Spinal Injuries Flashcards
What is the most common cause for trauma injuries
Trauma
What is the anterior column made up of
Corticospinal tract- motor function
●Anterior spinothalamic tract- touch and pressure
What is the lateral column made up of
Lateral spinothalamic tract- pain and temperature from contralateral side.
-Lateral corticospinal tract- motor information from contralateral brain to ipsilateral extremities
●Posterior Column:
-Transmits ipsilateral touch, pressure, vibration,proprioception and two point descrimination
Mention some examples of injuries to the spine
To the spinal vertebrae
●To the spinal cord
●Both
●Injuries occur commonly at the transition segments of the spinal column.
●Most common site is the lumbar region, commonly in the upper lumbar segments, then cervical and finally thoracic.
Mention some injuries to the spinal vertebrae
●The injury could be to the vertebrae, to the cord or both
●The type of injury depends on the mechanism of the injury
●Compression injury
-Wedge fracture
-Burst fracture
-Tear drop
●Flexion injury
●Extension injury
●Rotation injury
What are the groupings to injuries to the cervical spine
Injuries to the cervical spine is grouped into:
●Upper cervical C1-3
●Lower cervical C4-7
●Fractures above C4 with cord injury is associated with paralysis of muscles of respiration.
●Fractures in the mid cervical spine is associated with dysfunction of upper extremities
What are some injuries to the spinal cord
Irrespective of the mechanism of injury
●Cord injury could be:
-Complete
-Incomplete
●The type of cord injury depends on the neurologic function distal to the level of injury
●Depending on the level could be either a quadri (cervical level)or para(below cervicithoracic level) plegia/parasis
●ASIA classification system
Neurologic assessment of the spinal injuries assess spinal nerves from each segment to ascertain motor (myotomes) and sensory (dermatome) function.
●Common incomplete spinal injuries:
●Central cord syndrome
●Brown-Sequard syndrome
●Anterior cord syndrome
●Posterior cord syndrome
Conus medullaris syndrome
●Cauda equina syndrome
●Other forms of spinal cord injuries:
-Spinal shock
-Neurogenic shock
●Types of complete cord injuries:
-Paraplegia
-Tetraplegia
How are spine injuries managed
Commences from the site of injury.
●Motive is to prevent further damage to the cord aside the initial injury .
●Immobilize the spine- cervical collar and spine board
●Primary survey
●Secondary survey
●History
●Examination ie neurologically
●Maintenance of immobilisation
●Neuroimaging –CT scan or MRI
How are spine injuries treated
●Role of steroids
●Analgesics
●I V fluids
●Maintain spine immobilisation
●Rule out other injuries ie abdominal visceral organs, thoracic injuries
●Surgery
●Not all spinal injuries need surgical interventions
What are some indications for spine injuries
Neurologic deterioration- progressive loss of function on review post trauma
●Unstable fracture- fracture involving more then one vertebral column as per the Denis 3 column theory
●Epidural hematoma- collection of blood around the cord
●Narrowing of spinal canal- decrease in the AP diameter of the vertebral canal
What are the goals of spinal injury
●Decompress the spinal canal
●Stabilize the spine by pedicle screw placement and connecting rods
●Maintain and improve neurologic function
What are some post surgery managements
●Complete cord injury
-Avoid pressure sores
-Splint extremities to prevent flexion contracture.
-Physiotherapy / ROM
-Psychotherapy
-Occupational rehabilitation
-Housing restructuring
-Intermittent catheterisation
-DVT prevention
Incomplete cord injury:
●Physiotherapy
●Psychotherapy
●Frequents follow ups and neurologic assessment
