SPINAL TRAUMA
?
Arwinder Singh
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10/5/17
Paraplegia :
injury in thoracic, lumbar or sacral segments
2 extremities affected
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10/5/17
Incomplete:
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10/5/17
Spinal shock is mainly a loss of reflexes (flaccid Transient reflex depression of cord function below level of
paralysis) injury
Neurogenic shock is mainly hypotension and Initially hypertension due to release of catecholamines
Followed by hypotension
bradycardia due to loss of sympathetic tone Flaccid paralysis
Bowel and bladder involved
Sometimes priaprism develops
Symptoms last several hours to days
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10/5/17
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10/5/17
Clinically:
Loss of power
Decrease in pain and sensation below lesion
Dorsal columns remain intact
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10/5/17
Clinically:
Proprioception affected ataxia and
faltering gait
Usually good power and sensation
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10/5/17
Clinically
Non specific symptoms back pain
- bowel and bladder dysfunction
- leg numbness and weakness
- saddle parasthesia
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10/5/17
CT scan MRI
Good in acute situations Almost never an emergency
Shows bone very well Exception: cauda equina syndrome
Sagittal reconstruction is mandatory Shows tumors and soft tissues (e.g., herniated
Soft tissues (discs, spinal cord) are poorly discs) much better than CT scan
visualized May be used to clear c-spine in comatose
Do NOT give contrast in trauma patients patients
(contrast is bright, mimicking blood)
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10/5/17
Timing
Emergent
Incomplete lesions with progressive neurologic deficit
Elective
Complete lesions (3-7 days post injury)
Central cord syndrome (2-3 weeks post injury)
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10/5/17
thank you
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