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M6 13-005

Exam 15: Spinal cord Injuries

Major causes of spinal cord injury: Automobile Motorcycle Diving Surfing Other athletic accidents Gunshot wounds
Flexion injury seen with rapid deceleration injuries, whiplash.
Extension injury seen with rapid deceleration injuries, whiplash
Flexion rotation injury twisting of the spinal cord.
Compression injury Stacked down
Pathophysiological changes: Damage to the spinal cord ranges from transient concussion, contusion, laceration, compression to complete transection of the cord
Complete cord injury or total transaction (Symptoms) All voluntary movement below the level of injury is lost.
Incomplete or partial transaction (Symptoms) Symptoms will vary.
If the spinal cord is completely transected there is total sensory loss and motor paralysis below level of the injury. If damage is minimal some function may be maintained:
Cervical spinal cord injuries will produce tetraplegia--loss of function of all four extremities.
Injuries to the thoracic spinal cord below the level of T1 will produce paraplegia; paralysis of the lower extremities.
Loss of sweating and vasomotor tone below the level of the cord lesion
areflexia (Spinal shock) sudden depression of reflex activity below the level of injury.
areflexia (Spinal shock) happens A complete loss of motor, sensory, reflex and autonomic activity below the level of the lesion. Usually occurs within 30-60 minutes of injury.
Autonomic dysreflexia: (Hyperreflexia) an exaggerated sympathetic nervous system response. Occurs in patients with cord injuries at T6 and above. It can occur suddenly at any time after spinal shock subsides.
Factors that will precipitate autonomic dysreflexia Impacted feces. Full bladder. Labor and delivery.
Areflexia resolves itself
Dysreflexia resolves Spontaneously
Dysreflexia Clinical Signs Severe Bradycardia. Hypertension (systolic pressure up to 300mm Hg). Severe pounding headache. Flushed skin with gooseflesh (Piloerection).
Uncontrolled autonomic dysreflexia is a medical emergency that requires immediate treatment to prevent a stroke, seizures, or death.
Methods used to evaluate spinal cord injuries: Dx Tests History of trauma. Neurological exam. X-ray of the spinal column--possible MRI, CT scan. Spinal tap or myelogram may be done to detect occlusion.
Cervical spine (Injury associated manifestations) tetraplegia with residual function depending on involvement of specific cervical segments.
C1-C3 movement in neck and above:
Injury to C1-C3 results in 1) Loss of innervations to diaphragm. 2) Absence of independent respiratory function.
Above C4 complete quadriplegia, complete dependence.
Injury above C4 results in 1) Sensation and movement in neck and above. 2) May be able to breathe without a ventilator.
C4-C5 some shoulder movement possible, requires respiratory support.
Injury to C4-C5 results in 1) C5: full neck, partial shoulder, back, biceps; gross elbow. 2) Inability to roll over or use hands; decreased respiratory reserve.
C6 / C7 / C8 incomplete quadriplegia- some elbow, arm and wrist movement. No sensation below midchest.
C6 shoulder and upper back abduction and rotation at shoulder.
C7 - C8 all triceps to elbow extension, finger extensors and flexors.
C6 injury results in a) Full biceps to elbow flexion, wrist extension, weak grasp of thumb. b) Decreased respiratory reserve.
C7 - C8 all triceps to elbow extension, finger extensors and flexors.
C7 - C8 injury results in a) Good grasp with some decreased strength. b) Decreased respiratory reserve.
Cervical Spine C1-C8
Thoracic Spine T1-T12
T1-T6 paralysis below the waist with control of hands
T1-T6 injury results in 1) Abdominal breathing: decreased respiratory reserve. 2) Full innervations of upper extremities, back. 3) Essential intrinsic muscles of hand; full strength and dexterity of grasp. 4) Decreased trunk stability.
T7 - T12 full, stable thoracic muscles and upper back.
T7 - T12 injury results in 1) Functional intercostals resulting in increased respiratory reserve.
Lumbar spine L1-L5
L 1-2 Hip abduction impaired. No sensation below lower abdomen.
L 3-5 Knee and ankle movement impaired. No sensation below upper thigh.
S 1-5 bowel/bladder dysfunction, variable motor and sensory loss in lower extremities and perineum.
Foremost priority in spinal injury Airway, breathing, Circulation.
Crutchfield tongs burr in the skull holes are required for insertion.
Gardner-Wells tongs burr holes not needed
Halo traction burr holes are required for insertion.
A turning frame (Stryker or Foster) is used to change the patient's position without changing alignment.
Created by: jtzuetrong