Spinal Cord

Injuries

Who to immobilise

Immobilisation

“we argue that fully alert, stable and co-operative trauma patients do not require the application of a semi-rigid

cervical collar, even if they are suspected of underlying cervical spine fracture, unless their conscious level

deteriorates or they find the short-term support of a cervical collar helpful

When to image?

v

NEXUS

Canadian

What are you looking at?

Vertebral Body

Pedicle

Lamina

Spinous Process

Ligaments

Ant

erio

r Lo

ngitu

dina

l Lig

amen

t

Post

erio

r Lo

ngitu

dina

l Lig

amen

t

Liga

men

tum

Fla

va

Ant

erio

r Lo

ngitu

dina

l Lig

amen

t

Post

erio

r Lo

ngitu

dina

l Lig

amen

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Liga

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3 Columns in Spinal Injury

AntMidPost

What type of injuries to

expect

•Young male•Fall 10 m on building site•Not able to mobilise on scene•Back pain, but no other apparent injuries

Examination•Below T11

•Flaccid Paralysis•Absent sensation to pain•Fine touch present at all levels

Posterior Columns

CorticoSpinal

Spino

Thalam

ic

Touch

Motor

Pain

Anterior Cord Syndrome

Touch

Motor

Pain

Touch

Motor

Pain

Text

Touch

Motor

Pain

Incomplete Cord Injury

History•60 year old male•Fall from waterski - fairly low speed

Symptoms•Complaining of neck and arm pain•Arms feel weak

Examination•Sore - but all in the arms and neck•Legs moving fine•Power 3/5 in the upper limbs, esp proximally

Touch

Motor

Pain

Central Cord Syndrome

Arms

Trunk

Legs

Arms

Trunk

Legs

The Upper limbs lie more centrally in the

tracts

Why the upper limb distribution?

Spinal Stenosis

•50M chronic LBP•significant increase in low back pain•Some weakness in both legs but variable between sides and levels.•Similar picture regarding sensation

Is his neurology inconsistent and functional?

L3

L5

L1

L2

L4

CES Red Flags

•Urinary incontinence/retention•Saddle anaesthesia•Decreased anal tone/faecal incontinence•Bilateral neurological symptoms/deficit•Major motor/sensory impairment

End