Spinal Cord Injury Overview and Management

Injuries from MVAs, falls, GSWs, diving, sports.

Traumatic Causes

Vascular accidents, cord compression, spinal diseases.

Non-Traumatic Causes

Common unstable vertebral injury involving three columns.

Fracture-Dislocations

Fractures causing vertebrae to collapse.

Compression Fractures

Injuries from excessive backward bending of the neck.

Hyper-Extension Injuries

Injuries from excessive forward bending of the neck.

Hyper-Flexion Injuries

Blood collection compressing the spinal cord. Rupture of a blood vessel, bleeding causes ischemia or pressure on the cord

Hematoma

Blood supply cut off, causing ischemia.

Thrombosis

Vertebral fx can increase pressure on and possibly injure the spinal cord and its nerves

Spondylitis

Degenerative disorder that causes loss of normal spinal function

osteoarthritis/ Spondylosis

Fluid-filled cyst forms on the spinal cord.

Syringomyelia

Progressive neurodegenerative disease that affects the nerve cells in teh brain and spinal cord

Amyotrophic Lateral Sclerosis (ALS)

any paralysis of upper and lower extremities due to a cervical injury

Tetraplegia (quadriplegia)

partial of complete paralysis of the Legs and trunk due to thoracic, lumbar, or sacral injury

Paraplegia

complete motor and sensory loss below the level of injury, loss of cortical control of bowel and bladder

Complete Lesion

Partial disruption with some motor or sensory function intact.

Incomplete Lesion

perianal sensation or toe flexion may be intact

Sacral Sparing

Lowest spinal segment with normal function (most caudal)

Neurological Level

Skin areas innervated by sensory nerve roots.

Dermatomes

Muscle fibers innervated by motor nerve roots.

Myotomes

Classifies spinal injuries by preserved function.

ASIA Impairment Scale

most common incomplete SCI, more damage to central cord than periphery, falls, hyperextension injuries, older adults w/ arthritic changes

Central Cord Syndrome

one side of the cord is damaged, stabbing or a gun shot wound, motor and proprioception loss on ipsilateral side, loss of pain, temperature and touch on contralateral side

Brown Sequard Syndrome

Loss of pain and temperature sensation.

Anterior Cord Syndrome

Injury below L2 causing flaccid paralysis.

Cauda Equina Syndrome

Temporary loss of reflexes post-injury.

Spinal Shock

-Bladder dysfunction requiring catheterization

-high risk of UTI

-spastic bladders allow for reflex emptying

-(T12 and above has no control over when the bladder empties)

-(T12-L1 is unable to detect when the bladder is full)

Neurogenic Bladder

Reflex response to a noxious stimulus below level of injury.

Autonomic Dysreflexia

Abnormal bone growth in SCI patients.

Heterotopic Ossification

Skin ulcers due to loss of blood supply.

Pressure Sores

lead to pain, paralysis and neruological disfunctions

tumors

inflammation of the arachnoid mater

arachnoiditis

what is another name for spinal tuberculosis

potts disease

what are two associated injuries that can occur with spinal cord injuries

TBI and Brachial plexus injury

in complete injuries, this refers to partially innervated myotomes or dermatomes below the neurological level

zone of partial preservation (ZPP)

what kind of stabilization and immobilization device is a cervical traction or halo brace

closed methods

what kind of stabilization and immobilization device is a bone graft or the use of wiring

open methods

what are some medical complications that go along with spinal cord injuries

spinal shock, insensitive skin, bowel and bladder dysfunction, sexual dysfunction, pain, spasticity, respiratory, orthostatic hypotension, autonomic dysreflexia, osteoporosis, heterotopic ossification, pressure injuries

how long does spinal shock last

1-6 weeks

why do people with spinal cord injuries often have problems with respiration

due to their "butter bean" posture

what area of the cervical spine requires tracheostomies or respirators

c4-c6

when moving supine to sitting, BP drops, causing dizziness or black-out. PT must be tilted back and legs elevated

orthostatic hypotension

what are some causes of autonomic dysreflexia

distended bladder or UTI, bowel impaction, winkled clothing, pressure sores or pain

due to lack of weight-bearing, may be a cause of pathological fractures

osteoporosis

what percentage of patients who have spinal cord injuries have heterotopic ossification

16-53%

what are the common sites of heterotopic ossification

hips, knees, shoulders, and elbows