Spinal Cord Injury Flashcards
(37 cards)
What sections are the vertebral column composed of and how many vertebrae in each?
- cervical (7)
- thoracic (12)
- lumbar (5)
- sacral (5 - fused in adults)
- coccygeal (4 - fused in adults)
Total of 33
What causes most spinal cord injuries (SCIs)?
Most are trauma-related injuries. Those most common ones are motor vehicle crashed, falls, and then acts of violence and sports/recreation activities.
What are the classifications of spinal cord injuries?
- complete spinal cord injury (loss of all voluntery motor and sensory function below the level of injury) - caused by damage to the entire level of the spinal cord
- incomplete spinal cord injury - preservation of some sensory or motor function below the level of injury because of partial damage to the spinal cord)
What kind of injury causes paraplegia?
Injury to the thoracolumbar region (T1 - L1) that causes loss of motor and sensory function of the lower extremities
What kind of injury causes tetraplegia (also referred to as quadriplegia)?
Result of injury to the cervical regions (C1 - C7)
Damage to upper motor neuron pathways results in what type of muscle and reflex affect?
Produces hypertonia, spastic paralysis, persistent muscle spasms, abd exaggerated tendon reflexes
Damage to the lower motor neurons produces what kind of affect?
Flaccid paralysis, characterized by weakness, loss of motor tone, and no reflexes
Why are complete spinal cord injuries to C1 and C2 often fatal?
Because the patient is unable to breathe spontaneously
What is the primal injury to the spinal cord?
Occurs when excessive force is applied to the cord; it is neurologic damage that occurs at the moment of impact
What causes primary injury to the spinal cord?
- violent motions of the head and trunk
- fracture and dislocation of the vertebral column
- blunt or penetrating trauma
What are four different mechanisms of injury in SCIs?
- hyperflexion
- hyperextension
- flexion-rotation
- blunt or penetrating trauma
What typically causes a hyperextension injury and what is the associated pathophysiology?
- Caused by a forward and backward motion of the head by sudden acceleration
- Rear end collisions and falls where the chin is pushed up (think whiplash as a mild form)
- Causes posterior compression and anterior ligament may stretch or tear
What typically causes a hyperflexion injury and what is the associated pathophysiology?
- Most often caused by a sudden deceleration of the motion of the head
- Causes can be a head on collision or diving accident
- The head and cervical spine continue forward while the thorax stops
- Ruptured or torn posterior ligaments result
What typically causes a compression/axial-loading injury and what is the associated pathophysiology?
Caused by a vertical force along the spinal cord that fractures vertebral bodies and sends bony fragments into the cord
Typically occurs with diving into shallow water or jumping from tall heights and landing on the feet or buttocks
What is a distraction injury and what causes it?
Occurs when the vertebrae and spinal cord are stretched excessively, pulling the structures apart, as in hanging.
What is secondary injury r/t SCI?
Refers to the multifaceted pathological mechanisms that start after the primary SCI that can last from days to weeks. These can include edema, bleeding, and ischemic injury to the cord.
What typically causes a rotation SCI injury and what is the associated pathophysiology?
- Caused by lateral flexion or twisting of head and neck
- Causes tear or rupture of posterior ligaments, dislocation or facet joints, and fractures at articular processes
- T-bone MVAs and falls, as well as sports injuries
What are two pathophysiological proceses that contribute to secondary injury?
- intraparenchymal hemorrhage and ischemia
- inflammatory processes
What are some interventions that decrease secondary injury?
Immobilization & stabilization
Airway management
Adequate physiological support
Methylprednisolone
What diagnostic tools are used for SCI?
X-ray
Computed Tomography (CT) Scan
Magnetic Resonance Imaging (MRI)
Angiograph
Somatosensory-evoked potentials (SEPs)
What is included in the assessment for SCI?
Physical Assessment:
- Includes assessment of motor, sensory, and reflex function
- serial neurological exams hourly for first 24 hours
- Monitored closely for respiratory failure
Assessing for shock states:
Spinal shock
Neurogenic shock
What is the most importat data to collect in the sensory examination?
The exact point on the patient where normal sensation is present. Sensory assessment moves from lower to upper body regions because it is easier for the patient to recognize the onset of a sensory stimuus that the cessation of a stimulus.
How is sensation tested?
Sensation is tested along dermatomes.
True or false: Autonomic dysfunction is more extensive when the level of injury is higher.
True
