Spinal Cord Injury (SCI)

Elda Grace G. Anota, MD Physical Medicine and Rehabilitation Cebu City

Anatomy

Anatomy

Dermatomes

Total Sensory Index Score (SIS)

Myotomes

Total Motor Index Score (MIS)

Causes

Tumors Infection Disc disease and Spondylosis Hematoma Cystic lesions trauma

penetrating, mauling, MVA, falls, sports injury

Causes

Tumors

primary or secondary extradural/intradural/intramedullary

Causes

Infection

Acute (e.g. staphylococcal) or chronic (e.g. TB) Potts disease extradural/intradural

Causes

Disc disease and Spondylosis

Causes

Hematoma

AVM/spontaneous/trauma Extradural/intradural/intramedullary

Causes

Cystic lesions

Extradural Intradural - arachnoidal Intramedullary - syringomyelia

Causes

trauma

penetrating, mauling, MVA, falls, sports injury

Manifestations

Depend on:

site of lesion vascular involvement speed of onset

Manifestations

Depend on:

site of lesion

Manifestations

Depend on:

vascular involvement
Anterior spinal artery Posterior spinal artery

Clinical features

Depends on the site and level of the lesion from the level down

sensory impairment weakness or paralysis neurogenic bladder neurogenic bowel pain

Spinal Cord Injury (SCI)

Anterior Cord Syndrome

Posterior Cord Syndrome

Central Cord Syndrome

Brown Sequard Syndrome

American Spinal Injury Association (ASIA) Classification

A: complete, no sensory and no motor function from the SCI level down, including the sacral segments (S4-S5) B: incomplete, sensory but not motor function is preserved below the neurologic level and includes the sacral segments

American Spinal Injury Association (ASIA) Classification

C: incomplete, motor function is preserved below the neurologic level, and more than half of the key muscles below the neurologic level have a muscle grade <3/5 D: incomplete, motor function is preserve below the neurologic level, and at least half of key muscles below the neurologic level have a muscle grade >/= 3/5

American Spinal Injury Association (ASIA) Classification

E: normal, sensory and motor function are normal

Spinal Cord Injury

Morbidity

most common: pressure ulceration 2nd most common: urinary tract infection

Early mortality
during the 1st year after the injury

most common: pneumonia non-ischemic heart disease, pulmonary embolism *increased frequency in SCI: pulmonary embolism, sepsis, pneumonia

Spinal Cord Injury

Late Mortality

surviving > 5 years

3 most common cause of death: pneumonia, non-ischemic heart disease, inintentional injury *increased incidence in SCI: sepsis (due to UTI, pressure ulcers, pneumonia), pneumonia, UTI

Spinal Cord Injury

Life expectancy

increased in the past decades lower than normal

Diagnostics

Imaging studies

sagittal, transverse

MRI CT scan X-ray

Somatosensory Evoked Potentials (SSEP) CSF analysis

Diagnostics

Imaging studies

sagittal, transverse

MRI AP, lateral, oblique CT scan sagittal, transverse X-ray sagittal, transverse

Diagnostics - Imaging

Diagnostics - Imaging

Diagnostics

Somatosensory Evoked Potentials (SSEP)

Diagnostics

CSF analysis

Conditions/Problems in SCI

Pulmonary problems

atelectasis, pneumonia ventilatory failure gastric atony, hyperkalemia gastrointestinal bleeding superior mesenteric artery syndrome

GIT problems

Conditions/Problems in SCI

Cardiac Problems

Levels of increase in HR and O2 uptake during exercise are lower than normal due to less functioning muscle mass, poor venous return, poor ventilatory dynamics Tetraplegics: impaired autonomic response which limit HR elevation (chronotropic and inotropic), catecholamine production, thermoregulation Decr exercise capacity decr HDL levels incr risk for CV diseases Orthostatic hypotension, bradyarrythmias Deep Venous Thrombosis and Pulmonary Embolism

Conditions/Problems in SCI

Heterotropic Ossification

Deposition of new bone around a joint\potentials loss of joint range Most common: Hip > knee Noted 19 days to several years (1-4 months) SSx: joint swelling, heat, fever, peripheral neuropathy

Conditions/Problems in SCI

Pain

radicular, central, visceral, musculoskeletal, psychogenic

Osteoporosis, Pathologic fracture Autonomic Dysreflexia

unique to SCI patients SSx: headache, hypertension, nasal congestion, diaphoresis, piloerection, tachycardia or bradycardia, flushing shoulder pain, UE neuropathies

Upper Extremity pain and overuse

Management

Acute

Goal: prevent or minimize any resulting neurologic deficit Supporting the spine (immobilization) during transport and transfers Diagnostics Medical management

steroids within 8 hours of injury airway, breathing, circulation urethral catheter instrumentation bone grafting

Surgical management if necessary

Spine surgery

Management

Chronic

Rehabilitation management
exercises orthosis assistive device work simplification techniques energy conservation techniques patient education caregiver education psychology

Sensory level Motor level Sensorimotor level Beevors sign

Other conditions

Cauda Equina Syndrome Bends disease/Caissons disease/Decompression sickness