Spinal Cord Injury: Intro, Syndromes, & Acute Management

Practice flashcards covering definitions, syndromes, and clinical considerations for Spinal Cord Injury (SCI) management.

Tetraplegia

Condition where all 4 limbs are affected, occurring with a cervical injury.

Paraplegia

Condition where the lower extremities are affected, occurring with thoracic, lumbar, or below injuries.

Orthopedic level of injury

The spinal segment(s) at which bony and/or other soft tissue structure compromise has occurred; applies only to traumatic SCI.

Neurologic(al) level of injury

The most caudal level of the spinal cord in which sensory and motor function is intact on both sides of the body.

Traumatic SCI (tSCI)

Spinal cord injury resulting from external, physical trauma or damage to the spine and spinal cord.

Non-Traumatic SCI

Spinal cord injury not caused by external physical trauma, such as congenital disorders, vascular disorders, or inflammatory/neurologic disorders.

Bimodal distribution

The age pattern of SCI occurrence, with the 1st peak between $15-29$ years old and the 2nd peak at $> 65$ years old.

Spinal Shock

Transient neural depression with loss of all spinal reflexes below the level of injury, resulting in flaccid paralysis (hypotonia) and sensory loss.

Bulbocavernosis reflex (BCR)

A reflex tested via sensory stimulus to the glans penis, clitoris, or catheter tubing; its return indicates the resolution of spinal shock ($S2-S4$).

Neurogenic Shock

An interruption of sympathetic pathways leading to decreased vasomotor tone (hypotension) and decreased input to the heart (bradycardia).

Motor Level

The most caudal level of the spinal cord with normal motor function bilaterally.

Sensory Level

The most caudal level of the spinal cord with normal sensory function bilaterally.

AIS Level A (Complete)

No motor or sensory function is preserved in the sacral segments $S4-S5$.

AIS Level B (Sensory Incomplete)

Sensory, but not motor function, is preserved below the neurological level of injury (NLI) including sacral segments $S4-S5$, with no motor function more than $3$ levels below the motor level.

AIS Level C (Motor Incomplete)

Motor function is preserved at the most caudal sacral segments or sensory incomplete status with some motor sparing, where less than half of key muscles below the NLI have a grade of $3$ or greater.

AIS Level D (Motor Incomplete)

Motor incomplete status where at least half (half or more) of key muscle functions below the NLI have a muscle grade of $3$ or greater.

AIS Level E (Normal)

Sensation and motor function are graded as normal in all segments at the time of testing in a patient who had prior deficits.

Central Cord Syndrome

The most common clinical syndrome, often caused by hyperextension, where UE motor loss is greater than LE motor loss ($UE > LE$).

Brown-Séquard Syndrome

A hemi-section of the spinal cord resulting in ipsilateral loss of motor function and light touch/proprioception, and contralateral loss of pain and temperature.

Anterior Cord Syndrome

Interruption of the anterior spinal artery (anterior $\frac{2}{3}$ of the SC) causing total loss of motor and pain/temperature below the lesion, with spared light touch and proprioception.

Posterior Cord Syndrome

The rarest syndrome affecting the posterior $\frac{1}{3}$ of the SC, resulting in loss of light touch and proprioception; motor function remains intact but movement is non-functional.

Conus Medullaris Syndrome

Injury occurring between $T11 - L2$ resulting in mixed Upper Motor Neuron (UMN) and Lower Motor Neuron (LMN) signs.

Cauda Equina Syndrome

Injury to the 'horse's tail' (below $L1$) resulting in Lower Motor Neuron (LMN) signs, saddle anesthesia, and bowel/bladder/sexual dysfunction.

Autonomic Dysreflexia (AD)

A potentially life-threatening mismatch between sympathetic and parasympathetic systems in response to strong sensory input below the injury, typically affecting lesions at $T6$ or above.

Spastic (Reflexive) Bowel/Bladder

UMN condition occurring with injuries above the conus medullaris (usually above $T12$) where the bowel/bladder reflexively contract in response to filling.

Flaccid Bowel/Bladder

LMN condition occurring with injuries below the conus medullaris (usually below $L1$) where the bowel/bladder fill and leak without reflexive contraction.

Heterotopic ossification

A secondary complication of SCI usually involving large joints like the hips and knees where bone forms in soft tissue.