Spinal Cord Injuries

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Spinal Cord Injuries
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What Is the Spinal Cord?

• The spinal cord is a bundle of nerves carrying
  impulses to and from the brain.
• It is protected by vertebrae.
• SCI is damage to the spinal cord that results in
  a loss of function.
• Each root has a motor
• branch and a sensory
• branch.

www.apparelyzed.com
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Statistics

• More than 8,000 injuries yearly in the US
• Most injuries result from trauma, some from
  disease
• 44 Automobile accidents, 24 violence, 22
  falls, 8 sports (2/3 diving)
• 80 males
• Average patient age 33
• Most frequent injury age 19

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Christopher Reeve

• 1995 (age 42), suffered from a fall off a horse
• Was totally paralyzed (tetraplegia) from a
  complete C1/C2 injury
• Died October 2004 from a pressure sore

http//www.IMDB.com
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Breakdown

• 33 vertebrae, 31 nerve roots
• 5 segments of the spine
• Cervical
• 7 vertebrae, 8 nerve roots
• Thoracic
• 12 vertebrae, 12 nerve roots
• Lumbar
• 5 vertebrae, 5 nerve roots
• Sacrum
• 5 fused vertebrae, 5 nerve roots
• Coccyx
• 4 fused vertebrae, 1 nerve roots

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Paralyzed

• Paralysis
• The complete loss of function, especially
• involving the motion and/or sensation in
• part of the body
• Quadriplegia or Tetraplegia
• Paralysis of both arms and legs
• Above T1
• Paraplegia
• Paralysis of only the legs
• Below T1
• Lesion
• Injury level
• Complete Lesion all the sensory, motor, and
  reflex areas below injury effected
• Incomplete Lesion some of the functions below
  the injury effected

http//www.paraquad.asn.au
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Special Injury Types

• Anterior Cord Syndrome-frontal spinal cord damage
  causes loss of pain, temperature, and touch
  sensation.
• Central Cord Syndrome-central spinal damage
  causes loss of arm movement.

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Special Injury Types (Contd)

• Posterior Cord Syndrome-rear spinal cord damage
  causes loss of limb movement coordination.
• Brown-Séquard Syndrome-damage on one side causes
  loss of movement on that side and loss of pain,
  temperature, and touch sensation on the other.

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SCI Signs and Symptoms

• Fading consciousness
• Back or neck pain or pressure
• Any weakness, paralysis, or loss of coordination
  or balance
• Numbness, tingling or loss of sensation in limbs
  or digits
• Loss of bladder or bowel control
• Impaired breathing
• An oddly positioned or twisted neck or back
• Later Signs
• Exaggerated reflex activities or spasms
• Changes in sexual function, sexual sensitivity
  and fertility

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Complications

• Urinary tract problems
• Bowel management difficulties
• Pressure sores
• Deep vein thrombosis/pulmonary embolism
• Lung/breathing problems
• Spasticity
• Weight control problems
• Sexual dysfunction
• Pain
• New injuries
• Autonomic dysreflexia

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Cervical Spine (C1-C4)

• Usually fatal
• Limited head, neck, and shoulder movement
• Hard to test due to diminished sensitivity
• Need breathing assistance
• Full paralysis of arms, body, and legs
• Need complete personal care

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Cervical Spine (C5-C8)

• Full head, neck and shoulder control
• Low stamina
• Full paralysis of body and legs
• Varying levels of arm and hand control
• Amount of needed personal care varies
• May be capable of using a manual wheelchair on
  flat surfaces for short time

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Thoracic Spine (T1-T9)

• Full paralysis of lower body and legs
• Limited upper body movement
• Full use of arms
• Capable of using a manual
• wheelchair for extended time
• No personal care needed

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Autonomic Dysreflexia/ Hyperreflexia

• Abnormally increased or decreased response to
  stimuli
• T5-T6 injury or above
• Caused by potential pain below injury level
• High blood pressure, headaches, vision changes,
  anxiety, paleness, goosebumps

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Orthoses
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Thoracic Spine (T10-S5)

• Partial paralysis of lower body and legs
• Stronger chest and upper body
• Possibly capable of walking with assistance

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John Q

• Motorcycle accident injured his back
• No sensation and muscle control from mid-chest
  down
• Full arm control, twisted back
• Loss of bowel and
• bladder control

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Compression Fractures

• Caused by hyperflexion
• Automobile accident
• Neurological outcomes
• No serious damage
• Nerve damage
• Cord damage

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L1 Orthoses
www.spinaltech.com
BI-valve Orthosis

• Corset Front
• Rigid posterior to reduce abdominal pressure

• Maximizes adjustability
• Stabilizes pelvis

• Anterior Overlap
• Simple, adjustable

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Cauda Equina

• Spinal cord ends between L1 and L2
• Cauda Equina are the nerves past the spinal cord,
  in the lumbar and sacral vertebrae.
• If the nerves are not
• too badly damaged,
• they may grow back
• and may regain
• functionality.

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Johhny Q Jr.

• Climbing a tree in the woods and fell
• Following day, exhibited muscle weakness in legs
• Slowly moved up the body through the trunk and
  arms
• Eventual loss of sensation and function of all
  limbs
• Shortness of breath

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Misdiagnosis

• Paralysis can be a complication caused by a
  disease or a symptom of the disease
• Complications
• Botulism
• Meningitis
• Stroke
• Symptom
• Rabies
• Tetanus
• Syphilis
• Make sure for complete diagnosis before treatment

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References

• http//www.apparelyzed.com/
• http//www.neurosurgery.ufl.edu/Patients/sci.html
• http//www.makoa.org/nscia/index.html
• Hoppenfeld, Stanley, Orthopaedic Neurology, A
  Diagnostic Guide to Neurologic Levels. Lippincott
  Williams Wilkins, New York, 1977.