spinal cord injury 7

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spinal cord injury 7
2013-02-18 15:51:25
spinal cord injury

rosen & karpatkin spring 2013
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  1. 4 indidcations for laminectomy
    • ascending neurological deficit
    • progressive paralysis
    • dev of paralysis after free interval
    • pain due to irritation of a nerve root
  2. 4 reasons for surgical procedures in later stages after SCI
    • persistant or recurring instability
    • restitution of neural function
    • treatment of spasticity and contractures
    • treatment of pain
  3. methylprednisolone
    • a bit of a wonderdrug
    • an antiinflammatory
    • if given within 8 hours of trauma the results of injury are significantly lessened
    • no known downside to this one-time usage
  4. sygen
    drug used experimentally to aid in neural regeneration
  5. use of diuretics for SCI pts?
    to prevent inflam / fluid buildup
  6. most common site of c-spine injury, what happens here and how it'll look on x-ray
    3 things about how this can present
    • C5
    • rupture of vertebral plates and shattering of body
    • on x-ray - wedge fracture

    • can involve roots and/orcord
    • fragments can project into cord
    • ligaments can remain intact
  7. cervical flexion injuries - un/stable? dislocating which way? probably in/complete?
    • unstable due to disruption of post ligs
    • ant dislocation w cord compression & shearing
    • likely complete
  8. where are most cervical hyperextension injuries? typically caused by what?
    • C4-5
    • MVA accell injuries
  9. 4 characteristics of cervical hyperextension injuries
    • occult soft tissue injuries
    • cord involvement probable
    • central cord syndrome
    • more common in elderly due to cervical DJD
  10. main feature of central cord syndrome, and what type of injury inspires this?
    • UE > LE involvement
    • cervical hyperextension injury
  11. flexion rotation injuries - most common where?
  12. main anatomical features of flexion rotation injury
    • unilateral facet joint dislocation
    • vertebra is displaced on x-ray
    • spinal canal narrowing
    • interruption of disc, joints, ligs, w/o fx
  13. why is there often no neural involvement in flexion rotation injuries?
    and if there is cord damage, what kind is it?
    • insufficient canal narrowing
    • incomplete
  14. 3 main causes for complete lesions
    • bilateral facet joint dislocation
    • thoracolumbar flexion/rotation
    • transcanal gunshot/projectile wound
  15. 3 main causes for incomplete lesions
    • cervical spondylosis
    • unilateral facet joint dilocation
    • projectile injuries w/o canal penetration
  16. spondylosis
    degeneration of a vertebra
  17. 5 reasons for progressive surgical approach
    • anterior decompression
    • reduction of dislocation w locked facets
    • reduction of compression fractures
    • posterior element fractures
    • upper cervical spine fractures
  18. 5 basica aims of acute SCI management
    • prevent complications
    • prevent further damage to spinal cord
    • aid healing of damaged spine
    • relieve pressure on cord
    • achieve healing of compound injuries after proper wound debridement
  19. 5 additional medical problems in SCIs
    • labile BP
    • congested nasal passages
    • decreased blood sugar
    • difficulty swallowing
    • loss of heat control
  20. 5 basic findings w complete SCIs -- loss of...?
    • vol movement below the level
    • sensation below the level
    • bowel & bladder control
    • normal sexual function
    • contorl of symp nervous system
  21. primary causes of death in SCI (post acute)
    • acute respiratory failure (if diaphragm is involved) or pneumonia
    • heart disease
    • subsequent trauma
    • septicemia (infection)
  22. secondary causes of death in SCIs (post acute)
    • chrinic respiratory failure
    • bladder dysfunction
    • bowel dysfunction
    • cachexia / failure to thrive
  23. spinal shock - lasts how long, char by what, what do we think of early res?
    • period lasting hours to weeks or months
    • flaccid paralysis characterized by complete paralysis, arreflexia, and sensory loss below level of lesion
    • early resolution of spinal shock is considered an important pos prognostic sign
  24. 2 things that can prolong spinal shock
    • sepsis
    • malnutrition
  25. an early sign that spinal shock is resolving (ending)
    bulbocavernosus reflex - put a digit of probe in the rectum and stim the genitals, looking for a clenching of the rectum
  26. which way do symptoms progress as you enter and leave shock?
    they progress distally and as they recede they move proximally