TRAUMA TO SPINAL

CORDBy : Mustafa Mushtaq Kirkuk University College of medicine

WHAT IS TRAUMA!? In general it has two meaning: In physical medicine, major trauma is

injury or damage to a biological organism caused by physical harm from an external source

In psychology, Psychological trauma  is a type of damage to the psyche that

occurs as a result of a severely distressing event.

CLASSIFICATION OF MOST COMMON SPINAL CORD TRAUMA

Injury :

Spinal Shock:

Vertebral Herniation:

It has two types

Complete: a person loss all ability to feel and voluntary move below the level of injury

Incomplete: there is some functioning below the level of injury

Complete spinal injury : occurs when there is a loss of function below the

site of injury. The brain is no longer able to send signals down the spinal cord past the lesion line and depending on which part of the spinal cord is damaged

Has two types Paraplegia

Teteaplegia

TYPES OF COMPLETE INJURY 1-Paraplegia: Complete or incomplete paraplegia can arise when

a spinal injury occurs below the neck(C1-C8)starts in thoracic region (T1-T12). Damage to the following regions of the spine can result in paraplegia , its effects may range from impaired leg movement to total paralysis of the legs and trunk up to chest level

It can be present in

Thoracic (T1-T12) the upper middle region

Lumbar (L1 to L5) the lower middle region.

Sacral (S1 to S5the lower region

Thoracic (T1 to T12) – the upper middle region

Its symptoms 1-Paralysis of lower body and legs. 2- Varying abdomina strength / upper-body strength. 3-The lower the injury, the greater the strength. 4-This affects the ability to balance while sitting. 5-Inability for a man to achieve erection or ejaculation

Lumbar (L1 to L5) – the lower middle region. Symptoms 1-Normal upper-body strength. 2-May possess ability to havePsychogenic erections(thought controlled)

Sacral (S1 to S5) – the lower region

may loss of sexual function

In addition to same Lumbar symptoms may possess very limited ability to control extension / flexion of the hip, thighs, knees and toes

At the end we must mention that The degree of paralysis for complete paraplegia varies, and it depends on the site of injury on the spinal cord. Whilst use of the arms and hands is retained in paraplegia

TETRAPLEGIA   (sometimes called quadriplegia) occurs when a

significant injury is sustained to the neck in the cervical region of the spine (C1—C7).

It can result in complete or incomplete paralysis of the arms, legs and body.

 partial or total loss of use of all four limbs and torso

Complete tetraplegia is the most severe and debilitating type of spinal injury. It is the loss of function and sensation in the arms, legs and body caused by complete damage to the spinal cord in the neck (cervical region).

Universal effects (anywhere on the cervical region)

• Complete paralysis of the body and legs .• Loss of sexual function.• Loss of bladder and bowel control.

What is Function after complete cervical spinal cord injury?

C1–-C4 → Full paralysis of the limbsC5 →Paralysis of the wrists, hands, and tricepsC6 → Paralysis of the wrist flexors, triceps, and

handsC7–C8 →Some hand muscle weakness,

difficulty grasping and releasingRespiratory EffectC1 → Cannot breathe without mechanical

ventilationC5-C8 → resparatory effect Difficulty

coughing, may need help clearing secretions

INCOMPLETE SPINAL INJURY If the spinal cord has only been partially

damaged With an incomplete injury, it is possible that some motor and sensory function may remain below the level of the injury .

However, the effects vary from patient to patient

It has 5 types

Anterior cord syndrome

Posterior cord syndromeCentral cord syndrome

Brown-Sequard syndrome

Cauda equina syndrome

ANTERIOR CORD SYNDROME Damage will have occurred towards the front of the

spinal cord. Usually caused by hyperflexion injuries .

Major Symptoms : 1-Pain and temperature loss. 2-Paralysis below the level of lesion. 3-Area supplied by anterior spinal artery is affected.

POSTERIOR CORD SYNDROME Damage will have occurred towards the back of the

spinal cord. Occurs due to neurosyphilis,diabetes mellitus

Usually occurs 10 to 20 yrs after infection The patient may retain muscle power, pain and

temperature sensation. However, they may experience difficulty in coordinating movement of their limbs.

Other Symptoms1-Impaired position and vibration sense in LL2-Sensory ataxia.3-Numbness or paresthesia are frequent complaints..

Loss of position vibration and touch sense.preservation of power ,pain and tempreture

CENTRAL CORD SYNDROME Damage will have occurred in the centre of the

spinal cord. Preservation of control over the bowel and bladder

may also be possible.

Symptoms:1-Upper limb weakness >lowerlimb 2-Shawl like distribution of sensory loss.3-Pain and temperature are affected.4-Touch and proprioception are preserved.

BROWN-SEQUARD SYNDROME Damage will have occurred towards one side of the

spinal cord. Usually caused by penetrating trauma or tumour.

Symptoms : ● This causes an impaired or loss of movement to

the injured side____ and opposite is still Normal ● the loss or impaired pain ,temperature sensation

on the opposite of the lesion.

CAUDA-EQUINA SYNDROME Is a compression of the nerves that are located

between the L1 and L2 vertebrae. Occurs due to acute disk herniation

Injury will cause partial or complete loss of movement and sensation.

Symptoms ●flaccid lower extremities ● Knee and ankle jerk absent. ● Saddle anaesthesia ● Loss of sensation around perineum,anus,genitals.

CAUDA-EQUINA SYNDROME

SPINAL SHOCK  The term "spinal shock" applies to all phenomena

surrounding physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most spinal reflex activity below the level of the injury.

This term used in different sense : 1— hypotension (shock) that follows spinal cord injury (SBP usually = 80 mmHg) ●A-interruption of sympathetic Caused by multiple factors 1- loss of vascular tone (vasoconstrictors) below the level

of injury 2-leaves parasympathetic relatively unopposed causing

bradycardia ●B-loss of muscle tone due to paralysis below level of injury

results in venous pooling and thus relative hypovolemia ●C-blood loss of associated wounds → true hypovolemia

2—transients loss of al neurologic function →flaccid paralysis and areflexia lasting varing period in 1-2 week or sometimes months

Is transients physiological rather than anatomical reflex depression of cord function below the level of injury with associated with sensorimotor function present in

Symptoms :

These symptoms tend to 24-48 hrs until the return of the bubocarvenosus rflex and anal wink

1-Hypotension 2-Bradycardia 3-Flaccid paralysis 4-Hypothermia 5-Loss of sensation 6-Areflexia 7-Urinary and bladder incontinence 8-Sweating

VERTEBRAL DISC HERNIATION:

Disc Herniation is usually due to age-related degeneration of the outer ring also known as a slipped disc , is a medical condition affecting the spine in which a tear in the outer, fibrous ring of an intervertebral discThe majority of spinal disc Herniation cases occur in: ●The Lumbar region (95% in L4-L5 or L5-S1) 

●The second most common site is the Cervecal region (C5-C6, C6-C7).

●The Thpracic region accounts for only 0.15% to 4.0% of cases. 

●High-Cervical Nerves (C1 – C4)● Low-Cervical Nerves (C5 – C8)● Thoracic Nerves (T1 – T5)● Thoracic Nerves (T6 – T12)● Sacral Nerves (S1 – S5)● Lumbar Nerves (L1 – L5)

Types

Can be caused because of Degenerative disc disease and aging

 With degeneration the contents of the disc, the Nucleus Pulposus and Anulus fibrosus, are exposed to altered loads.

Specifically, the nucleus becomes fibrous and stiff and less able to bear load.

The load is transferred to the anulus which, if it fails to bear the increased load, can lead to the development of fissures. If the fissures reach the periphery of the anulus, the nuclear material can pass through as a disc herniation.

Location of Injury Possible Effects

At or above C5 Respiratory paralysis and quadriplegia

Between C5&C6 Paralysis of legs, wrists, and hands; weakened shoulder abduction and elbow flexion; loss of brachioradialis reflex

C6-C7 Paralysis of legs, wrists, and hands, but shoulder movement and elbow flexion usually possible; loss of biceps jerk reflex

C7-C8 Paralysis of legs and hands

C8-T1 With transverse lesions, Horner's syndrome (ptosis, miotic pupils, facial anhidrosis), paralysis of legs

T1-T12 Paralysis of leg muscles above and below the knee

At T12 to L1 Paralysis below the knee

Cauda equina Hyporeflexic or areflexic paresis of the lower extremities, usually pain and hyperesthesia in the distribution of the nerve roots, and usually loss of bowel and bladder control

At S3 to S5 or conus medullaris at L1

Complete loss of bowel and bladder control

And at the end

Thank you