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Flashcards in Spinal Cord Injury Deck (59)
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1

Anatomy review

-spinal cord runs through the vertebral column with spinal cords extending out, into the body

-31 pairs of spinal nerves

-33 vertebrae in total

2

The vertebrae

-when talking about SCI we identify the level of injury by the vertebrae

Cervical: C1-C7

Thoracic: T1-T12

Lumbar: L1-L5

Sacrum: (S1-S5)--all 5 are fused

Coccyx: CO1-CO4--all 4 are fused

3

How many new incidents per year

12k

4

plurability are related to...

MVAs

5

Falls account for...

second highest incidence

6

Biggest at risk groups are...

men, young adults 16-30, Caucasians

7

Most SCIs occur at...

C1-5, T12, L1-3

8

Patho of SCIs

-initial trauma which kills neuron, initiates inflammatory response

-reduced blood flow due to trauma, swelling, edema

-compression due to swelling from injury and inflammation

-WBCs bleeding into spinal cord causing more inflammation. Cytokine release may lead to scar tissue formation

-early intervention and tx can help limit degree of damage to spinal cord

9

Etiology of SCIs

-excessive force to the spinal column in one of several ways

10

Hyperflexion

bend neck forwards

11

hyperextension

bend neck backwards

12

compression

landing on head or butt

13

rotational

bend neck to side or turn to side

14

transection

partial or complete severance

15

Grade A ASIA

-complete
-no sensory or motor fx preserved in sacral segments S4-S5

16

Grade B ASIA

-incomplete
-sensory but not motor fx preserved below the neurologic level and extending through sacral segments S4-S5

17

Grade C ASIA

-incomplete
-motor fx preserved below the neurologic level
-majority of key muscle have a grade less than 3

18

Grade D ASIA

-incomplete
-motor fx preserved below the neurologic level
-majority of key muscles have a grade greater than 3

19

Grade E

normal motor and sensory fx

20

Complete SCIs

-total loss of fx below level of injury

21

Incomplete SCIs

some feeling or movement remains

-central cord
-anterior cord
-posterior cord
-brown-sequard syndrome
-conus medullaris syndrome and cauda equina

22

Central cord damage

-more severe motor loss in UE than LE

-bladder dysfunction, retention

-almost all will have some degree of recovery, usually starting in LE

23

Anterior cord damage

-damage to anterior 2/3rds of cord
-loss of fx below level of injury
-loss of pain, temp sensations
-keep proprioception
-poor prognosis, some motor recovery may be possible

24

Posterior cord damage

-very rare, damage to posterior portion of spinal cord

-most have good motor, pain, and temp control

-mainly loss of proprioception, light touch

25

Brown-Sequard Syndrome

-hemisection of spinal cord

-same side (ipsilateral) motor paralysis

-loss of proprioception below LOI

-opposite side (contralateral) loss of pain and temp sensation below LOI

-best prognosis, majority will be able to ambulate independently eventually with tx

26

Conus Medullaris Syndrome and Cauda Equina

-injury to tapered end of spinal cord (L1, rarely L2)

-not a true SCI, injury to spinal nerves branching from SC

-partial or complete loss of sensation below LOI, saddle anesthesia, low back pain

bladder and bowel incontinence, constipation, etc

-prognosis is poor for complete recovery, some possible

27

saddle anesthesia

loss of feeling/sensation in areas you'd feel when sitting on a saddle

28

Spinal shock

-not a true shock of the neurogenic, septic, etc

-occurs in about half of all SCI

-occurs immediately after SCI, within a few mins to hours

-even undamaged nerves lose fx for a bit

-loss of nervous system functioning due to decreases reflexes below level of injury, loss of sensation, flaccid paralysis below level of injury

29

Spinal Shock Tx and Management

-lasts between a week up to several months

-difficult to assess degree of permanent or chronic injury/loss of fx during this time

-want to avoid exacerbating injury

-immobilize spine and be careful moving

-steroids to reduce swelling
(typically methylprednisone titrated to pt weight)

30

Primary or initial injury

-disrupts or severs nerve connections in one of the ways mentioned before