9.transection of sc kjg
TRANSCRIPT
Spinal Cord Injuries
Causes (in order of frequency)
Motor Vehicle Accidents
Gunshot wounds/acts of violence
Falls
Sports injuries
Classification of SCI
1. Flexion: Head is suddenly & forcefully accelerated forward causing extreme flexion of the neck “Kiss the Chest
Classification of SCI
3. Vertical compression
Blow to the top of the head
Often begins with a sudden, traumatic force
Types of Cord Injury
1. Concussion
Similar to cerebral concussion
Temporary and transient disruption of cord function
2. Contusion
Bruising of the cord
Tissue damage, vascular leakage, and swelling
3. Compression - Secondary to:
Displacement of the vertebrae
Herniation of inter vertebral disk
Displacement of vertebral bone fragment
Swelling from adjacent tissue
4. Laceration
Direct damage to cord with associated bleeding, swelling and potential disruption of cord
5. Hemorrhage
Associated with contusion, laceration, or stretching
6. Transection
Partial or complete severing of cord
Common sites of Spinal Injury
C-1/C-2: Delicate vertebrae
C-7: Transition from flexible cervical spine to thorax
T-12/L-1: Different flexibility between thoracic and lumbar regions
Complete spinal cord injury
Most severe form of injury
All sensations & motor functions will be lost beneath the level of the injury
Depend on the level of the injury!
Tetraplegia (formerly quadriplegia)occurs with C-1 to C-8 injuries.
Paraplegia occurs with T-1 to L-4
Complete Cord Transection
Complete spinal cord injury
Stages
1. Stage of spinal shock
2. Stage of reflex activity
3. Stage of reflex failure
Spinal shock:
Begins within hour of injury & Lasts from few minutes up to several months & Ends with return of reflex activity: Hyper reflexia, Muscle spasticity, Reflex bladder emptying.
Stage of spinal shock
1.Spinal Shock - Temporary loss of reflex function (a reflexia) below level of injury beginning immediately after complete transection of spinal cord
Temporary insult to the cord
Affects body below the level of injury
Cramp like pains at the level of lesion
Loss of all sensations below the lesion
Muscles are paralyzed
Muscle tone is lost
Reflexes are lost
Bladder & the rectum are paralyzed
Sphincters paralyzed but recover their activity faster
Vasomotor tone lost, so BP falls
Skin becomes cold & blue- bed sores may develop
Effects of section at various levels
At C1 segment level
Quadriplegia
Maximum fall in BP
Anaesthesia
Paralysis of respiratory muscles
Death
At C5 segment level
Quadriplegia
Maximum fall in BP
Anaesthesia below the lesion
Diaphragm is not paralysed. So, respiration is maintained
Horner’s syndrome develops
Effects of section at various levels
At C8
Miosis
No sweating on the face and the neck
Ptosis due to paralysis of the Muller’s muscle
Enophthalmos
Loss of ciliospinal reflex – (stimulation of skin over the neck produces reflex dilatation of the pupil)
Other features remain the same
At upper thoracic level
Paraplegia
Maximum fall in BP
Anaesthesia below the lesion
No Horner’s syndrome
Effects of section at various levels
At lower thoracic level
BP fall is less
Other features remain the same
At or below 2nd lumbar
Minimum or no fall in BP
Paraplegia
Anaesthesia below the lesion
Other features remain the same
Site Sensory Motor BP RS Other
C1 Anaesthesia Quadriplegia Max Fall Paralysis
of RS
muscles
Death
C5 Anaesthesia
below
Quadriplegia Max Fall No Horner‘s
develops
C8 SAME Full
Horner‘s
Upper
Thoracic
Anaesthesia
below
Paraplegia Max fall No
Horner”s
Lower
thoracic
SAME Less BP
fall
At or
below II
lumbar
SAME No BP fall
Stage of reflex activity
Sensations remain lost
Voluntary movements absent
Skeletal muscle tone increases in flexors first then in extensors
Functional activity of smooth muscle returns
Reflexes appear – Babinski reflex positive
Micturition & Defaecation reflex reappear
Mass reflex - Stroking the inner thigh – flexor spasm,contraction of abdominal muscles & evacuation of bladder
BP increases & skin sweats
Stage of reflex failure
Reflexes become functionless
Loss of muscle tone
Muscle wasting (degenerative changes)
General infection – bedsores, UTI, sepsis ----Death
Incomplete (partial transection)
Mixed loss of voluntary motor activity and sensation below level of injury as pathways are only partially interrupted
Four patterns or syndromes
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Brown-Sequard syndrome
Cord Syndrome
Brown-Sequard syndrome
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Brown-Sequard’s Syndrome
Incomplete Transection Cord Injury
Brown-Sequard’s Syndrome
Damage to one half of the cord on either side
Penetrating injury that affects one side of the cord
Ischemia,infectious or inflammatory diseases (tuberculosis,multiplesclerosis)& spinal cord tumor
Ipsilateral sensory and motor loss
Contralateral pain and temperature sensation loss
Brown Sequard Syndrome
Below the level of lesion:
Impairment of ipsilateral light touch, proprioception and vibration (dorsal columns) from site of lesion, caudally
Impairment of contralateral pain and temperature (spinothalamictract) below level of lesion
Impairment of ipsilateral voluntary movements (UMN type of paralysis) below level of lesion
Temporary loss of vasomotor tone
Brown Sequard Syndrome
Above the lesion
Small area of cutaneous hyperaesthesia on the same side
No motor involvement on both sides
At the level of lesion
Complete sensory loss on the same side
LMN paralysis – same side
Vasomotor paralysis – same side
No sensory motor & vasomotor involvement on the opposite side
Brown Sequard’s Syndrome
Site Function Same side Opp. side
Above the level Sensory
Motor
Vasomotor
Normal
Normal
Normal
Normal
Normal
Normal
At the level Sensory
Motor
Vasomotor
Total sensory loss
LMN type palsy
Vaso dilatation
Normal
Normal
Normal
Below the level Sensory
Motor
Vasomotor
Dorsal column lost
UMN type palsy
Vaso dilatation
Spino thalamic lost
Normal
Normal