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| ==Background==
| | #REDIRECT[[Spinal cord injury]] |
| *Surgical intervention indicated for:
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| **Progressive neurologic deficits
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| **Spinal instability
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| *Penetrating injury
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| **GSW
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| ***Most are stable injuries and only require supportive orthosis, analgesia
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| ***Give Abx if GSW traversed the abdomen before injuring the cord
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| ***Bullet removal does not improve neuro status for stable cervical and thoracic lesions
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| ***Bullet removal may improve neuro status for thoracolumbar region injury (T11-L2)
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| **Stabbing
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| ***Vertebral instability is generally not an issue
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| ***Delayed deficits are rare
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| ****If do occur related to retained fragment of blade within spinal canal
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| ==Peds==
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| *In pts <10yr spinal injury occurs mainly in upper cervical vertebrae
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| *In pts >10yr majority of injuries occur in lower cervical spine, similar to adults
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| *Odontoid fractures are among most common cervical spine injuries in children
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| **Do not confuse w/ normal anatomic variations in odontoid seen in children up to 7yr old
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| *SCIWORA
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| **Spinal cord injury without radiologic abnormality
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| **MRI has shown significant pathology in many of these pts
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| **Symptoms
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| ***Delayed onset (w/in 48hr) of numbness, paresthesias in extremities
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| *Transient quadriparesis ("stinger")
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| **Occurs most often in boys after sports injuries
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| **Paresthesias or weakness of extremities lasting from seconds to minutes
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| ***Complete recovery w/in 48hr
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| ==Management==
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| *Consider intubation for pt w/ injury at C5 or above
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| *Steroids are no longer recommended
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| *Complete lesion means absence of sensory and motor function below level of injury
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| **May be confused w/ spinal shock
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| ==Anatomy==
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| *Doral columns
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| **Proprioception, vibration touch
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| **Decussation at medulla
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| *Corticospinal Tract
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| **Voluntary motor
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| ***Upper extremity fibers more central, lower extremity fibers more lateral
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| **Decussation at medulla
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| *Spinothalamic
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| **Pain, temp, touch
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| **Decussates one level above entry point to spinal cord
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| ==Spinal Cord Syndromes==
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| ===Complete Transection===
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| *Higher lesions are a/w spinal shock and autonomic dysfunction
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| *Priapism implies a complete injury
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| *Sacral sparing excludes complete transection
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| **Perianal sensation, rectal tone, bulbocavernosus/cremasteric reflexes
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| ===Anterior Cord===
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| *Etiology
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| **Direct anterior cord compression
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| **Flexion of cervical spine
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| **Thrombosis of anterior spinal artery
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| *Symptoms
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| **Complete paralysis below the lesion with loss of pain and temperature sensation
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| **Preservation of proprioception and vibratory function
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| *Prognosis poor
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| ===Central Cord===
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| *Etiology
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| **Hyperextension injuries
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| **Disruption of blood flow to the spinal cord
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| **Cervical spinal stenosis
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| *Symptoms
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| **Quadriparesis (greater in upper extremities than lower extremities)
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| **Some loss of pain and temperature sensation also greater in the upper extremities
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| *Prognosis good
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| ===Brown-Sequard===
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| *Etiology
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| **Transverse hemisection of spinal cord
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| **Unilateral cord compression
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| *Symptoms
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| **Ipsilateral spastic paresis
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| **Loss of proprioception and vibratory sensation
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| **Contralateral loss of pain and temperature sensation
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| *Prognosis good
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| ===Cauda Equina ===
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| *Etiology
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| **Peripheral nerve injury
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| *Symptoms
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| **Variable motor and sensory loss in the lower extremities
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| **Sciatica
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| **Bowel/bladder dysfunction
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| **Saddle anesthesia
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| *Prognosis good
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| ==See Also==
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| *[[Neurogenic Shock]]
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| *[[Cord Compression]]
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| *[[C-spine (NEXUS)]]
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| ==Source==
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| *Tintinalli's
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| [[Category:Neuro]]
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| [[Category:Trauma]]
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