spinal cord injury 1

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  1. high level vs low level cord injury
    they refer to the location of the injury, so "high level" = "low function" and someone with a low level injury will be high functioning
  2. succussion - who, what?
    Hippocrates, hung spinal pts upside down on a ladder
  3. age norms of SCI pts
    16-30, though it's getting older
  4. how many new SCIs/year in US? how many SCIs alive in US now?
    • 12,000
    • 236,000-327,000
  5. etiology of SCIs
    • 39.2% MVA
    • 28.3% falls or falling objects
    • 14.6% acts of violence
    • 8.2% sporting injuries (mostly diving, football, gymnastics)
    • 9.7% other
  6. %s for in/complete para/tetraplegia
    • incomplete tetraplegia 40.8%
    • complete paraplegia 21.6%
    • incomplete paraplegia 21.4%
    • complete tetraplegia 15.8%
  7. where is the cord most vulnerable
    • C5-7 - apex of cervical lordosis
    • T4-7 - apex of thoracic kyphosis
    • T10-12
  8. how many vertebrae in each of the 5 areas
    • 7 cervical
    • 12 thoracic
    • 5 lumbar
    • 5 sacral
    • 4 coccyx
  9. ligamentum flavum - where? nickname?
    • yellow ligament
    • connect adjacent lamina
    • very flexible
  10. ant/post longitudinal ligaments
    • ant/post to vertebral body
    • so, the PLL is inside the spinal canal
  11. ligamentum nuchae where?
    external occipital protuberance to C7 along the SPs
  12. supraspinous lig - where?
    • goes along SPs
    • a continuation of the nuchal lig
    • C7 to sacrum
  13. interspinous lig - where
    connects adjacent SPs, running from the bottom of one to the top of the next in an infero-postero manner
  14. intertransverse lig - where
    btwn TPs
  15. how many paired roots?
  16. av length & wt of spinal cord
    • men - 45 cm
    • women - 42 cm
    • 30 grams (a bit more than one big egg)
  17. meninges, and their layers
    tough connective tissue, protective layer around the cord

    • pia -inner
    • arachnoid - middle
    • dura - most superficial
  18. where do nerve roots exit relative to the vertebra of the same name/number?
    • cervical nerve roots: exit above the vert of the same name (C7 exits btwn C6 and C7)
    • all others: exit below their namesakes (T3 exits between T3 and T4)
  19. anatomical rel btwn spinal cord and vertebral column
    • in the cervical spine the roots exit horizontally, but as you descend the start to descend before they exit. So, a fracture lower down actually damages the cord at a further lower level. Ex - fracture at T9, cord damage at T12
    • the rough rule is: C5-T10, add 2 segments, below add 3
    • it's very approximate, but it gives you a rough starting point for your eval
    • When we give a level of injury, it's the neuro, not bony, level
  20. anterior spinal artery
    responsible for what?
    • runs down ant groove in spinal cord
    • supply the cervical spine
    • gives rise to sulcal arteries which supply the central cord
  21. lateral spinal artery
    • a branch off from vertebral artery
    • responsible for C2-T2
  22. semental radicular arteries
    • come off ant spinal artery below T4, also fed by intercostal arteries from aorta
    • vessel of adam kiewicz, the longest radicular component, feeds T9-L4 and some sacral area
  23. vessel of adam kiewicz
    • a segmental radicular artery, the largest radicular component
    • feeds T9-L4 and some sacral area
  24. posterior spinal arteries - where, supply what
    • come down post. aspect of spinal cord as a pair along where posterior roots come off
    • supply the posterior horns of whole cord
  25. pial arteries supply what
    peripheral lateral cord
  26. centrifugal system - supplies what, arises from what
    • vascular system supplying central spinal cord, the gray matter and the innermost white matter (centripetal system supplies peripheral spinal cord)
    • arises from ant spinal artery
  27. centripetal system - arises from what, supplies what
    • arises from ant & post spinal arteries
    • supplies peripheral cord - the outher whatie matter
  28. central cord syndrome - is what?
    • centrifugal system is down
    • UEs are affected
  29. 3 types of developmental causes for spinal cord troubles
    • incomplete closure of spinal cord (spinabifida)
    • structural deformities (scoliosis, kyphosis, spondylolysthesis (vert slippage)...)
    • familial paralysis
  30. Klippel-Feyl syndrome
    • congenital deformation
    • vertebra isn't fully formed and is angulated --> scoliosis
  31. sacralization or lumbarization
    • TP of lumbar vert is fused to sacrum
    • the TP is enlarged, like a big wedge
    • L5 can be completely fused to sacrum
  32. spondylolisthesis
    • slipping of one vertebrae on another
    • grade 4 = dislocation
    • grade 1 = asymptomatic
  33. spinal cord agenisis
    • congenital
    • it didn't fully develop
  34. Arnold-Chiari syndrome
    • brain (medulla) intrudes inferiorlly into cervical spine
    • presents like CP (until MRI)
    • treated w decompression laminectomy
  35. 7 non traumatic ways to acquire non-congenital spinal paralysis
    • infection
    • degenerative
    • neoplastic
    • vascular
    • idiopathic
    • iatrogenic (caused by medical exam or tx)
    • psychological
  36. a bunch of infections that can cause spinal paralysis
    • bacterial abscess
    • Pott's disease (TB of the spine --> bone collapse)
    • transverse myelitis (neurological disorder caused by inflam process of spinal cord)
    • syphylis (usually affects post. column)
    • polio
    • herpes
  37. ankylosing spondylitis
    • inflam of the spinal joints, can lead to fusion
    • try to get the pt to fuse in an upright pos
    • this tarts w sacrolilitis and red iris
  38. various neoplasms that can cause spinal paralysis
    • meningioma (compresses cord)
    • neuroma (in meninges)
    • extradural
    • fibroblastoma
    • vascular tumor - hemanioma
    • osteosarcoma (agressive malignant bone tumor)
    • metastatic tumor - usually from breast or lung
    • glioma or glioblastoma - nasty aggressive tumor

    may remove a portion of a vertebra to get to the tumor
  39. 2 vascular problems that can lead to spinal paralysis
    • hemangioma (these can happen in many places, including on the skin)
    • AV malformation in brain or spinal cord
  40. syringomyeli
    • idiopathic
    • holes in spinal cord
    • can range from asymptomatic to nightmare
  41. radiation's impact on spinal cord
    • causes fibrotic changes
    • makes tissues firm and shrunken
  42. conversion hysteria
    • a mental disorder characterized by the conversion of mental conflict into
    • somatic forms (into paralysis or anesthesia having no apparent cause)

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spinal cord injury 1
2013-02-03 15:50:37
spinal cord injury

rosen & karpatkin spring 2013
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