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    Spinal Cord Injury

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    Hanis Malek
    Spinal cord injuries occur in about 8,000-10,000 people per year in the United States. Motor vehicle crashes account for 48% of injuries, while falls account for 21% and assaults 15%. Half of injuries involve the cervical spine, and 40% result in quadriplegia. Initial treatment involves immobilization, steroids such as methylprednisolone, and rehabilitation. Outcomes depend on the severity and location of injury, with complete injuries generally having worse prognoses than incomplete injuries. Long-term complications can include blood clots, respiratory issues, skin breakdown, and autonomic dysreflexia above T6.

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    Spinal Cord Injury

    Uploaded by

    Hanis Malek
    889 views27 pages
    Spinal cord injuries occur in about 8,000-10,000 people per year in the United States. Motor vehicle crashes account for 48% of injuries, while falls account for 21% and assaults 15%. Half of injuries involve the cervical spine, and 40% result in quadriplegia. Initial treatment involves immobilization, steroids such as methylprednisolone, and rehabilitation. Outcomes depend on the severity and location of injury, with complete injuries generally having worse prognoses than incomplete injuries. Long-term complications can include blood clots, respiratory issues, skin breakdown, and autonomic dysreflexia above T6.

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    Spinal cord injuries occur in about 8,000-10,000 people per year in the United States. Motor vehicle crashes account for 48% of injuries, while falls account for 21% and assaults 15%. Half of injuries involve the cervical spine, and 40% result in quadriplegia. Initial treatment involves immobilization, steroids such as methylprednisolone, and rehabilitation. Outcomes depend on the severity and location of injury, with complete injuries generally having worse prognoses than incomplete injuries. Long-term complications can include blood clots, respiratory issues, skin breakdown, and autonomic dysreflexia above T6.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    889 views27 pages

    Spinal Cord Injury

    Uploaded by

    Hanis Malek
    Spinal cord injuries occur in about 8,000-10,000 people per year in the United States. Motor vehicle crashes account for 48% of injuries, while falls account for 21% and assaults 15%. Half of injuries involve the cervical spine, and 40% result in quadriplegia. Initial treatment involves immobilization, steroids such as methylprednisolone, and rehabilitation. Outcomes depend on the severity and location of injury, with complete injuries generally having worse prognoses than incomplete injuries. Long-term complications can include blood clots, respiratory issues, skin breakdown, and autonomic dysreflexia above T6.

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 27

    Spinal Cord Injury

    Incidence
    8,000-10,000 per year

    Mechanisms
    MVC 48% Falls 21% Assaults 15% Sport-related 14% (majority diving)

    Incidence
    50% involve cervical spine (C5-6)
    40% lead to quadriplegia

    Co-morbidity
    Limb fractures - 67% Intrathoracic - 53% Head injury - 33%

    Anatomy

    NETTER'S CONCISE ORTHOPAEDIC ANATOMY

    Spine stability dependents


    bone
    ligaments joints applied force

    axial

    extension
    rotation

    Pathophysiology
    Initial insult to cord Local deformation Energy transformation

    ASIA Score
    Based on key muscle strength & key sensory points Useful for following improvement or deterioration

    Spinal shock:
    transient flaccid paralysis areflexia (incl. lack of bulbocav. reflex) while present (usu <48 h), unable to predict

    recovery

    Classification
    Complete absence of sensory & motor function in lowest sacral segment Incomplete presence of sensory & motor function in lowest sacral segment (indicates preserved function below the defined neurological level)

    Incomplete Syndromes

    E. Posterior Cord Syndrome

    Frankel Classification
    Grade A: Absent motor and sensory function

    Grade B: Absent motor function, sensation

    present Grade C: Motor function present, but not useful (2 or 3/5), sensation present Grade D: Motor function present and useful (4/5), sensation present Grade E: Normal motor (5/5) and sensory function

    Xrays
    Cervical
    neck tenderness, intoxication, abnormal neuro

    exam, distracting injury, difficult clinical exam


    Thoracolumbar
    spine tenderness, MVC ejections, falls > 10 ft,

    neurologic deficit, difficult clinical exam

    Spine Instability
    Indicators of instability on plain radiographs > 5 mm subluxation bilateral jumped facets burst fractures with bone fragments in canal widening of interspinous space fractures of posterior element Columns - 2 of 3 damaged Flexion/extension plain radiographs - no pain & active full motion

    Treatment
    Immobilization

    Drug Therapies
    Steroids GM-1 Gangliosides

    Surgical management Rehabilitation

    Steroids
    Standard of Care
    National Acute Spinal Cord Study within 8 hours of injury methylprednisolone 30mg/kg load, 5.4 mg/hr x23 hrs. result: slight but significant improvement in motor function and sensation at 6 months NASCS 2nd trial some benefit of 48hrs of steroids, but significant morbidity (severe sepsis and pneumonia)

    Surgical Management
    Subluxation/angulation
    immobilization with traction not recommended with fractures

    Braces
    Halo brace Minerva jacket/vest

    Surgical Management
    C1 rotatory subluxation- after reduction treatment

    with Halo 3 months


    C1 fx (Jefferson) - usually stable treat with hard

    collar (ligament injury- Halo)


    Odontoid fx - depend on type
    Type I and III usually hard collar/halo 3 mos Type II - young (halo) and older (ORIF)

    C2 fx (Hangmans) - Halo at least 3 months

    Surgical Management
    Lower cervical
    fracture/dislocation - posterior ORIF with/without collar

    compression/burst - anterior ORIF or halo

    Thoracolumbar
    compression without subluxation usually stable require

    brace only severe subluxation/retropulsion bone fragments require ORIF

    Complications
    *Cardiovascular
    hemodynamics sinus bradycardia

    *Venous Thromboembolism *Pulmonary problems Skin breakdown

    (most avoidable) Autonomic Hyperreflexia (usually above T6) Muscle spasiticity (trial of baclofen)

    Rehabilitation
    Begins immediately

    Objectives
    maintain full range of motion of joints use of orthotics to prevent contractures muscle strenghtening patient education self-range techniques activities of daily living

    Prognosis
    Depends
    severity and location of injury age comprehensive rehab facilities

    Mortality
    Early mortality < 50 = 11%
    > 50 = 39%

    Quadriplegia - 15-37% die within first year

    Prognosis
    Cause of death
    pulmonary - 21% 20% who require vent assistance die within 3 mos cardiovascular - 15% accidents, poisoning, or violence -10%

    infections - 9%

    Prognosis
    Up 7% have progressive decrease
    neurologic function develop painful dysesthesias syrinx - fluid in injured necrotic cavity compress surrounding tissue

    Thank You

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