Spinal Cord Injury

What is the average age at injury for traumatic SCI?

Approximately 45 years old

Is traumatic SCI more prevalent in males or females?

Males (78%)

What are the two leading causes of traumatic SCI?

Vehicles and falls

What is neurologic level of injury?

The lowest nerve level with normal sensory and motor function

Which two criteria are used to extrapolate functional outcomes?

Neurologic level of injury and completeness classification

What characterizes ASIA impairment scale A classification?

Complete injury - no sensory or motor function preserved in sacral segments S4/5

What characterizes ASIA impairment scale B classification?

Sensory incomplete - light touch/pin prick at S4/5 or deep anal pressure preserved with no motor function preserved more than three levels lower than the neurologic level of injury

What characterizes ASIA impairment scale C classification?

Motor incomplete - voluntary anal contraction spared OR patient meets criteria for sensory incomplete with some motor sparing greater than three levels below the neurologic level of injury (less than half ≥ grade 3)

What characterizes ASIA impairment scale D classification?

Motor incomplete - voluntary anal contraction spared OR patient meets criteria for sensory incomplete with some motor sparing greater than three levels below the neurologic level of injury (at least half ≥ grade 3)

What characterizes ASIA impairment scale E classification?

Normal - sensation and motor function graded as normal in all segments

Do individuals without initial spinal cord injury receive an ASIA impairment scale score?

No

At what points in the continuum of care are the ISNSCI criteria evaluated for patients with spinal cord injury?

ER, surgery, IRF admission, IRF discharge, annually

What percentage of patients with spinal cord injury have concurrent brain injury?

Approximately 30%

If C0-C4 are innervated, which muscles retain function?

Scalenes, sternocleidomastoid, levator scapulae, upper trapezius, portion of diaphragm

If C0-C5 are innervated, which muscles retain function?

C4 + trapezius, rhomboids, deltoid, brachialis, and partial biceps, pecs, serrates, rotator cuff, and brachioradialis

If C0-C6 are innervated, which muscles retain function?

C5 + pec major, serratus, rotator cuff, extensor carpi radialis longus/brevis, supinator, pronator teres, and partial triceps

If C0-C7/C8 are innervated, which muscles retain function?

C6 + pec major/minor, triceps, extensor digitorum, extensor carpi ulnaris, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, and partial flexor digitorum profundus

If C0-T1/T6 are innervated, which muscles retain function?

C8 + abductor digiti minimi, thoracic extensor spinae, intercostals, abdominals (at T5)

If C0-T7/T12 are innervated, which muscles retain function?

T6 + intercostals, abdominals, thoracic erector spinae, and partial lumbar extensors

If C0-L1/L3 are innervated, which muscles retain function?

T12 + iliopsoas (at L2), quadratus lumborum, sartorius, adductors, and partial quadriceps

If C0-L4/L5 are innervated, which muscles retain function?

L3 + quadriceps, tibialis anterior (at L4), extensor hallicus longus (at L5), gluteus medius/minimus, and fibularis longus/brevis

If C0-S1/S3 are innervated, which muscles retain function?

L5 + gastrocnemius (at S1), soleus (at S1), biceps femoris, semimembranosus, flexor hallicus longus (at S1)

What symptoms are associated with upper motor neuron lesions?

Damage to ascending tracts, spastic paralysis, cervical and upper thoracic lesions, hyperreflexia, spastic bowel and bladder

What symptoms are associated with lower motor neuron lesions?

Damage at or peripheral to anterior horn cells, flaccid paralysis, lumbar/sacral lesions, areflexia, flaccid bowel and bladder

What type of injury can cause mixed upper and lower motor neuron signs and symptoms?

Injury to conus medularis and the cauda equina

What is spinal shock?

Occurs after injury with temporary effects causing loss of spinal reflexes, voluntary motor function, sensory functions, and autonomic control

What deficits are associated with anterior cord syndrome?

Loss of motor function and pain/temperature sensation

What deficits are associated with Brown-Sequard Syndrome?

Ipsilateral loss of proprioception, vibration, two-point discrimination, and motor control; contralateral loss of pain, temperature, and crude touch a few levels below injury

What percentage of spinal cord injuries result in Brown-Sequard Syndrome?

2-4%

What is the most common type of incomplete SCI?

Central cord syndrome

What is the most common symptom associated with central cord syndrome?

Pronounced upper extremity weakness, typically accompanied by high spasticity

What symptoms are commonly associated with conus medullaris syndrome?

Hyperreflexia, hypertonicity, bilateral symptoms, spastic bowel and bladder; requires specific MMT to differentiate from cauda equina

What symptoms are commonly associated with Cauda Equina Syndrome?

Flaccid paralysis, absent reflexes, flaccid bowel and bladder, usually asymmetrical