Spinal cord trauma: Difference between revisions

Revision as of 20:46, 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

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

Diagnosis

See

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

Source

Tintinalli's

Authors:

@@ Line 28: / Line 28: @@
 **Paresthesias or weakness of extremities lasting from seconds to minutes
 ***Complete recovery w/in 48hr
+==Diagnosis==
+See
+*[[Spinal Cord Syndromes]]
+*[[C-spine (NEXUS)]]
 ==Management==
@@ Line 34: / Line 39: @@
 *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
-*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==