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Vitya Chandika
2013-061-060
2013-061-070
Definition
Spinal cord injury (SCI) An insult to the
spinal cord resulting in a change, either
temporary or permanent, in the cords
normal motor, sensory, or autonomic
function.
Anatomy
Ligamentous Anatomy
a = Ligamentum flavum
b = Interspinous
ligaments
c = Supraspinous
ligament
ANATOMY
Spinal cord is divided into 31 segments
Each with a pair of anterior (motor) and dorsal (sensory)
spinal nerve roots
The spinal cord extends from the base of the skull to the
lower margin of L1 vertebral body
Injuries below L1 are not considered spinal cord injuries
NEUROPATHWAYS
Bulbar-cervical dissociation
Brown-sequard syndrome
Brown Sequard
Syndrome
BULBAR-CERVICAL
DISSOCIATION
Occurs as a result of spinal cord
injury at or above C3
Bulbar-cervical dissociation
produces immediate pulmonary
and, often, cardiac arrest
Presentation
Motor: weakness of upper extremities with lesser effect on lower
extremities
Sensory: varying degrees of disturbance below level of lesion may
occur
Myelopathic findings: sphincter dysfunction (usually urinary
retention)
May result from occlusion of the anterior spinal artery, anterior cord
compression, e.g. by dislocated bone fragment, or by traumatic
herniated disc
Presentation
paraplegia, or (if higher than C7) quadriplegia
dissociated sensory loss below lesion:
loss of pain and temperature sensation (spinothalamic tract lesion)
preserved two-point discrimination, joint position sense, deep
pressure sensation (posterior column function)
Brown-sequard syndrome
Classical findings (rarely found in this pure form):
ipsilateral findings:
motor paralysis (due to corticospinal tract lesion) below lesion
loss of posterior column function (proprioception & vibratory
sense)
contralateral findings: dissociated sensory loss
loss of pain and temperature sensation inferior to lesion
beginning 1-2 segments below (spinothalamic tract lesion)
preserved light (crude) touch due to redundant ipsilateral and
contralateral paths (anterior spinothalamic tracts)
Relatively rare
Complications
Neurogenic Shock = autonomic dysfunction,
interruption of sympathetic nervous system. Common
above T6.
vasomotor disruption: vasodilatation Flush,warm
Heart problem :bradicardia hypotension
Spinal Shock = complete loss of all neurologic function
Flaccid + areflexia
Who?
Any of the following patients should be treated as having a SCI until
proven otherwise:
Initial assessment
Initial management
Maintain oxygenation
Brief motor exam to identify deficits move arms, hands, legs, toes
Management
Hypotension maintain SBP 90 mm Hg
Oxygenation
NG tube to suction prevents vomiting and aspiration
Temperature regulation
Electrolytes
Neuro evaluation American Spinal Injury Association
Spinal-Dose Steroids
Injury < 8 hours: metilprednisolone 30 mg/kgBB IV bolus in 15 min. 45 minute
pause, then continue with 5,4 mg/kgBB/jam for 23 h
Injury >8 hours : steroid IV for 48 h
Surgery: decompression and stabilize
Thank you