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Functional
Anatomy of
the Spinal Cord
Upper Cervical Spinal Anatomy is designed to facilitate motion.
Injury is uncommon and the canal is spacious.
Secondary Injury
Hemorrhage, oedema, and Ischemia secondary to the insult.
Therapeutic strategies are directed at reducing secondary injury.
Extremes of Motion
Hyperextension:
Common in the neck
Anterior ligaments and disc may be damaged.
Hyperflexion:
If posterior ligament is intact , wedging of vertebral body
Mechanisms of occurs.If torn , may cause subluxation.
Spinal Injury Axial compression:
Causes burst fractures. Bony fragments may be pushed
into spinal canal.
Flexion with rotation:
Causes dislocation with or without fracture.
Flexion with posterior distraction:
May disrupt middle and posterior column
Shear
Spinal Cord
Injuries
Neurologic function
Above the injury: intact.
Identification of Shock
Three types of Shock may occur in spinal trauma:
Physical Hypovolaemic Shock: Presents with hypotension, tachycardia, cold
Examination clammy peripheries. Caused by hemorrhage; treated with appropriate
fluid replacement.
Neurogenic Shock: Hypotension w/ normal heart rate or bradycardia
and warm peripheries. Caused by unopposed vagal tone resulting from
cervical spinal cord injury above the level of the sympathetic outflow
(C7/T1).
Spinal Shock: Characterized by paralysis, hypotonia, and areflexia.
Lasts for only 24 hours. Assess patient neurologically. When it starts to
resolve bulbocavernosus reflex returns.
Bulbocavernosus
reflex
The bulbocavernosus reflex (BCR)
or "Osinski reflex" is a polysynaptic
reflex that is useful in testing for
spinal shock and gaining
information about the state of
spinal cord injuries (SCI)
Spinal Examination
Spine Log Roll must be performed to achieve proper examination.
Inspect and palpate entire spine.
Swelling, tenderness, palpable steps or gaps suggest a spinal injury.
Note the presence of any wounds that might suggest penetrating
trauma.
Spinal
Examination
American Spinal Injury Association neurological evaluation system
is used.
Motor Function assesses key muscle groups. Grade (0-5)
Sensory Function assesses dermatomal map. (Pinprick and light
touch) Score: 0-2
Rectal examination:
Neurological Anal tone.
Voluntary anal contraction.
Evaluation Perianal sensation.
E Normal Function.
Transection leads to immediate, complete, flaccid paralysis (including
loss of anal sphincter tone), loss of all sensation and reflex activity,
and autonomic dysfunction below the level of the injury.
High cervical injury (at or above C5) , causing
Respiratory insufficiency especially in patients with injuries at or above
C3.
Anterior Cord
Syndrome
Hyperextension of the cord results in pinching of the cord in pre-
existing degenerative narrowing od the spinal cord.
Upper limbs and hands profoundly affected.
Distal motor function in the legs usually spared.
Fair Prognosis
Central Cord
Syndrome
Penetrating injury that affects one side of the cord
Ipsilateral motor loss vibration and position sense.
Contralateral pain and temperature sensation loss
Best prognosis
Brown-
Sequard’s
Syndrome
Least frequent syndrome
Injury to the posterior (dorsal) columns
Loss of proprioception
Pain, temperature, sensation and motor function below the level
of the lesion remain intact
Posterior Cord
Syndrome
Cauda Equina
Syndrome
85% of significant spinal injuries will be seem on standard lateral
cervical spine.
CT Scan should be obtained.
Most Sensitive in spinal trauma.
Complex patterns and fractures can be understood.
Diagnostic MRI
Best at visualizing soft-tissue elements of the spine.
Imaging Possible to view spinal cord hemorrhage, epidural and prevertebral
hematomas.
Not good at assessing bony structures.