SCI

Question 0

4 types of compression fractures

Answer 0

1. tear drop, chip breaks off
2. entire upper 1/2 of vertebrae crushed
3. fx of both superior and inferior plates
4. burst fx, crushes and destroys entire vertebral body

Question 1

pathological changes after SCI (3)

Answer 1

1. ischemia
2. inflammation/ ion derrangement** causes the most damage
   due to ion concentration shifts
3. apoptosis in oligodendrocytes (cells that make myelin)

Question 2

flexion cervical injury (3)

Answer 2

1. very unstable due to dislocation of posterior ligaments
2. anterior dislocation of C-spine => shearing of cord
3. likely complete

Question 3

hyperextension injury

Answer 3

1. most common C4-C5
2. acceleration/decceleration injury
3. can be elderly/ DJD
4. cord involvement likely, not mandatory

Question 4

flexion/rotation cervical injury

Answer 4

1. most common C5-C6
2. unilateral facet joint dislocation => narrowing of canal
3. often non neuro involvement above C5 because vertebral foramen large enough

Question 5

complete transection def

Answer 5

actual space between 2 segments of cord

Question 6

complete lesions usually due to… (3)

Answer 6

1. bilateral facet joint dislocation
2. thoracolumbar flex/rotation injury (because so much force needed)
3. transcanal projectile (GSW)

Question 7

incomplete lesions due to… (3)

Answer 7

1. unilateral facet jt dislocation
2. cervical spondylosis (1 vertebra slips forward)
3. projectile injuries w/o canal penetration

Question 8

dorsal column medial leminiscal
 tracts
 where they cross
 what they are responsible for
 general location

Answer 8

fasiculus gracilis & cuneatus
cross in medulla
fine touch, 2 point descrimination, proprioception
posterior cord

Question 9

anterolateral 
 tracts
 where they cross
 what they are responsible for
 general location

Answer 9

tracts: anterior & lateral spinothalamic

cross immediately

gross touch, pain & temp

close together, anterior

Question 10

motor pathways
tracts
general location & organization

Answer 10

lateral & medial corticospinal

lateral is more posterior & arranged with tracts CTLS (medial -> lateral)
so central cord syndrome leads to loss of UE > LE

Question 11

cauda equina
 location/ what it is
 special thing to know
 syndrome:
 causes (5)
 symptoms (3) (compared to conus medularis syndrome)

Answer 11

nerve roots at L1-L2
junction of CNS &PNS so symptoms are PNS = LMN

syndrome is caused by:

1. tumor
2. trauma
3. spinal stenosis
4. bleeding
5. inflammation

symptoms:

1. gradual presentation
2. asymmetrical saddle anasthesia
3. asymmetrical flaccid paralysis

Question 12

conus medullaris
location/ what it is

syndrome:
causes (3)
symptoms (3) (compared to cauda equina syndrome)

Answer 12

distal bulbous end of SC

causes of syndrome:

1. damage from compression (most common)
2. stenosis
3. trauma

symptoms:

1. bilateral
2. sudden onset
3. flaccid paralysis

Question 13

quick and dirty ASIA motor assessment

C5-T1

Answer 13

C5- biceps
C6- wrist extensors
C7- elbow extensors
C8- finger flexion
T1- finger adduction (intrinsics)

Question 14

quick and dirty ASIA motor assessment

L2-S1

Answer 14

L2- hip flexors
L3- knee extensors
L4- ankle DF
L5- toe extensors
S1- ankle PF

Question 15

ASIA motor scoring
higest level possible
LEMS (2) and what they mean for potential ambulation

Answer 15

highest motor score is 100; 25 points/ extremity

LEMS 30 = likelihood of being a community ambulator

Question 16

ASIA scoring if pt has contracture/ spasticity (3)

Answer 16

1. if ROM is limited by less than 25-50% of range, grade throughout available range
2. if limited >50% graded as NT
3. if spasticity or clonus prohibits testing, graded as NT

Question 17

ASIA sensory testing
scores (3)
complete vs. incomplete

Answer 17

0- absent or cannot reliably distinguish btwn sharp/dull
1- impaired (diminished sensation) but can reliably distinguish btwn sharp/dull
2- normal and reliable

if pt has 0 throughout, do deep anal sensation to test S4-5 to determine if complete or incomplete