Spinal Cord Injury

Question 1

Spinal Cord Injury Epidemiology

% Cervical, thoracic, and lumbar

Answer 1

50% Cervical (C5 most common)
35% Thoracic
11% Lumbar
4% Unknown

Question 2

Patients with SCI are ___ - ___ times more likely to die prematurely.

Answer 2

2-5

Question 3

What age/gender groups are most likely to sustain a SCI?

Answer 3

Males, m/c individuals ages 16-30 (Trauma) and also age 60+ (OA)

Question 4

What is the most common classification of SCI?

Answer 4

Incomplete paraplegia

Question 5

What are the most common causes of SCI?

Answer 5

1. MVA
2. Falls
3. Violence
4. Sports
5. Medical/surgical

Question 6

Sympathetic nervous system responsibilities and location

Answer 6

Fight or flight
Ganglia in the spinal cord

Question 7

Parasympathetic Nervous System responsibilities and location

Answer 7

Rest and digest
Brainstem and sacral spinal cord

Question 8

Parasympathetic nerves are responsible for what?

Question 9

Sympathetic Nerves are responsible for what?

Question 10

Primary injury

Answer 10

Initial mechanical force directly damaging the cord

Question 11

Secondary injury

Answer 11

Persistant physiologic insult

Question 12

Phases of spinal cord injury

Answer 12

1. Acute: Cytotoxic, inflammatory, hemorrhage, edema, necrosis, nerve depol
2. Subacute: Macrophage infiltration, excitotoxicity, and scar initiation
3. Intermediate: Continued scar formation
4. Chronic: Wallerian degeneration, myelomalacia, cystic caviations

Question 13

Pathophys spinal cord

Answer 13

Impaired auto regulation, loss of sympathetic tone, pooling of venous blood due to atonia results in Hypotension, bradycardia, neurogenic shock

Question 14

If someone is in neurogenic shock they will appear ____ and ____.

Answer 14

Warm and dry

Question 15

Neurogenic shock will most often occur at what injury level

Answer 15

Thoracic level injury above T6

Question 16

Treatment for neurogenic shock

Answer 16

Fluid resusitation then vasopressors (norepinephrine preferred)

Question 17

When handling a patient with spine trauma how should they be handled initially?

Answer 17

• Immobilization with c-collar, full length backboard, side supports/straps, head of bed flat/log roll only.

Question 18

What does the exam involve for a spine trauma?

Answer 18

• ABC’s
• Initial neurological survey: gross motor/sensory, tenderness, STEP OFFS, palpable fluid collections/hematoma, bruising or abrasions/wounds
• Later complete neuro exam with additional repeat.

Question 19

What is the first line imaging for spine trauma (textbook)?

Answer 19

X-ray (AP and Lat + odontoid for c-spine)

Question 20

What is the first line imaging for spine trauma (in practice)?

Answer 20

CT

Question 21

How would you treat a stable spine fracture?

Answer 21

Conservative, typically with brace for immobilization

Question 22

How would you treat an unstable spine fracture?

Answer 22

ORIF, usually a fusion

Question 23

What are the grades of spinal cord injury?

Answer 23

A (worst)-E (normal)

Question 24

Transient SCI

Answer 24

comes and goes, spinal shock
* Acute areflexia
* Flaccid paralysis
* Absence of bulbocavernosus reflex
* Resolves in 24-72 hours

Question 25

Complete

Answer 25

Absence of sensory and motor function distal to injury * Poor prognosis * Quadriplegia vs. paraplegia

Question 26

Incomplete

Answer 26

Some degree of neurological function present distal to injury * May have sacral sparing-voluntary anal sphinctor tone, perineal sensation, great toe flexion * Greater function initially = better prognosis

Question 27

Ascending tracts carry sensory or motor information?

Answer 27

sensory

Question 28

Decending tracts carry sensory or motor information?

Answer 28

Motor

Question 29

Dorsal columns are responsible for what?

Answer 29

* Proprioception * Vibratory sense * Fine touch

Question 30

Lateral and ventral corticospinal tracts are responsible for what?

Answer 30

Motor

Question 31

Lateral spinothalamic tract is responsible for what?

Answer 31

* Pain * Temperature

Question 32

Ventral spinothalamic

Answer 32

* Light touch

Question 33

Central cord syndrome

Answer 33

* m/c incomplete pattern * m/c involves the cervical spine * Extension injuries in setting of OA * Disruption of corticospinal and spinothalamic tract.

Question 34

Central cord syndrome presentation

Answer 34

* Flaccid paralysis of UE (more common) * Spastic paralysis of LE * Sacral sparing

Question 35

Anterior cord syndrome

Answer 35

* m/c from ischemic injury (compression anterior spinal injury) * Injury to the corticospinal and spinothalamic tracts * Equal injury to UE, LE, and sacral area * Dorsal columns preserved

Question 36

Anterior cord syndrome symptoms

Answer 36

* Loss of motor, pain, temp, and light touch below level or injury. * Worst prognosis of incomplete SCIs

Question 37

What sensations will remain intact in anterior cord syndrome?

Answer 37

Proprioception, position sense, vibratory sense, and discrimination preserved.

Question 38

Brown-Sequard Syndrome

Answer 38

* Rare, often due to penetrating injury. * 1/2 of the spinal cord is damaged

Question 39

Brown-Sequard Syndrome presentation

Answer 39

* Ipsilateral loss of motor, proprioeption, light touch, vibration, position sense, discrimination * Contralateral loss of pain and temperature * Good prognosis

Question 40

Posterior cord syndrome

Answer 40

* Rare, seen with tumors, vascular disorders, demyelinating disorders. * Injury to dorsal columns

Question 41

Posterior cord syndrome presentation

Answer 41

Loss of proprioception, position sense, vibration, and discrimination.

Question 42

Common complications from SCI's

Answer 42

* Gastritis/ileus-NG tube and H2 blockers * Urinary dysfunction-foley or intermittent caths (risk UTI) * Breathing difficulty (C3-5 injury) * Skin breakdown, reposition every two hours * Vascular complications