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