Spinal Cord Injury

Question 1

Anterior cord syndrome

Answer 1

Compression and damage to anterior spinal cord or anterior spinal artery usually due to hyperextension injury.
Loss of motor function and pain and temperature sense. Likely dysfunction of bowel and bladder and and sexual depending on level of injury. Proprioception and vibration intact.
Damage to corticospinal and spinothalamic tracts
Worst prognosis for all spinal cord syndromes, with 10-15% achieving functional recovery

Question 2

Brown-Sequard’s syndrome

Answer 2

Usually due to stab wound
Paralysis and loss of vibratory and position sense on same side of lesion due to damage to corticospinal tract and dorsal columns
Loss of pain and temperature sense on the opposite side of the lesion due to damage of the lateral spinothalamic tract

Question 3

Cauda Equina Injury

Answer 3

Injuries below L1 level. Considered a peripheral nerve injury.
Due to compression of cauda equina nerve roots from spinal structure pathology (ruptured disk, fracture, stenosis), trauma (fall, gunshot), infectious conditions (abscess or tuberculosis), tumor, or iatrogenic factors.
Characteristics include flaccidity or decreased strength, diminished sensation in the saddle area, areflexia, and bowel/bladder function impairment. May also include severe back pain and sexual dysfunction.
Full recovery unlikely due to distance needed for axonal recovery

Question 4

Central Cord syndrome

Answer 4

Most common incomplete spinal cord lesion.
Compression and damage to the central portion of spinal cord, usually due to cervical hyperextension, often from a fall or other trauma.
Damage to spinothalamic tract, corticospinal tract, and dorsal columns.
UE involvement greater than LE, more severe distally than proximally.
Greater motor deficits than sensory deficits

Question 5

Posterior Cord syndrome

Answer 5

Relatively rare syndrome caused by compression of the posterior spinal artery.
Loss of proprioception, two-point discrimination, and stereognosis.
Motor function preserved

Question 6

ASIA (American Spinal Injury Association) Impairment Scale

Answer 6

A: Complete. No sensory or motor function is preserved in sacral segments S4-5.
B: Sensory incomplete. Sensory but not motor function is preserved below level and extends through sacral segments S4-5.
C: Motor incomplete. Motor function preserved below level, and most key muscles below the level have a muscle grade less than 3.
D: Motor incomplete. Motor function preserved below level, and most key muscles below level have a muscle grade greater than or equal to 3.
E: Normal. Sensory and motor functions are normal.

Question 7

Motor Level of Injury

Answer 7

Determined by most caudal key muscles that have muscle strength of 3 or greater with superior segment tested as normal or 5.

Question 8

Motor Index Scoring

Answer 8

Each key muscle graded from 0-5 with each extremity totaling 25 points. Total score is 100.

Question 9

Sensory Level of Injury

Answer 9

Determined by most caudal dermatome with normal score of 2/2 on pinprick and light touch.

Question 10

Complications of SCI: DVT

Answer 10

At greater risk due to absence or decrease in the normal pumping action of muscles
Symptoms: swelling, pain, sensitivity over clot, warm
Treatment: no active or passive movement of involved extremity. Bed rest and anticoagulants; surgery if needed.

Question 11

Complications of SCI: Ectopic Bone

Answer 11

Formation of bone in soft tissue possibly from tissue hypoxia to abnormal calcium metabolism.
Symptoms: edema, decreased ROM, increased temperature of involved joint
Treatment: Diphosphates that inhibit ectopic bone formation. PT maintains function ROM and functional independence.

Question 12

Complications of SCI: Orthostatic Hypotension

Answer 12

Decrease in systolic BP of 20 mmHg and diastolic of 10 mmHg with position change.
Symptoms: lightheadedness, nausea, and blacking out
Treatment: elastic stockings, Ace wraps to LEs, abdominal binders. Gradual progression to vertical position

Question 13

Complications of SCI: Pressure Ulcers

Answer 13

Common sites are coccyx, sacrum, ischium, trochanters, elbows, buttocks, malleoli, scapulae, and prominent vertebrae
Symptoms: reddened skin
Treatment: change position frequently, proper skin care, appropriate sitting cushion, weight shifts, proper nutrition and hydration

Question 14

Complications of SCI: Spasticity

Answer 14

Symptoms: increased involuntary contraction of muscle groups, increased tonic stretch reflexes, exaggerated DTRs
Treatment: Dantrium, baclofen, lioresal. Phenol blocks, rhizotomines, myelotomines. PT includes positioning, aquatic therapy, weight bearing, function e-stim, ROM, resting splints, and inhibitive casting.

Question 15

Myelotomy

Answer 15

Surgical procedure that severs certain tracts within spinal cord to decrease spasticity

Question 16

Neurectomy

Answer 16

Removal of segment of a nerve to decrease spasticity

Question 17

Rhizotomy

Answer 17

Surgical resection of the sensory component of a spinal nerve to decrease spasticity

Question 18

Spinal shock

Answer 18

Occurs 30-60 minutes after trauma and can last weeks. Total flaccid paralysis and loss of all reflexes below level of injury.

Question 19

Zone of preservation

Answer 19

Poor or trace motor or sensory function for up to three levels below the neurologic level of injury