Spinal Cord Injury

Team V

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 Incidence

8,000-10,000 per year

Mechanisms
MVC 48%
Falls 21%
Assaults 15%
Sport-related 14% (majority diving)

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 Incidence

50% involve cervical spine (C5-6)

40% lead to quadriplegia
Co-morbidity
Limb fractures - 67%
Intrathoracic - 53%
Head injury - 33%

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Anatomy

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 Spine stability dependents
bone
ligaments
joints
applied force

axial
extension
rotation
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 Pathophysiology

Initial insult to cord

Local deformation

Energy transformation

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 ASIA Score
Based on key muscle strength & key sensory points
Useful for following improvement or deterioration

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 Spinal shock:

transient flaccid paralysis

areflexia (incl. lack of bulbocav. reflex)
while present (usu <48 h), unable to
predict recovery

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 Classification

Complete
absence of sensory & motor function in
lowest sacral segment
Incomplete
presence of sensory & motor function in
lowest sacral segment (indicates
preserved function below the defined
neurological level)

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Incomplete Syndromes

E. Posterior Cord
Syndrome

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 Frankel Classification
Grade A: Absent motor and sensory function
Grade B: Absent motor function, sensation
present
Grade C: Motor function present, but not
useful (2 or 3/5), sensation present Grade
D: Motor function present and useful (4/5),
sensation present Grade
E: Normal motor (5/5) and sensory function

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 Xrays

Cervical
neck tenderness, intoxication, abnormal neuro
exam, distracting injury, difficult clinical exam
Thoracolumbar
spine tenderness, MVC ejections, falls > 10 ft,
neurologic deficit, difficult clinical exam

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 Spine Instability

Indicators of instability on plain radiographs

> 5 mm subluxation
bilateral jumped facets
burst fractures with bone fragments in canal
widening of interspinous space
fractures of posterior element
Columns - 2 of 3 damaged
Flexion/extension
plain radiographs - no pain & active full motion

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 Treatment

Immobilization
Drug Therapies
Steroids
GM-1 Gangliosides
Surgical management
Rehabilitation

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 Steroids

Standard of Care
National Acute Spinal Cord Study
within 8 hours of injury
methylprednisolone 30mg/kg load, 5.4 mg/hr x23
hrs.
result: slight but significant improvement in motor
function and sensation at 6 months
NASCS 2nd trial
some benefit of 48hrs of steroids, but significant
morbidity (severe sepsis and pneumonia)

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 Surgical Management

Subluxation/angulation
immobilization with traction
not recommended with fractures
Braces
Halo brace
Minerva jacket/vest

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 Surgical Management

C1 rotatory subluxation- after reduction treatment

with Halo 3 months

C1 fx (Jefferson) - usually stable treat with hard

collar (ligament injury- Halo)

Odontoid fx - depend on type

Type I and III usually hard collar/halo 3 mos
Type II - young (halo) and older (ORIF)

C2 fx (Hangmans) - Halo at least 3 months

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 Surgical Management

Lower cervical
fracture/dislocation - posterior ORIF with/without collar
compression/burst - anterior ORIF or halo

Thoracolumbar
compression without subluxation usually stable require
brace only
severe subluxation/retropulsion bone fragments require
ORIF

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 Complications

*Cardiovascular
hemodynamics
sinus bradycardia
*Venous Thromboembolism
*Pulmonary problems
Skin breakdown (most avoidable)
Autonomic Hyperreflexia (usually above T6)
Muscle spasiticity (trial of baclofen)

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 Rehabilitation

Begins immediately
Objectives
maintain full range of motion of joints
use of orthotics to prevent contractures
muscle strenghtening
patient education
self-range techniques
activities of daily living

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 Prognosis

Depends
severity and location of injury
age
comprehensive rehab facilities
Mortality
Early mortality
< 50 = 11% > 50 = 39%
Quadriplegia - 15-37% die within first year

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 Prognosis

Cause of death
pulmonary - 21%
20% who require vent assistance die within 3 mos
cardiovascular - 15%
accidents, poisoning, or violence -10%
infections - 9%

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 Prognosis

Up 7% have progressive decrease

neurologic function
develop painful dysesthesias
syrinx - fluid in injured necrotic cavity compress
surrounding tissue

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Thank You

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