Spinal Injury

Question 1

What are the curvatures of the vertebral column?

Answer 1

Cervical - Lordosis

Thoracic - Kyphosis

Lumbar - Lordosis

Question 2

What vertebrae make up each section of the vertebral column?

Answer 2

Cervical - 7

Thoracic - 12

Lumbar - 5

Sacral - 5

Question 3

What muscles help to stabilise the vertebral column?

Answer 3

Erector Spinae Muscles:

• Iliocostalis
• Longissimus
• Spinalis

Question 4

In relation to the vertebral bodies of the spine, where do the spinal nerves exit the the spinal column?

Answer 4

Spinal nerves exit the spinal column below the pedicle of the correspnding vertebral body, i.e. spinal nerve T10 exits below the pedicle of vertebral body T10

Question 5

What is a dermatome and a myotome?

Answer 5

Dermatome - An area of skin supplied by a single spinal nerve

Myotome - A group of muscles which are innervated by a single spinal nerve

Question 6

How are spinal injuries classified?

Answer 6

ASIA classification:

A - Complete (No sensory or motor function preserved in sacral segments S4-5)

B - Incomplete (Sensory but not motor function preserved below neurologic level and extending throgh sacral segments S4-5)

C - Incomplete (Motor function preserved below neurologic level, majority of muscles have a grade < 3)

D - Incomplete (Motor function preserved below neurologic level, majority of muscles have a grade > 3)

E - Normal motor and sensory function

Question 7

What are the main causes of spinal injury in the UK?

Answer 7

• RTA’s
• Sport and recreational activities
• Falls

Question 8

What is the definition of the following terms; spasticity, quadriplegia & paraplegia?

Answer 8

Spasticity - Increased muscle tone caused by an UMN lesion

Quadriplegia - Partial or total loss of sensation of all 4 limbs, including the trunk and loss motor/sensry function in the cervical section of the spinal cord

Paraplegia - Partial or total loss of use of the lower limbs, impaired or total loss of motor/sensory function in the thoracic, lumbar and sacral segments of the spinal column

Question 9

What are the clinical features of cervical spinal injury?

Answer 9

• Quadraplegia
• Respiratory function lost
• Low HR & BP

Question 10

What are the clinical features of thoracic spinal injury?

Answer 10

• Inability to control abdominal muscles
• Loss of function of lower limbs
• Function of upper limbs spared

Question 11

What are the clinical features of lumbar spinal injury?

Answer 11

• Decreased control of legs and hips, GI/urinary system and anus
• Incontinence

Question 12

What are the initial stages of management of spinal injury?

Answer 12

1) Prevent secondary insult/injury
2) ABCD:

Airway - Cervical spine control (neck brace)

Breathing - Ventilation and Oxygen

Circulation - IV fluids and consider neurogenic shock

Disability - Assess neurological function, including PR and perianal sensation

3) ATLS (Advanced Trauma Life Support)

Question 13

What are the surgical options and long term rehabilitation of spinal cord injuries?

Answer 13

Surgical Fixation:

• Unstable fractures

Long-term Management:

• Physiotherapy
• Occupational Therapy
• Psychological support
• Urological/ sexual counseling