Spinal Cord Injury

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Spinal Cord Injury
2014-02-13 11:05:55
Spinal Cord Injury
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  1. Pathology of the Spinal Cord: Congenity Injury
    • Occurs in utero, present at birth
    • Defect in neural tube closure
    • Spina Bifida Occulta: lack of a bony arch, may be asymptomatic
    • Spina Bifida Cystica: talking about neural portion, bag external, filled w/ CSF
    • Meningocele: just the meninges external 

    Myelomeningocele: meninges and part of cord external
  2. Pathology of the Spinal Cord: Traumatic
    • Trauma: result of high velocity impact (indirect or direct)
    • Non-traumatic mechanisms: circulatory insult, compression/subluxation, inflammatory process (i.e. transverse myelitis)
  3. Complete Injury
    • No preservation of motor/sensory even in lowest sacral level
    • Etiology: congenital, traumatic, stroke
    • Presentation: loss of motor, sensory, autonomic functions below injury (problems w/ bowel and bladder)
    • Tetraplegia (quadriplegia)/Paraplegia
  4. Incomplete Injury
    • Preservation of motor and/or sensory functions below level of injury (sacral region)
    • Can see some preservation of extrapyramidal tracts (synergies, high tone)

    • Types:
    • Anterior Cord Syndrome
    • Posterior Cord Syndrome
    • Central Cord Syndrome
    • Brown Sequard Syndrome 
    • Cauda Equina Injuries
  5. Anterior Cord Syndrome
    • Anterior 2/3 of spine
    • Dorsal column preserved
    • May have sacral sparing, know where they are (proprioception)
    • No volitional motor movement below level of injury
  6. Posterior Cord Syndrome
    • Loss of dorsal column (just sensory issues)
    • Have no sense of where they are in space (may be in a WC despite having motor intact)
    • B12 deficiency common cause
  7. Central Cord Syndrome
    • Hyperflexion/hyperextension injury
    • Can have some preservation of lumbar/sacral sensory & motor (movement of legs/bowel & bladder)
    • Height of injury determines how involved pt is
  8. Brown Sequard Syndrome
    • Not common ("knifing situations")
    • Unilateral trauma
    • Think of it as a hemisection of cord (lose motor on one side and sensory deficits on the other)
    • Can also have sacral sparing
  9. Cauda Equina Injuries
    • Seen w/ spina bifida clients
    • Can also be due to trauma/knifing/gunshot incidents
    • Motor function - usually in great shape, reproductive function & bowel/bladder control affected
  10. Syringomyelia (Syringobublia)
    • Cyst formation of central cord that progresses peripherally (longitudinally)
    • Active disease process (progressive)
    • Death when cardiac-respiratory centers in brain affected
  11. Myelitis (Transverse-, Polio-, Meningo-)
    • Inflammatory process
    • Affecting cord & causing destruction
  12. Syrinx
    • Damaged cells stay weakened after injury ⇒ die at a faster rate (rapid aging of the spine)
    • CSF filled cavitation that forms
    • Cell death ⇒ can see changes in function (sensory & motor)
    • Often seen 10-20 years after initial spinal cord injury