Exam 15: Spinal cord Injuries
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| Major causes of spinal cord injury: | Automobile
Motorcycle
Diving
Surfing
Other athletic accidents
Gunshot wounds
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| Flexion injury | seen with rapid deceleration injuries, whiplash.
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| Extension injury | seen with rapid deceleration injuries, whiplash
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| Flexion rotation injury | twisting of the spinal cord.
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| Compression injury | Stacked down
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| Pathophysiological changes: | Damage to the spinal cord ranges from transient concussion, contusion, laceration, compression to complete transection of the cord
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| Complete cord injury or total transaction (Symptoms) | All voluntary movement below the level of injury is lost.
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| Incomplete or partial transaction (Symptoms) | Symptoms will vary.
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| 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:
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| Cervical spinal cord injuries will produce | tetraplegia--loss of function of all four
extremities.
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| Injuries to the thoracic spinal cord below the level of T1 will produce | paraplegia; paralysis of the lower extremities.
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| Loss of sweating and vasomotor tone below the level of the | cord lesion
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| areflexia (Spinal shock) | sudden depression of reflex activity below the level of injury.
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| 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.
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| 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.
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| Factors that will precipitate autonomic dysreflexia | Impacted feces.
Full bladder.
Labor and delivery.
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| Areflexia resolves | itself
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| Dysreflexia resolves | Spontaneously
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| Dysreflexia Clinical Signs | Severe Bradycardia.
Hypertension (systolic pressure up to 300mm Hg).
Severe pounding headache.
Flushed skin with gooseflesh (Piloerection).
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| Uncontrolled autonomic dysreflexia is a | medical emergency that requires immediate treatment to prevent a stroke, seizures, or death.
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| 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.
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| Cervical spine (Injury associated manifestations) | tetraplegia with residual function depending on involvement of specific
cervical segments.
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| C1-C3 | movement in neck and above:
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| Injury to C1-C3 results in | 1) Loss of innervations to diaphragm.
2) Absence of independent respiratory function.
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| Above C4 | complete quadriplegia, complete dependence.
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| Injury above C4 results in | 1) Sensation and movement in neck and above.
2) May be able to breathe without a ventilator.
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| C4-C5 | some shoulder movement possible, requires respiratory support.
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| 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.
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| C6 / C7 / C8 | incomplete quadriplegia- some elbow, arm and wrist movement. No sensation below midchest.
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| C6 | shoulder and upper back abduction and rotation at shoulder.
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| C7 - C8 | all triceps to elbow extension, finger extensors and flexors.
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| C6 injury results in | a) Full biceps to elbow flexion, wrist extension, weak grasp of thumb.
b) Decreased respiratory reserve.
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| C7 - C8 | all triceps to elbow extension, finger extensors and flexors.
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| C7 - C8 injury results in | a) Good grasp with some decreased strength.
b) Decreased respiratory reserve.
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| Cervical Spine | C1-C8
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| Thoracic Spine | T1-T12
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| T1-T6 | paralysis below the waist with control of hands
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| 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.
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| T7 - T12 | full, stable thoracic muscles and upper back.
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| T7 - T12 injury results in | 1) Functional intercostals resulting in increased respiratory reserve.
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| Lumbar spine | L1-L5
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| L 1-2 | Hip abduction impaired. No sensation below lower abdomen.
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| L 3-5 | Knee and ankle movement impaired. No sensation below upper thigh.
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| S 1-5 | bowel/bladder dysfunction, variable motor and sensory loss in lower extremities and perineum.
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| Foremost priority in spinal injury | Airway, breathing, Circulation.
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| Crutchfield tongs | burr in the skull holes are required for insertion.
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| Gardner-Wells tongs | burr holes not needed
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| Halo traction | burr holes are required for insertion.
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| A turning frame (Stryker or Foster) | is used to change the patient's position without changing alignment.
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