Spinal cord trauma: Difference between revisions
m (moved Spinal Cord Syndromes to Spinal Cord Trauma: Expanded beyond just syndromes) |
No edit summary |
||
| Line 14: | Line 14: | ||
****If do occur related to retained fragment of blade within spinal canal | ****If do occur related to retained fragment of blade within spinal canal | ||
==Peds== | ===Peds=== | ||
*In pts <10yr spinal injury occurs mainly in upper cervical vertebrae | *In pts <10yr spinal injury occurs mainly in upper cervical vertebrae | ||
*In pts >10yr majority of injuries occur in lower cervical spine, similar to adults | *In pts >10yr majority of injuries occur in lower cervical spine, similar to adults | ||
Revision as of 20:44, 16 July 2011
Background
- Surgical intervention indicated for:
- Progressive neurologic deficits
- Spinal instability
- Penetrating injury
- GSW
- Most are stable injuries and only require supportive orthosis, analgesia
- Give Abx if GSW traversed the abdomen before injuring the cord
- Bullet removal does not improve neuro status for stable cervical and thoracic lesions
- Bullet removal may improve neuro status for thoracolumbar region injury (T11-L2)
- Stabbing
- Vertebral instability is generally not an issue
- Delayed deficits are rare
- If do occur related to retained fragment of blade within spinal canal
- GSW
Peds
- In pts <10yr spinal injury occurs mainly in upper cervical vertebrae
- In pts >10yr majority of injuries occur in lower cervical spine, similar to adults
- Odontoid fractures are among most common cervical spine injuries in children
- Do not confuse w/ normal anatomic variations in odontoid seen in children up to 7yr old
- SCIWORA
- Spinal cord injury without radiologic abnormality
- MRI has shown significant pathology in many of these pts
- Symptoms
- Delayed onset (w/in 48hr) of numbness, paresthesias in extremities
- Transient quadriparesis ("stinger")
- Occurs most often in boys after sports injuries
- Paresthesias or weakness of extremities lasting from seconds to minutes
- Complete recovery w/in 48hr
Management
- Consider intubation for pt w/ injury at C5 or above
- Steroids are no longer recommended
- Complete lesion means absence of sensory and motor function below level of injury
- May be confused w/ spinal shock
Anatomy
- Doral columns
- Proprioception, vibration touch
- Decussation at medulla
- Corticospinal Tract
- Voluntary motor
- Upper extremity fibers more central, lower extremity fibers more lateral
- Decussation at medulla
- Voluntary motor
- Spinothalamic
- Pain, temp, touch
- Decussates one level above entry point to spinal cord
Spinal Cord Syndromes
Complete Transection
- Higher lesions are a/w spinal shock and autonomic dysfunction
- Priapism implies a complete injury
- Sacral sparing excludes complete transection
- Perianal sensation, rectal tone, bulbocavernosus/cremasteric reflexes
Anterior Cord
- Etiology
- Direct anterior cord compression
- Flexion of cervical spine
- Thrombosis of anterior spinal artery
- Symptoms
- Complete paralysis below the lesion with loss of pain and temperature sensation
- Preservation of proprioception and vibratory function
- Prognosis poor
Central Cord
- Etiology
- Hyperextension injuries
- Disruption of blood flow to the spinal cord
- Cervical spinal stenosis
- Symptoms
- Quadriparesis (greater in upper extremities than lower extremities)
- Some loss of pain and temperature sensation also greater in the upper extremities
- Prognosis good
Brown-Sequard
- Etiology
- Transverse hemisection of spinal cord
- Unilateral cord compression
- Symptoms
- Ipsilateral spastic paresis
- Loss of proprioception and vibratory sensation
- Contralateral loss of pain and temperature sensation
- Prognosis good
Cauda Equina
- Etiology
- Peripheral nerve injury
- Symptoms
- Variable motor and sensory loss in the lower extremities
- Sciatica
- Bowel/bladder dysfunction
- Saddle anesthesia
- Prognosis good
See Also
Source
- Tintinalli's