Spinal Cord Injury Lec. 5 PDF

Lec:5 Spinal Cord Injury Dr.Sarkawt S.Kakai KHCMS (Ortho.&Trauma) • Traumatic spinal cord injury (SCI) is a life-transforming condition of sudden onset that can have devastating consequences. • Clinical management involves the acute phase, rehabilitation to restore potential and subsequent interv...

Lec:5 Spinal Cord Injury Dr.Sarkawt S.Kakai KHCMS (Ortho.&Trauma) • Traumatic spinal cord injury (SCI) is a life-transforming condition of sudden onset that can have devastating consequences. • Clinical management involves the acute phase, rehabilitation to restore potential and subsequent interventions to restore function. • The objectives of management are to produce a healthy person who can choose his or her own destiny. Learning objectives • Etiology of SCI • Evaluation and classification • Initial and definitive treatment • Aim of rehabilitation • Prognosis Etiology • Incidence • 11,000 new cases/year in US • 34% incomplete tetraplegia • central cord syndrome most common • 25% complete paraplegia • Demographics • bimodal distribution • young individuals with significant trauma • older individuals compounded by degenerative spinal canal narrowing • Anatomic location • 50% in cervical spine Classification (Descriptive) tetraplegia • injury to the cervical spinal cord leading to impairment of function in the arms, trunk, legs, and pelvic organs paraplegia • injury to the thoracic, lumbar or sacral segments leading to impairment of function in the trunk, legs, and pelvic organs depending on the level of injury. Arm function is preserved complete injury • an injury with no spared motor or sensory function below the affected level. • classified as an ASIA A incomplete injury • an injury with some preserved motor or sensory function below the injury level • incomplete spinal cord injuries include • anterior cord syndrome • Brown-Sequard syndrome • central cord syndrome • posterior cord syndrome ASIA Impairment Scale A Complete B Incomplete C Incomplete D Incomplete E Normal Motor Sensory No motor function Complete deficit No motor function Motor function partially preserved: more than half of key muscles below the neurological level have a muscle grade less than 3. Motor function is partially preserved - at least half of key muscles below the neurological level have a muscle grade of 3 or more. Normal motor Incomplete deficit Incomplete deficit Incomplete deficit Normal sensory Acute phase conditions Spinal shock Neurogenic shock Sudden loss of sympathetic nervous system signals BP Immediate temporary loss of total power, sensation and reflexes below the level of injury Hypotension Pulse Bradycardia Bradycardia Bulbocavernous reflux Absent Variable Motor Flaccid paralysis Variable Definition Time Mechanism Hypotension 48-72 hrs. immediate after SCI Peripheral neurons become temporarily unresponsive to brain stimuli Disruption of autonomic pathways, loss of sympathetic tone and vasodilatation Evaluation (Field treatment) treatment of potential spinal cord injuries begins at the accident scene with proper spinal immobilization immobilization • immobilization should include a rigid cervical collar and transport on a firm spine board with lateral support devices • patient should be rolled with standard log roll techniques with control of cervical spine spine boards should be used for transport only and patients should be removed when clinically safe Initial medical treatment DVT prophlaxis • low-molecular weight heparin • rotating bed and pneumatic compression stocking cardiopulmonary management • careful hemodynamic monitoring and stabilization is critical in early treatment • hypotension should be avoided decubitus ulcer prevention Steroids • high dose methy-lprednisone Reduction Hypothermia • systemic and local • Nonoperative • bracing and observation • Operative • surgical decompression and stabilization Next • Multiple sclerosis, Alzheimer disease and Parkinson disease