Spine & SCI
Terms
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- SPI syndromes
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concussion
incomplete
complete - Complete SCI
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no sensory or voluntary motor fxn below level of injury
intact BC reflex
<5% chance recovery - Incomplete SCI
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some neuro fxn below injury level
intact BC reflex
(5 ex. syndromes seen later) - Mech of INjury
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Primary: Contusion, Compression, Stretch, Laceration
Secondary: ischemia, edema (accompanies all SCI 2ndary to vasc disruption and vasoactive subs) - Axial loading
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spinal compression, force transmitted via scolumn, like hit to top of head diving
mech: narrowing of IV spaces
shifts IV discs
fractures - Subluxation
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incomplete dislocation, still articular continuity
25% involve 1 facet
>50% involve 2 facets=complete dislocation!
mech: any direction of force-w/head flexed, hangman's - Hangman's Fracture ("Tip")
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C2 fx/ subluxation/ dislocation on C3=death
(vs. C5 on C6 snaps neck) - Occipitoatlantal dislocation
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Fatal
neuro deficit
c1 flacid quadriplegia
needs rigid immobilization - Jefferson Fx
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Bust fx of c1 atlas ring
caused by ax-loading on head
multiple fxs of ring
no cord compression- safe
4 mo immobilized - C1-C2 dislocation
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w.out fx: odontoid failed
w. fx: odontoid less likely assoc with severe neuro inj
immob until odontoid healed - odontoid fx
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c2
type I-III, III=unstable with lots of front/back motion causing compression - Unstable Axial Compression Fx
- Principle of ring: can't break just one side!
- Clay Shoveler fx
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ripped section of spinous process
no neuro deficit - hangman's fracture
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lethal
cord completely crushed
bilat fx of post arch of s2
spondylolysis
hyperextension - chance fx
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horizontal fx through vertebra
severe crush
area sags down
bleeding and inj to sc - Laminectomy
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decompression of sc
indications: - Quickenstedt test (blocked flow of CSF when pressure applied)
bony fragments in scanal
acute ant scord syndrome
Contraindications: acute ant cervical scord synd, recovers, met/pulm complications, other severe inj req sx - Transection cord injury
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partial/complete severing of scord
complete: cervical spine:quadriplegia, incont, resp paralysis
<T1: incont, paraplegia - Rectal Exam
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Bulbocaverosus reflex-anal sphincter contraction/wink
involved S1-3 nerve roots and reflex arch
absense of reflex=continuation of spinal shock
us resolves in 48 hrs and BC returns - Cauda Equina Synd
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incomplete SCI
Herniated L2
crushes spinal cord
no BC reflex
inj to lumbosacral roots
sensorymotor & bowel/ bladder deficits - Conus Medullaris Synd (S3-5)
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incomplete SCI
L1 burst inj
persistent loss of BC reflex
saddle anesthesia
sphincter loss
intact LE motor/sensory - Central Cord Synd.
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incomplete SCI
hyperextension, tumor
paresis/plegia of arms>legs
post column spared
more sensation in upper ext
sacral sparing
good prognosis - Ant Cervical Cord Synd
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incomplete SCI
hyperflexion
motor, pain, temp loss
dorsal column preserved
autonomic dysfunction
sacral sparing
50% recovery - Ant Spinal Cord Infarction
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incomplete SCI
common ant and thoracic
acute paralysis below lesion
dissociated sensory loss (pain/temp)
post column fxn remains
loss of sphincter fxn
Brown-sequard may occur - Brown-Sequard
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incomplete SCI
penetrating trauma (tumor, etc)
IPSILATERAL:motor paralysis, loss of touch/proprio below lesion, hyperanesthesia
CONTRALATERAL pain/temp loss 1 or 2 seg below lesion - Nerve Root LEsion
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isolated, at any level
partial or complete
radicular pain
sensory dysfunction
weakness
hyporeflexia or areflexia - Steroids
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to manage SCI
reduce body response to inj
reduce swelling and cord pressure
administer within 8hrs
1.Methylprednisolone - Solu-medrol
2.Dexamethasone- decadron or hexadrol (more potent than #1)
both lessen cap dilation and permeability - Managing SCI
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Body spica (w/mobility)
Knight-taylor brace
Surgical fixation - Pediatric spine
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up to 10:epiph growth
over 10: adult - Atlantooccipital (ped)
- rare
- atlantoaxial (ped)
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trauamatic lig disruption
lig laxity rel to local inflamm
rotary reformity
odontoid separation
pain, no neuro def, translation of C1 on C2 by forward slip - Atlantoaxial Rotatory Displacement (ped)
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common cause of TORTICOLLISIS
cause unknown
spontaneous onset w/URI
Sternocleidomastoid:neck spasms, head tilted to affected side, rotated to opp side w/slight flexion - Odontoid Fx (ped)
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epiphys slip
flexed head with acute trauma(drop kid on head) - Schuermann's Disease
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(peds!)
THORACIC KYPHOSIS
wedge of 5 adj vertebra=dorsal hump
end plate irregularity, disc space narrowing
can be hereditary
inhibition of growing, wedging
better by forward flexing, releved by rest - traumatic SPONDYLOLYSIS
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ped- MC at L5-S1
congenital or microtrauma to growth plate
lower back pain in kids <10, familial
aggravated by activity, better with rest
no nreve root compression
hamstring tightness
PARS INTERARTICULARIS defect: Scotty dog sign
neck failed to unite/broken to allows slipage of L5 on S1
feels better to lean forward - SPONDYLOLYSTHESIS
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ped spondylolysis that slips
grades 1-3 (3=severe)
onset teen/elderly
microtrauma
increased lordosis (big butt)
L4 slips on L5, pain worse with sitting - Sculiosis
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25deg:Brace
>45deg:Sx