Download MBBS Physical Medicine and Rehabilitation Presentations 13 Neurological Examination of Spinal Injury Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Physical Medicine and Rehabilitation 13 Neurological Examination of Spinal Injury PPT-Powerpoint Presentations and lecture notes


NEUROLOGICAL EXAMINATION

OF SPINAL CORD INJURY

Department Of PMR

ANATOMY OF SPINE

? 7 cervical vertebrae
? 12 thoracic vertebrae
? 5 lumbar vertebrae
? 5 fused sacral vertebrae
? 3-4 smal bones comprising the coccyx
q Spinal cord ends as conus medul aris at

level of first lumbar vertebra lumbar and

sacral nerve roots exit below this and
form the cauda equina




ANATOMY OF SPINE

ANATOMY OF SPINE


NEUROANATOMY

1&2 Posterior Columns: convey Ipsilateral information

about two Point discrimination, proprioception And

vibratory sense

5 Lateral Spinothalamic Tract: carries Pain and

Temperature Information From contralateral extremity

4 Lateral Corticospinal Tract: Carries Motor Information

from Contralateral Brain to Ipsilateral Extremity

MECHANISMS OF INJURY

? Compression
? Flexion Injury
? Extension Injury
? Rotation


COMPRESSION INJURY

? Vertebral body fracture
? Disc herniation
? Epidural hematoma
? Displacement of posterior wal of the vertebral body

JEFFERSON FRACTURE

? A comminuted fracture of the ring of C1.
? Compression of base of skul against C1
? Results in cracking the ring of C1
? Best seen on open mouth x-ray


ATLANTOAXIAL AND DENS

FRACTURES

? The result of hyperflexion or hyperextension injuries
8% of Dens Fractures associated with C1 fractures
C2 Fractures
Dens Fracture :
? Hyperflexion Injury
Hangman Fracture :
? Hyperextension Injury
? Traumatic spondylolisthesis of the axis
? Bilateral fractures through the pars interarticularis of the axis

FLEXION TEARDROP FRACTURE

Hyperflexion of the subaxial cervical spine
Retropulsion of the larger portion of a vertebral

body into the spinal canal, detached from an

anterior fragment (teardrop)

Often associated with an anterior cord

syndrome.


CLAY-SHOVELER'S

FRACTURE

? Avulsion fracture of the spinous process of C6,

C7, or T1.

? It is not typical y associated with neurologic

injury.

THORACOLUMBAR TRAUMA

q Mechanism of injury
? Compression
? Distraction
? Rotation


CHANCE FRACTURE

? Failure of al three columns due to flexion-distraction
? Fal s from a height
? Strikes part of the torso on an immovable object
? Injury pattern most likely to cause SCI

THE THREE-COLUMN CONCEPT OF SPINAL

ANATOMY

? The anterior column: ALL + anterior portion of the vertebral body + anterior portion of the

disk.

? The middle column: posterior portion of the vertebral body + the posterior portion of the disk

+ PLL

? The posterior column: the pedicles facet joints + laminae + supraspinous ligament,

interspinous ligament + facet joint capsule + ligamentum flavum.


STABLE Vs UNSTABLE FRACTURE

? When the integrity of the middle and either the anterior or

the posterior column is affected, the spine is likely to be

unstable.

qThe columns can be affected by:
? Fracture
? Ligamentous disruption
? Gunshot wounds
Because of the nature of the injury, can affect more than one

column and the spine can stil remain stable.

SCI can occur without obvious radiographic findings.

CLINICAL SYNDROMES AFTER INCOMPLETE

SPINAL CORD INJURY

? Central Cord Syndrome
? Brown-Sequard Syndrome
? Anterior Cord Syndrome
? Conus Medul aris Syndrome
? Cauda Equina Syndrome


CENTRAL CORD SYNDROME

? Motor>Sensory Loss
? Upper>Lower Extremity Loss
? Distal >Proximal Muscle Weakness
? Classical y occurs with hyperextension
injuries of the cervical spine

BROWN-SEQUARD LESION

q A burst fracture with posterior displacement
of bone fragments compresses one side of the spinal

cord.

? Loss of Ipsilateral Proprioception, Light Touch and
Motor Function
? Loss of Contralateral Pain and Temperature

Sensation

? Due to hemisection of the cord due to penetrating

injury

? Incomplete lesions most common


ANTERIOR CORD SYNDROME

q A large disk herniation compresses
the anterior aspect of the spinal cord,
leaving the dorsal columns intact.

? Loss of Motor function, Pain and
Temperature Sensation
? Preservation of Light touch, Vibratory Sensation
and Proprioception

CONUS MEDULLARIS SYNDROME

A burst fracture of with posterior displacement of bone
fragments compresses the conus medul aris.

Injury to sacral cord, lumbar nerve roots causing
? Areflexic bladder
? Loss of control of bowels
? Knee jerk relexes preserved, ankle jerk absent
? Signs similar to cauda equina syndrome except
more likely to be bilateral


CAUDA EQUINA SYNDROME

q A central disk herniation at L4-L5 level
compresses the cauda equina.

? Injury to nerve roots and not spinal cord itself
? Muscle weakness and decreased sensation
in affected dermatomes
? Decreased bowel and bladder control

CLASSIFICATION OF SPINAL CORD

INJURY

Patients are classified according to the ASIA Impairment Scale (AIS)
q Combined efforts from

vASIA: American Spinal Injury Association

vISCOS: International Spinal Cord Society
COMPONENTS OF THE TEST

Three Main Parts to the Exam:
? Strength Testing
? Light Touch Sensation
? Pinprick Sensation

Lowest Level of motor control:
? Voluntary Anal Contraction
? Lowest Level of Sensation:
? Deep Anal Pressure

NEUROLOGIC EXAM: DERMATOMES

? C5- Deltoid

? T12 ? Symphysis Pubis

? C6 ? Thumb

? L4 ? Medial aspect of leg

? C7 ? Middle Finger

? L5 - Space between first and second

toes

? C8 - Little Finger

? S1 ? Lateral border of the foot

? T4 ? Nipple

? S3 ? Ischial Tuberosity

? T8 ? Xiphoid

? S4-5 ? Perianal region

? T10 - Umbilicus


MYOTOMES

? C5 ? Deltoid

? L2 - Hip flexion

? C6 ? Wrist Extensors

? L3 - Knee Extension

? C7 ? Elbow Extensor

? L4 - Ankle dorsiflexion

? C8 ? Finger flexors

? L5 - Toe extension

? T1 ? Little finger abduction

? S1 ? Plantar flexion



Thank You

This post was last modified on 08 April 2022