Spinal cord trauma: Difference between revisions

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*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
*Odontoid fractures are among most common cervical spine injuries in children
*Odontoid fractures are among most common cervical spine injuries in children
.49 These fractures must not be confused with the normal anatomic variations in the odontoid due to synchondrosis between the body of the axis and the odontoid, which may be seen in children up to 7 years of age
**Do not confuse w/ normal anatomic variations in odontoid seen in children up to 7yr old
 
*SCIWORA
 
**Spinal cord injury without radiologic abnormality
cord injury without radiologic abnormality, or SCIWORA, refers to the lack of evidence of vertebral fracture or malalignment on plain radiographs and CT in a patient with spinal cord injury. It is more common in younger children and occurs most frequently with cervical spine injuries. SCIWORA has been reported in up to 55% of thoracolumbar injuries in the pediatric population.51 Despite the lack of findings on radiography or CT, MRI has shown significant pathology in many of these patients
**MRI has shown significant pathology in many of these pts
 
**Symptoms
Delayed onset of neurologic damage is usually apparent within 48 hours. Numbness, paresthesias, or "shock-like" sensations in the extremities are suggestive of SCIWORA, and should be expeditiously evaluated for evidence of spinal cord injury
***Delayed onset (w/in 48hr) of numbness, paresthesias in extremities
 
*Transient quadriparesis ("stinger")
Transient quadriparesis (referred to as "Stinger") is seen relatively frequently in children, most often in young boys after sports injuries. Clinically, there are paresthesias or weakness of the extremities, lasting from seconds to minutes, with complete recovery within 48 hours. No radiologic abnormalities are found
**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
*Consider intubation for pt w/ injury at C5 or above
*Steroids are no longer recommended
*Steroids are no longer recommended
*Complete lesion means absence of sensory and motor function below level of injury
*Complete lesion means absence of sensory and motor function below level of injury
**May be confused w/ spinal shock
**May be confused w/ spinal shock
*Anatomy
 
**Doral columns
==Anatomy==
***Proprioception, vibration touch
*Doral columns
***Decussation at medulla
**Proprioception, vibration touch
**Corticospinal Tract
**Decussation at medulla
***Voluntary motor
*Corticospinal Tract
****Upper extremity fibers more central, lower extremity fibers more lateral
**Voluntary motor
***Decussation at medulla
***Upper extremity fibers more central, lower extremity fibers more lateral
**Spinothalamic
**Decussation at medulla
***Pain, temp, touch
*Spinothalamic
***Decussates one level above entry point to spinal cord
**Pain, temp, touch
**Decussates one level above entry point to spinal cord


==Spinal Cord Syndromes==
==Spinal Cord Syndromes==

Revision as of 20:18, 13 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

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
  • 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
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