Spine Emergencies: Spinal Cord Injury (SCI) - The Basics
Spine Emergencies: Spinal Cord Injury (SCI) - The Basics
Spine Emergencies: Spinal Cord Injury (SCI) - The Basics
• Neurological
• Motoric
• Sensory
• Reflexes (pathological, physiological)
• Rectal examination
• Motoric
• Muscle Tone
• Resistance to passive range of motion:
• Move patient arm without any resistance provided by the patient.
• Assessment must be made at all major joints sequentially:
That is, wrist → elbow → shoulder.
• Hypertonia:
• Excessive contraction and stiffness to passive movement.
• Pathology involving upper motor neurons.
• Hypotonia
• No muscular contractions or resistance during passive movement.
• Pathology involving lower motor neurons.
• No muscular contractions or resistance during
• Muscle Strength
Neurological Assassement:
Reflexes
• Sensation
• Volition: A voluntary contraction of the
sphincter or the presence of rectal
sensation supports the presence of a
communication between the lower spinal
cord and supraspinal centers – favorable
prognosis
• Bulbocavernosus reflex:
• Negative: absent in spinal shock
The injury is complete if there is
• No voluntary anal contraction
• S4-5 sensory scores = 0
• no anal sensation = No
• Incomplete
• Anterior cord syndrome
• Brown-Sequard syndrome
• Central cord syndrome
• Posterior cord syndrome
Kelemahan Motorik:
atas > bawah
• Traumatic Brain Injury Increased risk cervical spine injury, compared with nonhead-related blunt
trauma injury
• 1 in 20 patients with moderate and severe head injury will sustain a cervical spine injury
• Symptoms
– Back pain
– Unilateral or bilateral leg pain
– Bladder dysfunction
– Bowel dysfunction
– Sexual dysfunction
– Diminished rectal tone
– Perianal sensory loss
– Lower extremity weakness
Cauda equine syndrome
• Symptoms
– Back pain
– Radicular pain
• Bilateral
• Unilateral
– Motor loss
– Sensory loss – saddle back anasthaesia
– Urinary dysfunction
• Overflow incontinence
• Inability to void
• Inability to evacuate the bladder completely
– Decrease in perianal sensation
Imaging
• The standard 3 view plain film series is the lateral, antero-posterior, and open-
mouth view
• The lateral cervical spine film must include the base of the occiput and the top
of the first thoracic vertebra
• The lateral view alone is inadequate and will miss up to 15% of cervical spine
injuries.
• If lower cervical spine difficult to see, caudal traction on the arms may be used
to improve visualization
• Repeated attempts at plain radiography are usually unsuccessful
• If the lower cervical spine is not visible, a CT scan of the region is then indicated
Imaging
• Who need an xray??
Screening Tool
NEXUS CCR
NEXUS
NEXUS mnemonic :
N : Neuro deficit/defisit Neurologis
E : EtOH/Ethanol/Intoksikasi
X : eXtreme distracting injury (ies)
U : Unable to provide history
S : Spinal Tendernes
CCR
(Canadian C-Spine Rule)
Imaging
• Computed tomography (CT) scan: sagittal and coronal
reconstructions:
• Improves visualization of occipital-cervical and cervicothoracic junctions, bony
structures, and occult fractures.
• Thin cut CT scanning should be used to evaluate abnormal, suspicious or
poorly visualized areas on plain radiology
Ventilatory Function
• A – Airway C1 - C7 = accessory muscles
• Risk Associated with Level of Injury C3 - C5 = diaphragm
“C3-4-5 keeps the diaphragm alive!”
• Decision to Intubate T1 - T11 = intercostals
• Airway Intervention T6 - L1 = abdominals
• B - Breathing
Primary Survey and Resuscitation—ATLS
• C - Circulation
Unopposed parasympathetic outflow can lead to cardiac dysrhythmias and hypotension (most
common within first 14 days)
• Hypotension is due to loss of vasomotor tone peripheral pooling of blood and decreased
preload
• Most common dysrhythmia is bradycardia
• Deformity correction
• Stabilization of the spine
• Decompression of neurologic elements (controversial)
• Does decompression improve neurologic outcome?
• Does timing of spinal cord decompression after trauma in patients with
complete SCI’s improve outcome?
Prognostic factors..