Spinal Cord Trauma: Review Questions and Answers, Exams of Biology

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TCRN Chapter 6: Spinal Cord

Trauma REVIEWED test questions

and answers

Common sites of spinal injury: < 65 y/o, 65 and older, Areas of greatest mobility C4-C7: most mobile 65 y/o and under, highest rate of injury:

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3. C We are less mobile with age 65 and older: C1 and C2 - most commonly injured Next generally most mobile area is T12-L Lumbar fractures are more uncommon - usually associated with improperly worn seatbelts. Anterior cord contains Descending motor neurons from brain to body Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute

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Full screen Brainpower Read More Posterior cord contains Ascending sensory nerves: Light touch Proprioception Vibration Lateral cord contains Ascending sensory nerves: Pain Temperature Crude touch Cross over points of spinal cord Anterior & Posterior cord: base of brain Lateral cord: crosses at entry point to spinal cord Complete cord injury Cord completely injured, severed, and destroyed SCI - motor deficits: muscles innervated, patient response Injury named by functional level, not level of injury C-4: diaphragm: ventilation C-5: deltoid, biceps, branchioradialis: shrug shoulders, flex elbows C-6: wrist extensor: extend wrist C-7: Triceps: extend elbow C-8: Flexor digitorum profundus: flex fingers T-1: Hand intrinsic muscles: spread fingers T-2 - L1: intercostals: vital capacity

L-2: iliopsoas: hip flexion L-3: quadriceps: knee extension L-4: Tibialis anterior: Ankle dorsiflexion L-5: Extension hallucis longus: ankle eversion C1-4: breathe no more C5: upper arm but little lower arm movement C6: lift arms but can't lower C7: put arms down C8: make a fist T4: lose sensation nipples down T10: lose sensation waist down S3: sensation around rectum Naming a spinal cord injury Patient still has movement and sensation at level named 50% of SCI are partial Anterior cord MOI Head thrown forward, injure front of spinal cord from vertebrae pinching spinal cord. Lose motor fxn, have sensation. Posterior cord MOI Head thrown backwards - injure back of spinal cord Lose sensation, have movement. Anterior vs posterior SCI occurrence Anterior > Posterior

Central cord syndrome Injure middle of cord - usually from subluxation - squishes cord without tearing - center injured more Center of cord innervates upper body Outside of cord innervates lower body Will lose movement and sensation to upper body Incomplete loss in lower body. "Walk into a bar but can't have a drink" Not uncommon - esp elderly falling up stairs and catching chin up stairs or on dryer Brown-Sequard Syndrome Injury to half of spinal cord (usually penetrating injury) Move one side of body but can't feel it; feel one side of the body but can't move it. Cauda Equina Syndrome Fall onto coccyx - injure nerves that fan out -Injury at the L1 level and below resulting in a LMN lesion -Flaccid paralysis w/no spinal reflex activity Varying degrees of motor and sensory loss to lower body. Problems with bowel and bladder control (especially retention) Sexual dysfxn. Sometimes ambulatory, sometimes wheelchair bound Sensory assessment: Posterior cord Cotton wisp, tuning fork, test proprioception (touch, vibration, finger placement) Sensory assessment: lateral cord Broken wooden end of stick (sharp) Always start from areas of decreased sensation and move towards increased sensation

Patients more sensitive to appearance of sensation than its disappearance. SCI assessment: loss of sympathetic tone Neurogenic shock: vasodilation and hypotension Anhydrosis (lack of sweating below lesion) Priapism Horner's syndrome: ipsilateral ptosis, pupillary constriction (miosis), anhydrosis (inability to sweat). Indicates high cervical injury with loss of sympathetic tone to face. Radicular pain "waves" of stabbing or sharp pain or a band of burning pain at the point where normal feeling stops Nerve itself irritated at level of injury. Islands of sparing Islands of sparing within dermatome and sacral sparing (perianal sensation, normal rectal tone and flexor toe movement) indicates a partial cord syndrome. Nerve that gives rectal tone and ability to move great toe runs down center of spinal cord and is most likely to be protected. Tx of SCI ABC Above C4: diaphragm paralysis - do not use succinylcholine without a defasciculation agent Below C4: Diaphragm supports breathing T1-T8: intercostal innervation (35% of resp effort) Above T7: diminished ability to cough and deep breathe, may not be able to clear airway. Limit suctioning to 10 seconds to decrease vagal stimulation.

Above T12: Loss of abdominal muscles, decreasing forceful expiration and coughing. SCI: edema Edema after an injury causes swelling to rise up spinal column in as little as 30-60minutes; a breathing patient may not continue to breathe. SCI Tx: circulation Monitor and treat neurogenic shock as it occurs. Remember hypovolemic shock may be masked and exacerbated by neurogenic shock. Patient may have limited or absent peripheral tone, avoid sudden movements/changes in position. Vasodilation causes poikilothermia - take efforts to reduce heat loss and rewarm patient (warm patients, warmed IVF, etc.) Bladder catheterization Any injury above S2 - prevent autonomic dysreflexia NG or OG tube Any high c-spine injuries Spinal shock Temporary local neurological condition that occurs immediately after the spinal injury Nerve impulse conduction interrupted (physiologic transection) Usually subsides in hours to weeks as long as there is no other injury. Presents like complete spinal cord injury but without radiographic abnormalities Severe pain just above injury Flaccid paralysis Absent reflexes Lack of sensory function Impaired thermoregulation

Bowel distention/ileus Spinal shock: outcome Bulbocavernosus reflex returns first Squeeze glans penis or clitoris or tug on urinary catheter Simultaneously assess for anal sphincter contraction One of the first reflexes to return as spinal shock resolves Return of function and sensation to uninjured part of spinal cord.