Spinal Cord Injury

Vitya Chandika

2013-061-060

Priscila Stevanni 2013-061-066

Pricilia Nicholas

2013-061-070

Definition
Spinal cord injury (SCI) An insult to the
spinal cord resulting in a change, either
temporary or permanent, in the cords
normal motor, sensory, or autonomic
function.

Anatomy

Ligamentous Anatomy

a = Ligamentum flavum
b = Interspinous
ligaments
c = Supraspinous
ligament

ANATOMY
Spinal cord is divided into 31 segments
Each with a pair of anterior (motor) and dorsal (sensory)
spinal nerve roots
The spinal cord extends from the base of the skull to the
lower margin of L1 vertebral body
Injuries below L1 are not considered spinal cord injuries

NEUROPATHWAYS

1 anterior and 2 posterior spinal arteries.

Anterior supplies 2/3 of the cord
Posterior primarily supply the dorsal columns

SPINAL CORD INJURIES

3 common mechanism :
Destruction from direct trauma
Compression by bone fragments,
hematoma, or disk material
Ischaemia from damage on the spinal
arteries

INCOMPLETE SPINAL CORD

INJURIES

Any residual motor or sensory function more than 3 segments

below the level of the injury

Signs of incomplete lesion:

sensation (including position sense) or voluntary movement in
the Lower Extremities
sacral sparing: preserved sensation around the anus,
voluntary rectal sphincter contraction, or voluntary toe flexion
an injury does not qualify as incomplete with preserved sacral
reflexes alone

Complete spinal cord

injuries
No preservation of any motor and/or sensory
function more than 3 segments below the
level of the injury.
Recovery is essentially zero if the spinal cord
injury remains complete beyond 72 hours.

Spinal Cord Injury

1. Complete Spinal Cord Injuries

Bulbar-cervical dissociation

2. Incomplete Spinal Cord Injuries

Central cord syndrome

Anterior cord syndrome

Brown-sequard syndrome

Posterior cord syndrome

Central Cord Syndrome

Anterior Cord Syndrome

Brown Sequard
Syndrome

BULBAR-CERVICAL
DISSOCIATION
Occurs as a result of spinal cord
injury at or above C3
Bulbar-cervical dissociation
produces immediate pulmonary
and, often, cardiac arrest

Central cord syndrome

Central cord syndrome (CCS) is the most common type of incomplete

spinal cord injury syndrome. Usually seen following acute
hyperextension injury in an older patient with pre-existing anterior spurs

Presentation
Motor: weakness of upper extremities with lesser effect on lower
extremities
Sensory: varying degrees of disturbance below level of lesion may
occur
Myelopathic findings: sphincter dysfunction (usually urinary
retention)

Anterior cord syndrome

Also known as anterior spinal artery syndrome

Cord infarction in the territory supplied by the anterior spinal artery

May result from occlusion of the anterior spinal artery, anterior cord
compression, e.g. by dislocated bone fragment, or by traumatic
herniated disc

Presentation
paraplegia, or (if higher than C7) quadriplegia
dissociated sensory loss below lesion:
loss of pain and temperature sensation (spinothalamic tract lesion)
preserved two-point discrimination, joint position sense, deep
pressure sensation (posterior column function)

Brown-sequard syndrome
Classical findings (rarely found in this pure form):
ipsilateral findings:
motor paralysis (due to corticospinal tract lesion) below lesion
loss of posterior column function (proprioception & vibratory
sense)
contralateral findings: dissociated sensory loss
loss of pain and temperature sensation inferior to lesion
beginning 1-2 segments below (spinothalamic tract lesion)
preserved light (crude) touch due to redundant ipsilateral and
contralateral paths (anterior spinothalamic tracts)

Posterior cord syndrome

Also known as contusio cervicalis posterior

condition caused by lesion of the posterior portion of the spinal

cord. It can be caused by an interruption to the posterior spinal
artery

Relatively rare

Produces pain and paresthesias (often with a burning quality) in

the neck, upper arms, and torso. There may be mild paresis of the
Upper Extremities.

Complications
Neurogenic Shock = autonomic dysfunction,
interruption of sympathetic nervous system. Common
above T6.
vasomotor disruption: vasodilatation Flush,warm
Heart problem :bradicardia hypotension
Spinal Shock = complete loss of all neurologic function
Flaccid + areflexia

Who?
Any of the following patients should be treated as having a SCI until
proven otherwise:

1. All victims of significant trauma

2. Trauma patients with loss of consciousness
3. Minor trauma victims with complaints referable to the spine (neck or
back pain or tenderness)or spinal cord (numbness or tingling in an
extremity, weakness)
4. Associated findings suggestive of SCI include
A.Abdominal breathing
B.Priapism (autonomic dysfunction)

Initial assessment

The major cause of death in SCI are aspiration and shock

A B C and brief neurologic exam

Clinical criteria to rule-out cervical spine instability

Awake, alert, oriented (no mental status changes,
including no alcohol or drug intoxication)
No neck pain (with no distracting pain)
No neurologic deficits

Initial management

Imobillization: prevent active and passive movement of the spine

Log roll
Back-board
Cervical collar

Maintain blood pressure

Pressors : dopamine, etc
Fluids
Military anti-shock trousers (MAST) : immobilizes lower spine, compensates for
loss of muscle tone in cord injuries (prevent venous pooling)

Maintain oxygenation

Brief motor exam to identify deficits move arms, hands, legs, toes

Management
Hypotension maintain SBP 90 mm Hg
Oxygenation
NG tube to suction prevents vomiting and aspiration
Temperature regulation
Electrolytes
Neuro evaluation American Spinal Injury Association
Spinal-Dose Steroids
Injury < 8 hours: metilprednisolone 30 mg/kgBB IV bolus in 15 min. 45 minute
pause, then continue with 5,4 mg/kgBB/jam for 23 h
Injury >8 hours : steroid IV for 48 h
Surgery: decompression and stabilize

Post Injury Assessment

Goals are to
Sustain life
Prevent further cord damage

Thank you