spinal cord injury 2

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spinal cord injury 2
2013-02-03 11:24:51
spinal cord

rosen and karpatkin spring 2013
Show Answers:

  1. retrohyperflexion / hyperextension
    an acceleration injury - your car is stopped at a light, someone rear-ends you fast, your head jerks back

    • there's a big force on the post aspect of vertebrae
    • SPs are pushed closer together --> fracture of SPs, tearing of ant long lig, avulsion fracturs where ALL attaches to vertebral bodies

    • to help healing, put head into slight flexion to reduce post. pressure and let ant structures reconnect
    • stability btwn vert is impaired --> fracture and dislocation

    and an osteophyte or broken bone can pierce the cord
  2. ventro-hyperflextion / anterior flexion injury
    • deceleration injury - your car smashes into a tree
    • head whips forward
    • ant. compression and fractures
    • supra and infraspinous ligs tear
    • stability btwn vert is impaired --> fracture and dislocation
    • and an osteophyte or broken bone can pierce the cord
    • if grade 4 dislocation, permanent damage to spinal cord
  3. "flexion with rotation" trauma to spinal cord
    retro/ventrohyperflexion while head is turned
  4. "vertical stress" spinal trauma
    • landing on head, like in a diving injury
    • or landing realy hard on feet
    • a vertebral body can burst
  5. "direct injury" spinal trauma
    knives and guns
  6. "teardrop fracture"
    a small piece gets avulsed off the vertebral body
  7. some flavors of direct injury to spinal cord
    • GSW (gunshot wound)
    • blast injury (grenades, construction sites)
    • stabs wounds
    • violent muscle contracture (tetany, seizures can cause fracture)
    • pathological fracture (metastatic disease, osteoporosis)
    • disc lesions
    • compression of spinal cord
  8. missile (bullet) logded intramedullary
    • bullet is sittin in the cord
    • probably a complete lesion
    • usually bullet is left in there
  9. missile is lodged extramedullary by intradurally
    • it's between the dura and the cord
    • probably in the arachnoid
    • now it's compressing the cord
    • probaby wnat to ttake it out
    • it's less dangerous to remove than an intramedullary bullet
    • removal may cause decompression of spinal cord, function may improve
  10. missile lodged extradurally
    • btwn bone and cord
    • easier to remove
  11. how are gunshot wounds described (2 criteria)
    • where the bullet is found
    • typed of bullet (spinning, exploding, BB...)
    • ex: missile penetrating the cord -- it pierces the cord, can sever it, can just damage one part, one nerve root, depends on where it is
  12. ricochet gunshot injury
    • bullet hits then leaves
    • may cause a fracture, then damage another part of the body
  13. indirect cord damage (gunshot wound)
    as bullet passes thru body it pulls on and avulses a nerve root
  14. two types of disc lesions
    • annular tears
    • cord pressure
  15. compression of spinal cord can have various causes that lead to rapid or slow onset of symptoms. give examples.
    • rapid onset: bleed, hemorrhage (like from being near an explosion that causes pressure), blown out a disc, agressive absess or infection
    • slow onset: tumor, TB, osteophyte development
  16. 4 pathologic changes resulting from spinal cord damage
    • ischemia
    • inflammation
    • ion derangement 
    • apoptosis
  17. transient findings
    temp changes in alignment (sublux) that disappear with time
  18. ischemia after SCI
    • CNS is very intolerant to vascular changes - 30 second later you can have permanent damage, esp in gray matter
    • if there's severe trauma, 2-3 hours later it'll cause white matter damage
    • anterior suclal arteries, centrifugal system, and some arteries to a/descending tracts
    • mechanical trauma + vasospasm --> vasoconstriction --> prostoglandins and histamines get released --> vascular changes
  19. trouble w inflammation in the spinal cord
    there'll be inflam cell release to segment above and below
  20. "ion derangement" after spinal cord injury
    • abnormal increase in concentration of K and Na
    • Ca shift (decrease)
    • --> tissue destruction
    • --> breakdown of proteins & demyelination
  21. when does apoptosis begin?
    4-6 hours post trauma, runs ~24 h, but can have rostral and caudal changes up to 3 weeks post trauma