Trauma: Spinal Cord Injury

Spinal Cord Injury

Basic Injury Managements

  • Steroids – Controversial
    • Give if Worsening Sx (Decrease Swelling)
  • Anticoagulation – Start Within 3 Days, Continue for 2-3 Months
  • Goal MAP: > 85-90 for 7 Days – Little Actual Data to Support

American Spinal Injury Association (ASIA) Impairment Scale

  • Grade A: Complete Injury
    • No Motor or Sensory Function Preserved in Sacral Segments S4-S5
  • Grade B: Sensory Incomplete Injury
    • Sensory Function is Preserved Below the Neurologic Level & Includes Sacral Segments S4-S5
    • No Motor Function is Preserved More than 3 levels Below the Neurologic Level of Injury on Either Side
  • Grade C: Motor Incomplete Injury
    • Sensory Function is Preserved Below the Neurologic Level & Includes Sacral Segments S4-S5
    • Motor Function is Preserved Below the Neurologic Level & > Half of the Key Muscle Functions Below the Neurologic Level of Injury Have a Muscle Grade < 3
  • Grade D: Motor Incomplete Injury
    • Sensory Function is Preserved Below the Neurologic Level & Includes Sacral Segments S4-S5
    • Motor Function is Preserved Below the Neurologic Level & ≥ Half of the Key Muscle Functions Below the Neurologic Level of Injury Have a Muscle Grade ≥ 3
  • Grade E: Normal
    • Normal Sensory & Motor Function

Anterior Cord Syndrome

  • Injury: Anterior 2/3 of the Spinal Cord
    • From Anterior Spinal Artery Injury
  • Presentation:
    • Bilateral Motor & Pain/Temp Loss
    • Spares Sensation

Brown-Sequard Syndrome

  • Injury: Cord Hemisection
  • Presentation:
    • Ipsilateral Motor & Sensation Loss
    • Contralateral Pain/Temp Loss

Central Cord Syndrome

  • Injury: Swelling of the Central Spinal Cord
    • From Hyperflexion of C-Spine
  • Presentation:
    • Bilateral Motor & Pain/Temp Loss
    • “Cape-Like” Affecting Arms More Than Legs

Spinal Cord Lesions 1

Brown-Sequard; (1) Lesion, (2) Motor/Sensation, (3) Pain/Temp 2

Cauda Equina Syndrome

  • Injury: Compression of Cauda Equina
  • Presentation:
    • Saddle Anesthesia
    • Bowel/Bladder Dysfunction
    • BLE Weakness

Horner Syndrome

  • Injury: Sympathetic Interruption
  • Presentation:
    • Ipsilateral Ptosis (Eyelid Droop)
    • Ipsilateral Miosis (Pupil Constriction)
    • Ipsilateral Anhidrosis (Unable to Sweat)

Horner Syndrome – Left 3

Neurogenic Shock

Spinal Shock

  • Presentation: Paralysis, Areflexia & Loss of Sensation Below Level of Injury
  • Usually Resolves Within 48 Hours
  • No Circulatory Compromise (Compared to Neurogenic Shock)
    • Injuries Above T6 May Result in Neurogenic Shock
  • Bulbocavernosus Reflex
    • Spinal Cord Reflex Involving S1-S3
    • Reflex: Anal Sphincter Contraction in Response to Squeezing of the Glans of the Penis, Clitoris or Tugging on the Foley Catheter
    • Carries Significant Prognostic Value in Cervical/Thoracic Spinal Cord Injury
      • Absence of Reflex Demonstrates Continued Spinal Shock
      • Presence of Reflex Demonstrates Resolution of Spinal Shock

Spinal Cord Injury Without Radiographic Abnormality (SCIWORA)

  • Newer Term: Spinal Cord Injury Without CT Evidence of Trauma (SCIWOCTET)
  • Demonstrate Clinical Findings of Spinal Cord Injury but Negative XR/CT
    • 2/3 Will Have Evidence of Injury by MRI
  • Most Common in C-Spine
    • Less in Thoracic Due to Rib Cage Splinting Protection

References

  1. Olson N. Wikimedia Commons. (License: CC BY-SA-3.0)
  2. Rhcastilhos, PbBR8498. Wikimedia Commons. (License: CC BY-SA-3.0)
  3. Waster. Wikimedia Commons. (License: CC BY-2.5)