spine and spinal cord trauma

8/18/2019 Spine and Spinal Cord Trauma

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Spine and Spinal Cor

Trauma


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Spinal Cord Tracts


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Dermatomes and Myotom


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Neurogenic Shock Versus SpShock

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Neurogenic shock results from impairment of thedescending sympathetic pathways in the cervicaupper thoracic spinal cord.

• This condition results in the loss of vasomotor to

which leads to hypotension and in sympatheticinnervation to the heart resulting in bradycardia

• Neurogenic shock is rare in spinal cord injury belevel of T6.


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Neurogenic Shock Versus SpShock

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The blood pressure may often be restored by the juse of vasopressors after moderate volume replac

• Atropine may be used to counteract hemodynamsignicant bradycardia.

• Spinal shock refers to the !accidity "loss of muscleand loss of re!e$es seen after spinal cord injury inthe duration of this state is variable


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Efects on The Organ Syste

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%ypoventilation due to paralysis of the intercostal muscresult from an injury involving the lower cervical or uppthoracic spinal cord.

• &f the upper or middle cervical cord is injured' the diapalso is paraly(ed because of involvement of the C) to

segments which innervate the diaphragm via the phren

• The inability to perceive pain may mask a potentially seinjury elsewhere in the body' such as the usual signs ofabdomen.


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Spinal Cord Syndromes

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Central cord syndrome is characteri(ed by lower motor(accid! paralysis o" upper lim#s with upper motor ne(spastic! paralysis o" lower lim#s and intact perianalsensation (sacral sparing!.

• This syndrome occurs after a hypere$tension injury in a pat

pree$isting cervical canal stenosis "often due to degenerativosteoarthritic changes#.

• +ecovery usually follows a characteristic pattern' with the loe$tremities recovering strength rst' bladder function ne$t' pro$imal upper e$tremities and hands last.


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$nterior cord syndrome is characteri(ed byparaplegia and a dissociated sensory loss wloss o" pain and temperature sensation. ,orscolumn function "position' vibration' and deep psense# is preserved.

• Anterior cord syndrome is due to infarction of thin the territory supplied by the anterior spinal ar

This syndrome has the poorest prognosis.


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%rown&S'uard syndrome results from hemisof the cord' usually as a result of a penetrating t

• &n its pure form' the syndrome consists of ipsilamotor loss "corticospinal tract# and ipsilateral

position sense "dorsal column#' associated witcontralateral loss o" pain and temperature sensation beginning one to two level below the linjury "spinothalamic tract#.


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-eneral anagement

&/01&2AT&/N• Suspected spine injury should be immobili(ed ab

and below the suspected injury site until a fractue$cluded by $3ray e$amination. Spinal protectionbe maintained until a cervical spine injury is e$c

• 4roper immobili(ation is achieved with the patieneutral position5that is' supine without rotatingbending the spinal column.


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-eneral anagement

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&mmobili(ation of the neck with a semirigid collar doesensure complete stabili(ation of the cervical spine.

• &mmobili(ation using a spine board with appropriate bdevices is more eective in limiting certain neck motiouse of long spine boards is recommended.

• Cervical spine injury re7uires continuous immobili(atioentire patient with a semirigid cervical collar' headimmobili(ation' backboard' tape' and straps before antransfer to a denitive3care facility.


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-eneral anagement

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The airway is of critical importance in patients wspinal cord injury' and early intubation should beaccomplished if there is evidence of respiratorycompromise.

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,uring intubation' the neck must be maintained neutral position and &f necessary' a sedative or pagent "short3acting' reversible# may be administwhile ensuring ade7uate airway protection' contventilation.


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-eneral anagement

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+emoval of the board is often done as part of the seconsurvey when the patient is logrolled for inspection andpalpation of the back.

• The safe movement' or logrolling' of a patient with an or potentially unstable spine re7uires planning and the

assistance of four or more individuals' depending on ththe patient.

• Neutral anatomic alignment of the entire vertebral colube maintained while rolling and lifting the patient.


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-eneral anagement


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-eneral anagement

&NT+A89N/:S ;1:&,S• &n patients in whom spine injury is suspected'

intravenous !uids are administered as they woulusually be for resuscitation of trauma patients.

• &f active hemorrhage is not detected or suspectepersistent hypotension should raise the suspicioneurogenic shock. 4atients with hypovolemic shousually have tachycardia' whereas those withneurogenic shock classically have bradycardia.


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-eneral anagement

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&f the blood pressure does not improve after a !uidchallenge' the judicious use of vasopressors may bindicated.

• 4henylephrine hydrochloride' dopamine' or norepinis recommended. /ver(ealous !uid administration cause pulmonary edema in patients with neurogen

• A urinary catheter is inserted to monitor urinary ouand prevent bladder distention.

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