Spinal Injuries Flashcards
In terms of Vertebrae, how is the spine separated. How many nerves for each part?
What investigations would you order for a patient with spinal injury (including escalations)
1) X-ray/CT spine (Saggital)
2) T2 MRI Saggital
When performing a clinical exam for spinal injury, how will you determine if the injury is complete or incomplete
We need to check function of 3 levels below the level of injury
OR
Motor and sensory function of lowest sacral segments (more practical) which are
Sensory: Perianal sensation
Motor: Toe flexion
Reflex: Anal reflex
Complete = No motor or sensory function
Incomplete = preservation
What is the anal reflex
Contraction of the external anal sphincter on perianal sensation stimulation (which is also part of the assessment)
What is involved in the initial management as part of the primary assessment of a patient with any head OR spinal injury? (other than ABCDE)
Conus Medullaris and Cauda equina can be differentiated by whether the injury occured above or below the end of the spinal cord respectively. Where does the spinal cord end?
L1/L2 in adults
Injury at what level (or above it) will lead to respiratory arrest?
C3 and above
The phrenic nerve is composed of which spinal nerves? (levels)
C3, C4, C5 keeps the diaphragm alive
The brachial plexus encompasses which spinal nerves?
C5-T1 resulting in Erb’s and Klumpke’s palsy
What are the UL Dermatomes and Myotomes?
What are the LL Dermatomes and Myotomes?
How would you grade power?
How would you grade Reflexes?
Graded from Absent to 4+ with 2+ being normal
Define Spinal shock
Give the 4 phases
What are the 3 relevant tracts in spinal injury?
For each, state what they control and where they decussate
Outline, in general, the order of the homunculus from central to peripheral
There are 2 patterns of spinal cord injuries, complete and incomplete. List the syndromes associated with each
Complete:
Tetraplegia
Paraplegia
Incomplete: ABC
Anterior cord syndrome
Brown Sequard syndrome
Central cord syndrome
Posterior cord syndrome
Tetraplegia is caused by
Paraplegia is caused by
Tetraplegia is caused by complete injury at the cervical level
Paraplegia is caused by complete injury at the thoracic or lumbar levels
Which incomplete spinal injury has the best and worse prognosis?
Best prognosis = Brown Sequard
Worst = Anterior cord syndrome
Anterior cord syndrome:
What artery is typically affected?
What tract is damaged?
What Motor sx?
What Sensory sx?
Artery: Anterior spinal artery
Brown Sequard Syndrome:
What is the typical mechanism of injury?
What tract is damaged?
What Motor sx?
What Sensory sx?
Central Cord syndrome:
What tract is damaged?
What Motor sx?
What Sensory sx?
Posterior Cord Syndrome:
What Gait is expected?
What tract is damaged?
What Motor sx?
What Sensory sx?
Give the causes of Cauda Equina/Conus Medullaris
Compare and contrast them
