This document provides instructions for classifying spinal cord injuries using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). It describes a 6 step process to determine: 1) sensory and motor levels, 2) neurological level of injury, 3) whether the injury is complete or incomplete, 4) ASIA Impairment Scale grade, 5) zone of partial preservation, and 6) non-key muscle testing. Key examination points include testing sensation, strength of specific muscles, and anal reflexes to classify injury severity and guide treatment.
This document provides information about the American Spinal Injury Association (ASIA) scale for classifying spinal cord injuries. It outlines the 5 steps for determining the ASIA grade: 1) determine sensory levels, 2) determine motor levels, 3) determine the neurological level of injury, 4) determine if the injury is complete or incomplete, and 5) determine the ASIA Impairment Scale grade (A-E). A 30-year-old man who fell 8 feet and had no motor function or voluntary anal contraction below his inguinal region is presented as a case example to demonstrate how to apply the ASIA scale.
1. Spinal cord injuries have an annual incidence of 15-40 cases per million people, with motor vehicle accidents and falls being the most common causes.
2. The American Spinal Injury Association (ASIA) impairment scale is the most widely used classification system for spinal cord injuries, grading injuries as complete or incomplete.
3. Common spinal cord syndromes include anterior cord syndrome (involving motor and pain pathways), posterior cord syndrome (involving proprioception and touch), and Brown-Sequard syndrome (unilateral involvement of pathways on one side of the spinal cord).
The American Spinal Injury Association created the International Standards for Neurological Classification of Spinal Cord Injury to standardize how severity of spinal cord injuries are determined and documented. The standards provide a standardized examination of motor and sensory function to assess the extent of loss after an injury. It examines dermatomes and myotomes to determine the affected spinal cord segments. The examination involves detailed sensory and motor testing to determine sensory and motor levels, neurological level, and whether the injury is complete or incomplete.
The document provides information on assessing spinal cord injuries, including key muscles associated with different spinal cord levels, grading scales for muscle function and sensory ability, how to evaluate motor and sensory subscores, and the steps to classify a spinal cord injury as complete or incomplete. It defines a complete injury as having no sensory or motor function preserved in sacral segments S4-S5, while an incomplete injury has some sensory or motor function spared below the neurological level.
This document provides instructions for classifying spinal cord injuries using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). It describes a 6 step process to determine: 1) sensory and motor levels, 2) neurological level of injury, 3) whether the injury is complete or incomplete, 4) ASIA Impairment Scale grade, 5) zone of partial preservation, and 6) non-key muscle testing. Key examination points include testing sensation, strength of specific muscles, and anal reflexes to classify injury severity and guide treatment.
This document provides information about the American Spinal Injury Association (ASIA) scale for classifying spinal cord injuries. It outlines the 5 steps for determining the ASIA grade: 1) determine sensory levels, 2) determine motor levels, 3) determine the neurological level of injury, 4) determine if the injury is complete or incomplete, and 5) determine the ASIA Impairment Scale grade (A-E). A 30-year-old man who fell 8 feet and had no motor function or voluntary anal contraction below his inguinal region is presented as a case example to demonstrate how to apply the ASIA scale.
1. Spinal cord injuries have an annual incidence of 15-40 cases per million people, with motor vehicle accidents and falls being the most common causes.
2. The American Spinal Injury Association (ASIA) impairment scale is the most widely used classification system for spinal cord injuries, grading injuries as complete or incomplete.
3. Common spinal cord syndromes include anterior cord syndrome (involving motor and pain pathways), posterior cord syndrome (involving proprioception and touch), and Brown-Sequard syndrome (unilateral involvement of pathways on one side of the spinal cord).
The American Spinal Injury Association created the International Standards for Neurological Classification of Spinal Cord Injury to standardize how severity of spinal cord injuries are determined and documented. The standards provide a standardized examination of motor and sensory function to assess the extent of loss after an injury. It examines dermatomes and myotomes to determine the affected spinal cord segments. The examination involves detailed sensory and motor testing to determine sensory and motor levels, neurological level, and whether the injury is complete or incomplete.
The document provides information on assessing spinal cord injuries, including key muscles associated with different spinal cord levels, grading scales for muscle function and sensory ability, how to evaluate motor and sensory subscores, and the steps to classify a spinal cord injury as complete or incomplete. It defines a complete injury as having no sensory or motor function preserved in sacral segments S4-S5, while an incomplete injury has some sensory or motor function spared below the neurological level.
This document provides guidance on assessing patients with spinal cord injuries. It outlines how to take a thorough history including injury details, symptoms, and rehabilitation. The assessment involves observing the patient, palpating for issues like edema, and examining motor function, sensation, reflexes, and functional abilities. Common scales for assessing spinal cord injuries are described, including the ISNCSCI for determining neurological level and the ASIA Impairment Scale for classifying injury severity. The SCIM is also summarized as a measure of independence in self-care, respiration/sphincter control, and mobility.
The document provides an overview of incomplete spinal cord injuries. Some key points:
- Spinal cord injuries can range from complete to incomplete, depending on the severity and location of the lesion in the spinal cord. Incomplete injuries result in partial preservation of motor or sensory function below the injury level.
- The American Spinal Injury Association (ASIA) scoring system is used to clinically classify spinal cord injuries based on motor and sensory function. Injuries are classified on a scale from A (complete injury) to D (near normal function).
- Recovery from incomplete injuries is possible, though most occurs within the first year as spontaneous recovery plateaus. Sensory preservation is a predictor of potential motor recovery.
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
Spinal cord injuries can cause paralysis, sensory loss, and autonomic dysfunction below the level of injury. There are two main types - complete lesions with no preserved function below the injury, and incomplete lesions with some preserved sensation or motor function. Complications include neurogenic bladder, spasticity, autonomic dysreflexia, pressure ulcers, and orthostatic hypotension. Early rehabilitation is important to prevent further issues and maximize recovery of function.
This document defines myotomes and how they are used to determine motor level after spinal cord injury. It provides the following key points:
- A myotome is the group of muscles innervated by a single spinal nerve. The motor level is determined by examining 10 key muscle functions on each side and finding the lowest muscle with a strength of 3 or greater.
- Muscle strength is graded on a scale of 0-5, with detailed descriptions of what each grade represents.
- The document lists the specific muscles assessed for each spinal nerve level from C5 to S1 and the positioning used to test each muscle group.
The document discusses the American Spinal Injury Association (ASIA) scale, which is used to document sensory and motor impairments following a spinal cord injury. The ASIA scale assesses motor and sensory function in different dermatomes and assigns a letter grade from A to E. It allows clinicians to categorize patients based on the completeness of their injury and guide appropriate nursing care, rehabilitation efforts, and prognosis. The document also describes the development of a computerized system to calculate ASIA scores in order to make the assessment more efficient and accurate.
This scale is used to categrise spinal cord injury patients. it helps prognosticate the spinal cord injuires. it also helps define the treatment protocols for spinal cord injury patients. American Spinal Cord Injury Association made this scale so as to make a standardization in assesemnent technique in acute spinal cord injury patients.
This document discusses the management of thoracolumbar spine injuries. It begins by outlining common causes of injury and why the thoracolumbar junction is susceptible. It then covers fracture classification systems including Denis' three column concept and the AO/Magerl classification. Evaluation and management approaches are discussed including non-operative treatment with bracing and operative options depending on fracture pattern and neurological status. Surgical techniques like posterior instrumentation with or without decompression or combined anterior-posterior procedures are mentioned.
This document discusses spinal anatomy, trauma, and injury. It covers the epidemiology, mechanisms, classifications, diagnosis, and management of spinal cord injuries. Some key points include:
- The cervical spine has greater range of motion while the thoracic and lumbar vertebrae are more rigid.
- Spinal cord injuries can be complete or incomplete. Complete injuries have no motor or sensory function below the level of injury while incomplete injuries have some spared function.
- Common mechanisms of injury are motor vehicle accidents, falls, and sports/recreation injuries. Indirect injuries from compression are most likely to cause significant damage.
- Imaging like CT and MRI are important for diagnosis but patient stabilization takes priority over imaging in trauma situations
This document discusses spinal anatomy, trauma, and injury. It covers the epidemiology, mechanisms, classifications, diagnosis, and management of spinal cord injuries. Some key points include:
- The cervical spine has greater range of motion while the thoracic and lumbar vertebrae are more rigid.
- Spinal cord injuries can be complete or incomplete. Complete injuries have no motor or sensory function below the level of injury while incomplete injuries have some spared function.
- Common mechanisms of injury are motor vehicle accidents, falls, and sports/recreation injuries. Indirect injuries from compression are most likely to cause significant damage.
- Imaging like CT and MRI are important for diagnosis but patient stabilization takes priority over imaging in trauma situations
This document discusses obstetrical brachial plexus palsy (OBPP), including its definition, risk factors, classification, investigations, management, and prognosis. OBPP is defined as a flaccid paralysis of the upper extremity caused by traumatic stretching of the brachial plexus during birth. It can be classified based on severity and anatomical location of injury. Management involves both conservative treatments like physiotherapy and surgical interventions like nerve grafts or transfers. Prognosis depends on the severity and location of injury.
This document provides an overview of spinal cord injury (SCI) management. It describes a case of a 47-year-old male who suffered a cervical spine injury in a motor vehicle accident 4 months ago and is now presenting with paraplegia and paraparesis. The document then outlines key topics related to SCI, including anatomy, causes, types, pathophysiology, clinical syndromes, diagnosis, neurological assessment classification, and management. Tables and diagrams are provided to illustrate spinal cord anatomy and tracts, dermatomes, myotomes, and the American Spinal Injury Association classification system.
Traumatic paraplegia & bladder management by dr ashutoshAshutosh Kumar
1) Traumatic paraplegia refers to spinal cord injury in the thoracic, lumbar, or sacral regions resulting in loss of muscle strength in the lower extremities. Initial management involves immobilization and transport to the emergency room for evaluation.
2) The bladder is commonly affected after paraplegia, resulting in either a flaccid or spastic bladder depending on the level of injury. Long-term management involves preventing complications like pressure ulcers, spasticity, and blood clots through rehabilitation therapies.
3) Rehabilitation is critical after spinal cord injury and involves a multidisciplinary team to address issues like bladder management, skin care, spasticity management, and prevention of secondary complications. The
This document summarizes the motor system and descending pathways that control movement. It discusses traditional categories of motor pathways and provides more detailed information on specific tracts like the corticospinal tract. It also describes properties of descending systems such as alpha-gamma co-activation and automatic load compensation. Additionally, it reviews motor areas of the cortex, eye movements, the vestibular system, and the cerebellum.
1) Spinal cord injuries can result from trauma like car accidents or disease and affect 250,000-500,000 people worldwide each year.
2) Patients with significant trauma, loss of consciousness from minor trauma, or symptoms referable to the spine/cord should be treated as having a spinal cord injury (SCI) until proven otherwise.
3) SCI causes primary injury from initial impact and secondary injury from an ongoing cellular process, so management aims to prevent further damage through immobilization, maintaining blood pressure and oxygen levels, and limiting secondary injury cascades.
This document provides an overview of spinal trauma. It begins with relevant spinal anatomy and the epidemiology of spinal injuries. The most common mechanisms of injury are motor vehicle accidents and falls. Clinical signs include neurological deficits that correspond to the level and completeness of injury. Radiological imaging such as X-rays, CT, and MRI are used to identify fractures and spinal instability. Early management focuses on immobilization, corticosteroids, and treating associated conditions like neurogenic shock. Surgical stabilization is indicated for incomplete injuries with neural compression or unstable fractures with neurological deficits. The goals of treatment are to preserve neurological function, minimize compression, stabilize the spine, and rehabilitate the patient.
This document provides an overview of traumatic paraplegia and spinal cord injury. It discusses the classification, epidemiology, mechanisms of injury, assessment, diagnostic modalities, management of complications like bladder dysfunction, and considerations for thoracolumbar injuries. Key points include that spinal cord injury results in changes to motor, sensory or autonomic function, most injuries occur in the cervical spine from motor vehicle accidents in young males, and diagnostic workup involves plain films, CT scans and potentially MRI to evaluate injury extent and neurological status.
Approach to Hypertension in Paediatrics.Halder Jamal
Hypertension in children is defined as blood pressure at or above the 95th percentile for age, sex, and height on at least three occasions. It is categorized based on age and blood pressure readings into normal, elevated, stage 1, or stage 2 levels. Blood pressure is measured using an appropriately sized cuff and after the child has relaxed. Causes can be primary or secondary to conditions affecting the kidneys, endocrine system, neurologic issues, vasculature, or other factors. Investigations include 24-hour ambulatory monitoring, basic lab tests, and studies tailored to clinical suspicion. Treatment focuses on lifestyle changes, managing underlying causes and comorbidities, and may include medications like ACE inhibitors or ARBs.
Circulatory Shock (causes and treatment)Halder Jamal
Shock is the inability to provide sufficient oxygenated blood to tissues, causing organ damage. There are four main types of shock: distributive, hypovolemic, cardiogenic, and obstructive. Distributive shock includes septic shock and anaphylactic shock. Hypovolemic shock can be caused by hemorrhage, diarrhea, or burns. Cardiogenic shock results from heart issues like arrhythmias or myocarditis. Obstructive shock involves issues blocking blood flow like tension pneumothorax. Treatment for shock involves ABCs, fluids, treating the underlying cause, and sometimes hydrocortisone. Complications can include acute renal failure, respiratory failure, and multiple organ dysfunction syndrome.
Weitere ähnliche Inhalte
Ähnlich wie Spinal Trauma (a guide to diagnosis & Treatment)
This document provides guidance on assessing patients with spinal cord injuries. It outlines how to take a thorough history including injury details, symptoms, and rehabilitation. The assessment involves observing the patient, palpating for issues like edema, and examining motor function, sensation, reflexes, and functional abilities. Common scales for assessing spinal cord injuries are described, including the ISNCSCI for determining neurological level and the ASIA Impairment Scale for classifying injury severity. The SCIM is also summarized as a measure of independence in self-care, respiration/sphincter control, and mobility.
The document provides an overview of incomplete spinal cord injuries. Some key points:
- Spinal cord injuries can range from complete to incomplete, depending on the severity and location of the lesion in the spinal cord. Incomplete injuries result in partial preservation of motor or sensory function below the injury level.
- The American Spinal Injury Association (ASIA) scoring system is used to clinically classify spinal cord injuries based on motor and sensory function. Injuries are classified on a scale from A (complete injury) to D (near normal function).
- Recovery from incomplete injuries is possible, though most occurs within the first year as spontaneous recovery plateaus. Sensory preservation is a predictor of potential motor recovery.
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
Spinal cord injuries can cause paralysis, sensory loss, and autonomic dysfunction below the level of injury. There are two main types - complete lesions with no preserved function below the injury, and incomplete lesions with some preserved sensation or motor function. Complications include neurogenic bladder, spasticity, autonomic dysreflexia, pressure ulcers, and orthostatic hypotension. Early rehabilitation is important to prevent further issues and maximize recovery of function.
This document defines myotomes and how they are used to determine motor level after spinal cord injury. It provides the following key points:
- A myotome is the group of muscles innervated by a single spinal nerve. The motor level is determined by examining 10 key muscle functions on each side and finding the lowest muscle with a strength of 3 or greater.
- Muscle strength is graded on a scale of 0-5, with detailed descriptions of what each grade represents.
- The document lists the specific muscles assessed for each spinal nerve level from C5 to S1 and the positioning used to test each muscle group.
The document discusses the American Spinal Injury Association (ASIA) scale, which is used to document sensory and motor impairments following a spinal cord injury. The ASIA scale assesses motor and sensory function in different dermatomes and assigns a letter grade from A to E. It allows clinicians to categorize patients based on the completeness of their injury and guide appropriate nursing care, rehabilitation efforts, and prognosis. The document also describes the development of a computerized system to calculate ASIA scores in order to make the assessment more efficient and accurate.
This scale is used to categrise spinal cord injury patients. it helps prognosticate the spinal cord injuires. it also helps define the treatment protocols for spinal cord injury patients. American Spinal Cord Injury Association made this scale so as to make a standardization in assesemnent technique in acute spinal cord injury patients.
This document discusses the management of thoracolumbar spine injuries. It begins by outlining common causes of injury and why the thoracolumbar junction is susceptible. It then covers fracture classification systems including Denis' three column concept and the AO/Magerl classification. Evaluation and management approaches are discussed including non-operative treatment with bracing and operative options depending on fracture pattern and neurological status. Surgical techniques like posterior instrumentation with or without decompression or combined anterior-posterior procedures are mentioned.
This document discusses spinal anatomy, trauma, and injury. It covers the epidemiology, mechanisms, classifications, diagnosis, and management of spinal cord injuries. Some key points include:
- The cervical spine has greater range of motion while the thoracic and lumbar vertebrae are more rigid.
- Spinal cord injuries can be complete or incomplete. Complete injuries have no motor or sensory function below the level of injury while incomplete injuries have some spared function.
- Common mechanisms of injury are motor vehicle accidents, falls, and sports/recreation injuries. Indirect injuries from compression are most likely to cause significant damage.
- Imaging like CT and MRI are important for diagnosis but patient stabilization takes priority over imaging in trauma situations
This document discusses spinal anatomy, trauma, and injury. It covers the epidemiology, mechanisms, classifications, diagnosis, and management of spinal cord injuries. Some key points include:
- The cervical spine has greater range of motion while the thoracic and lumbar vertebrae are more rigid.
- Spinal cord injuries can be complete or incomplete. Complete injuries have no motor or sensory function below the level of injury while incomplete injuries have some spared function.
- Common mechanisms of injury are motor vehicle accidents, falls, and sports/recreation injuries. Indirect injuries from compression are most likely to cause significant damage.
- Imaging like CT and MRI are important for diagnosis but patient stabilization takes priority over imaging in trauma situations
This document discusses obstetrical brachial plexus palsy (OBPP), including its definition, risk factors, classification, investigations, management, and prognosis. OBPP is defined as a flaccid paralysis of the upper extremity caused by traumatic stretching of the brachial plexus during birth. It can be classified based on severity and anatomical location of injury. Management involves both conservative treatments like physiotherapy and surgical interventions like nerve grafts or transfers. Prognosis depends on the severity and location of injury.
This document provides an overview of spinal cord injury (SCI) management. It describes a case of a 47-year-old male who suffered a cervical spine injury in a motor vehicle accident 4 months ago and is now presenting with paraplegia and paraparesis. The document then outlines key topics related to SCI, including anatomy, causes, types, pathophysiology, clinical syndromes, diagnosis, neurological assessment classification, and management. Tables and diagrams are provided to illustrate spinal cord anatomy and tracts, dermatomes, myotomes, and the American Spinal Injury Association classification system.
Traumatic paraplegia & bladder management by dr ashutoshAshutosh Kumar
1) Traumatic paraplegia refers to spinal cord injury in the thoracic, lumbar, or sacral regions resulting in loss of muscle strength in the lower extremities. Initial management involves immobilization and transport to the emergency room for evaluation.
2) The bladder is commonly affected after paraplegia, resulting in either a flaccid or spastic bladder depending on the level of injury. Long-term management involves preventing complications like pressure ulcers, spasticity, and blood clots through rehabilitation therapies.
3) Rehabilitation is critical after spinal cord injury and involves a multidisciplinary team to address issues like bladder management, skin care, spasticity management, and prevention of secondary complications. The
This document summarizes the motor system and descending pathways that control movement. It discusses traditional categories of motor pathways and provides more detailed information on specific tracts like the corticospinal tract. It also describes properties of descending systems such as alpha-gamma co-activation and automatic load compensation. Additionally, it reviews motor areas of the cortex, eye movements, the vestibular system, and the cerebellum.
1) Spinal cord injuries can result from trauma like car accidents or disease and affect 250,000-500,000 people worldwide each year.
2) Patients with significant trauma, loss of consciousness from minor trauma, or symptoms referable to the spine/cord should be treated as having a spinal cord injury (SCI) until proven otherwise.
3) SCI causes primary injury from initial impact and secondary injury from an ongoing cellular process, so management aims to prevent further damage through immobilization, maintaining blood pressure and oxygen levels, and limiting secondary injury cascades.
This document provides an overview of spinal trauma. It begins with relevant spinal anatomy and the epidemiology of spinal injuries. The most common mechanisms of injury are motor vehicle accidents and falls. Clinical signs include neurological deficits that correspond to the level and completeness of injury. Radiological imaging such as X-rays, CT, and MRI are used to identify fractures and spinal instability. Early management focuses on immobilization, corticosteroids, and treating associated conditions like neurogenic shock. Surgical stabilization is indicated for incomplete injuries with neural compression or unstable fractures with neurological deficits. The goals of treatment are to preserve neurological function, minimize compression, stabilize the spine, and rehabilitate the patient.
This document provides an overview of traumatic paraplegia and spinal cord injury. It discusses the classification, epidemiology, mechanisms of injury, assessment, diagnostic modalities, management of complications like bladder dysfunction, and considerations for thoracolumbar injuries. Key points include that spinal cord injury results in changes to motor, sensory or autonomic function, most injuries occur in the cervical spine from motor vehicle accidents in young males, and diagnostic workup involves plain films, CT scans and potentially MRI to evaluate injury extent and neurological status.
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Hypertension in children is defined as blood pressure at or above the 95th percentile for age, sex, and height on at least three occasions. It is categorized based on age and blood pressure readings into normal, elevated, stage 1, or stage 2 levels. Blood pressure is measured using an appropriately sized cuff and after the child has relaxed. Causes can be primary or secondary to conditions affecting the kidneys, endocrine system, neurologic issues, vasculature, or other factors. Investigations include 24-hour ambulatory monitoring, basic lab tests, and studies tailored to clinical suspicion. Treatment focuses on lifestyle changes, managing underlying causes and comorbidities, and may include medications like ACE inhibitors or ARBs.
Circulatory Shock (causes and treatment)Halder Jamal
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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6. • The injury carries a double threat: damage to the
vertebral column and damage to the neural tissues.
• Neurological injury is not always immediate and may
occur (or be aggravated) only if and when there is
movement.
• Fortunately, only 10% of spinal fractures are unstable
and less than 5% are associated with cord damage.
Spinal Injury
7. Stable Injury: injury of single column → normal daily
activity does not cause displacement of vertebral
components and no risk of neural tissue damage.
Unstable injury: injury of two or three columns → risk of
displacement of vertebral components:
• Risk of neural tissue damage
• Unacceptable deformity
Stability
8. Direct mechanism:
• Bullet (e.g gunshot)
• Blow
• Knife
Indirect mechanism (most cases):
• Road tra
ffi
c accidents
• Fall from height
• Sport injuries
• Head trauma
Mechanism and Causes
9. Spinal trauma is one of the few situations where
management starts before diagnosis.
• All trauma patients MUST be regarded as spinal injury UPO.
• The slightest possibility of spinal trauma should be treated by
immobilization until the patient has been resuscitated and
other life-threatening injuries have been identi
fi
ed and treated.
• Principles of ATLS applies to all (AcBCDE).
• The
fi
nding of a spinal injury makes it more (not less) likely that
there will be a second injury at another level (10-15%).
Approach
10. Hx:
• Mechanism of injury
• Pain
• Onset and duration of neurological symptoms
Ex (of entire spine using spinal log-roll)
• Look: penetrating wounds, swelling, ecchymosis
• Feel: tenderness, palpable steps or gaps
• Move: MUST be avoided.
• Neurology: ASIA
Approach
12. Page 2/2
A = Complete. No sensory or motor function is preserved
in the sacral segments S4-5.
B = Sensory Incomplete. Sensory but not motor function
is preserved below the neurological level and includes the
sacral segments S4-5 (light touch or pin prick at S4-5 or
deep anal pressure) AND no motor function is preserved
more than three levels below the motor level on either side
of the body.
C = Motor Incomplete. Motor function is preserved at the
most caudal sacral segments for voluntary anal contraction
(VAC) OR the patient meets the criteria for sensory
incomplete status (sensory function preserved at the most
caudal sacral segments S4-5 by LT, PP or DAP), and has
some sparing of motor function more than three levels below
the ipsilateral motor level on either side of the body.
(This includes key or non-key muscle functions to determine
motor incomplete status.) For AIS C – less than half of key
muscle functions below the single NLI have a muscle
grade ≥ 3.
D = Motor Incomplete. Motor incomplete status as
defined above, with at least half (half or more) of key muscle
functions below the single NLI having a muscle grade ≥ 3.
E = Normal. If sensation and motor function as tested with
the ISNCSCI are graded as normal in all segments, and the
patient had prior deficits, then the AIS grade is E. Someone
without an initial SCI does not receive an AIS grade.
Using ND: To document the sensory, motor and NLI levels,
the ASIA Impairment Scale grade, and/or the zone of partial
preservation (ZPP) when they are unable to be determined
based on the examination results.
ASIA Impairment Scale (AIS) Steps in Classification
Muscle Function Grading
Sensory Grading
When to Test Non-Key Muscles:
0 = Total paralysis
1 = Palpable or visible contraction
2 = Active movement, full range of motion (ROM) with gravity eliminated
3 = Active movement, full ROM against gravity
4 = Active movement, full ROM against gravity and moderate resistance in a
muscle specific position
5 = (Normal) active movement, full ROM against gravity and full resistance in a
functional muscle position expected from an otherwise unimpaired person
NT = Not testable (i.e. due to immobilization, severe pain such that the patient
cannot be graded, amputation of limb, or contracture of > 50% of the normal ROM)
0*, 1*, 2*, 3*, 4*, NT* = Non-SCI condition present a
0 = Absent 1 = Altered, either decreased/impaired sensation or hypersensitivity
2 = Normal NT = Not testable
0*, 1*, NT* = Non-SCI condition present a
In a patient with an apparent AIS B classification, non-key muscle functions
more than 3 levels below the motor level on each side should be tested to
most accurately classify the injury (differentiate between AIS B and C).
The following order is recommended for determining the classification of
individuals with SCI.
INTERNATIONAL STANDARDS FOR NEUROLOGICAL
CLASSIFICATION OF SPINAL CORD INJURY
Movement
Shoulder: Flexion, extension, adbuction, adduction,
internal and external rotation
Elbow: Supination
Elbow: Pronation
Wrist: Flexion
Finger: Flexion at proximal joint, extension
Thumb: Flexion, extension and abduction in plane of thumb
Finger: Flexion at MCP joint
Thumb: Opposition, adduction and abduction
perpendicular to palm
Finger: Abduction of the index finger
Hip: Adduction
Hip: External rotation
Hallux and Toe: DIP and PIP flexion and abduction
Hallux: Adduction
Hip: Extension, abduction, internal rotation
Knee: Flexion
Ankle: Inversion and eversion
Toe: MP and IP extension
Root level
C5
C6
C7
C8
T1
L2
L3
L4
L5
S1
4. Determine whether the injury is Complete or Incomplete.
(i.e. absence or presence of sacral sparing)
If voluntary anal contraction = No AND all S4-5 sensory scores = 0
AND deep anal pressure = No, then injury is Complete.
Otherwise, injury is Incomplete.
6. Determine the zone of partial preservation (ZPP).
The ZPP is used only in injuries with absent motor (no VAC) OR sensory
function (no DAP, no LT and no PP sensation) in the lowest sacral segments
S4-5, and refers to those dermatomes and myotomes caudal to the sensory
and motor levels that remain partially innervated. With sacral sparing of
sensory function, the sensory ZPP is not applicable and therefore “NA” is
recorded in the block of the worksheet. Accordingly, if VAC is present, the
motor ZPP is not applicable and is noted as “NA”.
3. Determine the neurological level of injury (NLI).
This refers to the most caudal segment of the cord with intact sensation and
antigravity (3 or more) muscle function strength, provided that there is normal
(intact) sensory and motor function rostrally respectively.
The NLI is the most cephalad of the sensory and motor levels determined in
steps 1 and 2.
2. Determine motor levels for right and left sides.
Defined by the lowest key muscle function that has a grade of at least 3 (on
supine testing), providing the key muscle functions represented by segments
above that level are judged to be intact (graded as a 5).
Note: in regions where there is no myotome to test, the motor level is
presumed to be the same as the sensory level, if testable motor function
above that level is also normal.
1. Determine sensory levels for right and left sides.
The sensory level is the most caudal, intact dermatome for both pin prick
and light touch sensation.
a
Note: Abnormal motor and sensory scores should be tagged with a ‘*’ to indicate an
impairment due to a non-SCI condition. The non-SCI condition should be explained
in the comments box together with information about how the score is rated for
classification purposes (at least normal / not normal for classification).
5. Determine ASIA Impairment Scale (AIS) Grade.
Is injury Complete? If YES, AIS=A
Is injury Motor Complete? If YES, AIS=B
Are at least half (half or more) of the key muscles below the
neurological level of injury graded 3 or better?
If sensation and motor function is normal in all segments, AIS=E
Note: AIS E is used in follow-up testing when an individual with a documented
SCI has recovered normal function. If at initial testing no deficits are found, the
individual is neurologically intact and the ASIA Impairment Scale does not apply.
(No=voluntary anal contraction OR motor
function more than three levels below the motor
level on a given side, if the patient has sensory
incomplete classification)
13. A: complete spinal cord injury
B: sensation present, motor absent
C: sensation present, motor present but not useful (MRC <3/5)
D: sensation present, motor useful (MRC ≥3/5)
E: Normal function
This is modi
fi
ed from Frankel grading classi
fi
cation.
ASIA Impairment Scale (AIS)
14.
15. X-Ray (plain radiographs):
• Cervical: AP, lateral and open mouth views.
• Whole spine if cervical # con
fi
rmed or suggestive mechanism
• Assess
1. Prevertebral soft-tissue swelling (hematoma)
2. Sagittal alignment (three imaginary lines)
3. For instability:
- sagittal translation of 3.5 mm
- sagittal angulation of >11°
Imaging
22. CT:
• Remains the gold standard in spinal trauma and is indicated
for patients with suspected or visible injuries on X-Ray.
• Screening cervical CT in head trauma
• Usually CT of chest and abdomen done in polytrauma also
shows spine.
Imaging
23. Plain x-ray alone may be insuf
fi
cient to show the true state of incident. This x-ray showed the
fracture, but it needed a CT scan to reveal the large fragment encroaching on the spinal canal
26. MRI:
• Shows intervertebral discs, ligaments & neural structures.
• Indicated for all patients with neurological signs and those
who are considered for surgery.
Imaging
31. The objectives of treatment are:
■ To preserve neurological function.
■ To relieve any reversible neural compression.
■ To restore alignment of the spine.
■ To stabilize the spine.
■ To rehabilitate the patient
Management
32. Realignment: traction, collar, halo jacket, braces.
Surgery: The indication is in
fl
uenced by the injury pattern,
level of pain, degree of instability and the presence of a
neurological de
fi
cit. The only absolute indication is
deteriorating neurological function.
• Stabilisation (ORIF)
• Decompression of neural elements (bony fragments,
hematoma)
Corticosteroids: although e
ff
ective for malignant cord
compression, they are not useful in traumatic cases.
Management
38. • Survival decreases with older age of acquiring injury and more severe neurological injury.
• Survival is similar for those who survive
fi
rst 24 hours compared to those who survive
fi
rst
year post injury (except for ventilator dependent)
• Complete spinal cord injury has <5% chance of recovery, and it drops to basically zero if
does not recover in
fi
rst 72 hours.
Prognosis