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Spinal Cord Injury  

Study Guide ​

 

Definition: Single or multiple physical insults to the spinal cord that can lead to temporary or permanent impairment of function.

 

ASIA Impairment Scale:  

 

 

Causes: 

Spinal Cord Injury Causes 

Traumatic  

  • Motor vehicle accidents

  • Violence

  • Falls

  • Recreational activities (e.g., diving) 

Non traumatic 

  • Congenital and developmental (e.g., spina bifida, cerebral palsy).

  • Degenerative CNS disorders (e.g., Amyotrophic lateral sclerosis).

  • Inflammatory diseases (e.g., multiple sclerosis). Infectious, ischemic causes, and toxic causes.  

Pathophysiology:   

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Pathophysiology of non traumatic spinal cord injury is disease specific 

 

Traumatic:  

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Trauma ➔Direct compression on the spinal cord from the neighbored structures➔Injury of blood vessels & neural-cell membrane➔Grey matter microhemorrhages➔Swelling of the spinal cord➔Secondary ischemia➔Spinal Neurogenic Shock and hypotension.

Red Flags

  • Insidious progression.

  • Lherimitte’s sign.

  • UMN signs in the lower limbs.(Babinski’s sign)

  • LMN signs in the upper limbs  

Figure 1
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Clinical Presentation:

Investigations:

 

Imaging:

  • X-ray (initial) " to detect any fractures.

  • MRI" best modality to define the neural tissues.

  • CT myelography "when MRI is contraindicated.

o CBC, ABGs, and renal function tests.
o CSF analysis "for non7traumatic causes.

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Management:

o Acute: resuscitation and immobilization.

o IV Dexamethasone within the first 8 hours (improves the patient’s outcome).

o Surgery to relieve the compression.
o Radiotherapy"if the cause was a tumor.

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Complications (there are others):

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o Spinal Shock:
Immediate flaccidity, paralysis, areflexia and loss of sensation below the level of the acute spinal cord injury.

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o Neurogenic Shock:

Caused by high thoracic, cervical spine, and profound brain injuries (spinal cord injury above T6).

 

Classic triad:

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o Others:

  •  Respiratory: pneumonia, atelectasis,

    ventilatory dependence etc.

  •  CVS: thromboembolism, autonomic dysreflexia etc.

  •  GI: fecal impaction, ileus, constipation, GERD etc.

  •  Genitourinary system: UTI, hydronephrosis etc.

  •  Deramtological: pressure ulcers.

  •  MSK: osteoporosis, fractures, chronic pains etc.

 

Prognosis:
o Nowadays, the leading cause of death is respiratory complication followed by cardiovascular complications.
o Earlier, the leading cause of death was urinary complication

 

 

References:

  1. Van Middendorp, Joost et al. 'Diagnosis And Prognosis Of Traumatic Spinal Cord Injury'. Global Spine J 1.01 (2011): 001-008. Web.

  2. Thietje, Roland et al. 'Mortality In Patients With Traumatic Spinal Cord Injury: Descriptive Analysis Of 62 Deceased Subjects'. The Journal of Spinal Cord Medicine 34.5 (2011): 482-487. Web. 26 Sept. 2015.

  3. Savić, Gordana. 'ABC Of Spinal Cord Injury'. Spinal Cord 41.1 (2003): 57-57. Web.

  4. Trauma, Spinal. 'Spinal Trauma - Injuries Poisoning'. MSD Manual Professional Edition. N.p., 2015. Web. 26 Sept.

    2015.

  5. Uptodate.com,. 'Chronic Complications Of Spinal Cord Injury And Disease'. N.p., 2015. Web. 26 Sept. 2015.

  6. Le, Tao et al. First Aid For The® USMLE. Print.

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Relative bradycardia 
Hypotension 
Hypothermia 

First author:Abdullah AlAsaad  


Second authors : Lama Al Luhidan 

                         Haifa Al Essa 

Web Publisher : Adel Yasky 

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