflexia

Sympathetic chain Associated with autonomic instability dec. BP dec. RR

Spinal Cord Injuries Flashcards by Scott Baxter

MC causes of spinal cord injury (in order of frequency)

Most common in older pts?

Motor vehicle accidents**
Gunshot wounds (violence)
Falls
Sports injuries

Increasingly largely due to MVAs

How well did you know this?

Not at all

Perfectly

Dermatomes

Trigeminal
Cervical
Thoracic
Lumbar
Sacral

How well did you know this?

Not at all

Perfectly

Spinal Cord Anatomy: Corticospinal Tracts

Motor from cerebral cortex
Cross in lower medulla
Control motor fxn on same side of body

How well did you know this?

Not at all

Perfectly

Spinothalamic Tracts

Pain and temp
Cross 1-2 levels above entry

How well did you know this?

Not at all

Perfectly

Anterior Cord

Spinothalamic tracts (lateral columns)
Pain (pinprick)
Temperature
Light touch
- From opposite side of body**

How well did you know this?

Not at all

Perfectly

Anterior Cord Syndrome

Cause
- pressure on paired anterior spinal arteries
- damage by bony fragments
Damage
- bilateral spinothalamic tracts
- bilateral corticospinal tracts
Result
- complete loss of:
  - distal motor fxn
  - pain and temp sensation
  - light touch sensation
- Sacral sparing
Position and Vibration are PRESERVED**

How well did you know this?

Not at all

Perfectly

Posterior Columns

Light touch
Pressure
Joint position (proprioception) and vibration
- same side of body
Same level entry

How well did you know this?

Not at all

Perfectly

Posterior Cord Syndrome

Cause
- hyperextension injuries (cervical)
  - falls on face/chin
Damage to corticospinal tracts and posterior columns
Retained spinothalamic fxn (pain and temp)
Lost movement? but still intact (corticospinal) and proprioception (posterior column)

How well did you know this?

Not at all

Perfectly

Brown-Sequard Syndrome

Cause
- penetrating trauma**
Damage
- ALL tracts on ONE SIDE of the cord
Results
- isolated loss of ALL fxns
  - motor - SAME SIDE as damage
  - position/vibration - SAME SIDE as damage
  - pain/temp - OPPOSITE SIDE as damage

How well did you know this?

Not at all

Perfectly

Complete Transection

MOST SERIOUS
Cause
- trauma
Damage
- ALL tracts on BOTH SIDES
Results
- total loss of fxn on BOTH SIDES
Initially areflexia
Becomes hyperreflexia, spasticity, pos. plantar reflex

How well did you know this?

Not at all

Perfectly

Atlanto-Occipital Disassociation

“Hangman’s Fracture”**
Severe flexion of the atlas C1
Can cause dislocation/disassociation

How well did you know this?

Not at all

Perfectly

Spinal cord vascular supply: Radicular arteries from aorta

Great Radicular artery of Adamkiewicz**
T10 - L2**

How well did you know this?

Not at all

Perfectly

Spinal Shock

Loss of motor and sensory after trauma
- total lack of fxn
Absent reflexes and flaccid paralysis
- lasts a week to several months
End of spinal shock
- signaled by muscular spasticity
- reflex bladder emptying
- hyperreflexia

How well did you know this?

Not at all

Perfectly

Neurogenic Shock

Sympathetic chain
Associated with autonomic instability
- dec. BP
- dec. RR

How well did you know this?

Not at all

Perfectly

Central Cord Syndrome

Damage
- Central Spinothalamic tracts
- Central Corticospinal tracts
Upper extremity weakness > Lower
Associated w/ FALLS (elderly w/ spondylosis/stenosis)
Can’t lift ARMS
- look like they’re in a “barrel”

How well did you know this?

Not at all

Perfectly

Cauda Equina/Conus Medularis

CONUS MEDULARIS
- S3-S5
  - spinal cord ends at L2**
- Saddle anesthesia **
  - numbness in seat (saddle) area
- Sphincter loss
- Intact LE motor and sensory
CAUDA EQUINA
- Spinal cord ends at L2**
- Injury to lumbosacral roots
- Bowel/bladder deficits

Level of Injury

Cervical (C1 - T1)
Thoracic (T1 - L1)
Lumbar (L1 - S1)

Thromboembolic Disease

200x more likely to die of PE in 1st year
Prophylactic Strategies
- Pneumonic compression devices
- Unfractionated heparin (Lovenox)
- Caval filters
  - pts w/ high cord lesions

High Thoracic and Cervical Lesions

Above T6
Loss of supraspinal control of sympathetic activity

Acute SCI (autonomic dysfuntion)

Low sympathetic activity

Chronic SCI (autonomic dysfunction)

High sympathetic activity

Autonomic Dysfunction

High thoracic and cervical lesions (above T6)
- Loss of supraspinal control of sympathetic activity
Acute SCI
- Low sympathetic activity**
Chronic SCI
- High sympathetic activity**
Resting BP low
Bradycardiac
- resolves after 1st week
Orthostatic changes
- weakness
- lightheadedness
- syncope
Management
- Mobilization
- Lots of Na**
- Compression socks
- Fludrocortisone acetate** 0.1 mg PO QD
  - vol. expansion (inc. BP)

Autonomic Hyperreflexia

Lesions above T7-T8 (variation)
Unmodulated sympathetic response to stimuli below level of lesion
- Bladder distention**
- Fecal impaction**
Symptoms (EMERGENCY)
- SEVERE HA
- HYPERTENSION
- BRADYCARDIA
Management
- Sitting position (dec. ICP)
- Check for stimulus
- Minimize noxious stimuli
- Nifedipine/Nitrate** (1st line)
  - AVOID Nitrate if using Sildenafil (Viagra)
- Alpha blocking agent (Terazosin)
- ADMIT

Neuropathic Spinal Pain

Occurs at or below injury level
Results from
- change in neuronal function
- inc. spontaneous activity
- dec. threshold of response
Descriptors
- temp
- electric
Look for other causes of pain
Tx
- PT
- Anticonvulsants
- Antidepressants

Neurogenic Bladder Dysfunction

* Initial * bladder flaccidity * keeps getting fuller * Later * reflexes return w/ suprasacral injury * Acute * indwelling catheter * **Detrusor Sphincter Dyssynergy\*\*** * bladder reflex and sphincter working against each other * Management to **avoid renal damage!** * **Clean intermittent Catheterizations (best tx)** * Reflex voiding into condom catheter (lower lever injury - paraplegic pts)

Neurogenic Bowel Dysfunction

* Constipation * Reflexes allowing defecation may be intact * CAUDA EQUINA * lower motor neuron (LMN) * causes constipation * incontinence (flaccid sphincter) * Treatment * manual disimpaction * stimulants

Hypertrophic Bone Formation

* New bone formation in soft tissue surrounding joint * **MC hip\*\*** * Presentation * Lower extremity swelling * Dec. hip ROM * Fever * Treatment * ROM exercise * **NSAIDs** * Irradiation * **Etridronate\*\*** (bisphosphonate)

Spasticity

* Resistance to passive movement * Good because: * It's easier to move pt * harder to work with flaccid paralysis * inc. circulation * dec. risk of DVT and osteoporosis * Disadvantage * positioning * painful * Treatment * **Baclofen\*\*** (1st line) * GABA-B analog (centrally acting) * **Tizanidine** (2nd) * **Diazepam** (3rd)

ASIA Impairment Scale

* A: **complete** (severed) * B: incomplete (sensory intact, but no motor fxn below injury) * C: incomplete (motor fxn preserved below level) * muscle grade \<3 * D: incomplete (motor fxn preserved below level) * muscle grade \>3 * E: **normal**

Cervical Extension Teardrop Fracture

* Abrupt neck extension * C5 - C7 * MVA * Central cord syndrome * Similar to Flexion teardrop fracture

Quadriplegia

* C1 - C8

Paraplegia

* T1 - L4

Cardiovascular System

* C1 - T5 * dec. SNS influence * Bradycardia * Hypotension

Respiratory

* C1 - C3: * can't breath independently * C4: * poor cough * diaphragmatic breathing * hypoventilation * C5 - T6: * dec. resp reserve * T6 or T7 - L4: * resp system functional * adequate reserve

L5 - S1 Disc Prolapse

* No ankle jerk reflex *