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high level vs low level cord injury
they refer to the location of the injury, so "high level" = "low function" and someone with a low level injury will be high functioning
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succussion - who, what?
Hippocrates, hung spinal pts upside down on a ladder
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age norms of SCI pts
16-30, though it's getting older
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how many new SCIs/year in US? how many SCIs alive in US now?
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etiology of SCIs
- 39.2% MVA
- 28.3% falls or falling objects
- 14.6% acts of violence
- 8.2% sporting injuries (mostly diving, football, gymnastics)
- 9.7% other
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%s for in/complete para/tetraplegia
- incomplete tetraplegia 40.8%
- complete paraplegia 21.6%
- incomplete paraplegia 21.4%
- complete tetraplegia 15.8%
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where is the cord most vulnerable
- C5-7 - apex of cervical lordosis
- T4-7 - apex of thoracic kyphosis
- T10-12
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how many vertebrae in each of the 5 areas
- 7 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 4 coccyx
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ligamentum flavum - where? nickname?
- yellow ligament
- connect adjacent lamina
- very flexible
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ant/post longitudinal ligaments
- ant/post to vertebral body
- so, the PLL is inside the spinal canal
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ligamentum nuchae where?
external occipital protuberance to C7 along the SPs
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supraspinous lig - where?
- goes along SPs
- a continuation of the nuchal lig
- C7 to sacrum
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interspinous lig - where
connects adjacent SPs, running from the bottom of one to the top of the next in an infero-postero manner
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intertransverse lig - where
btwn TPs
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how many paired roots?
31
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av length & wt of spinal cord
- men - 45 cm
- women - 42 cm
- 30 grams (a bit more than one big egg)
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meninges, and their layers
tough connective tissue, protective layer around the cord
- pia -inner
- arachnoid - middle
- dura - most superficial
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where do nerve roots exit relative to the vertebra of the same name/number?
- cervical nerve roots: exit above the vert of the same name (C7 exits btwn C6 and C7)
- all others: exit below their namesakes (T3 exits between T3 and T4)
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anatomical rel btwn spinal cord and vertebral column
- in the cervical spine the roots exit horizontally, but as you descend the start to descend before they exit. So, a fracture lower down actually damages the cord at a further lower level. Ex - fracture at T9, cord damage at T12
- the rough rule is: C5-T10, add 2 segments, below add 3
- it's very approximate, but it gives you a rough starting point for your eval
- When we give a level of injury, it's the neuro, not bony, level
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anterior spinal artery
where?
responsible for what?
- runs down ant groove in spinal cord
- supply the cervical spine
- gives rise to sulcal arteries which supply the central cord
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lateral spinal artery
- a branch off from vertebral artery
- responsible for C2-T2
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semental radicular arteries
- come off ant spinal artery below T4, also fed by intercostal arteries from aorta
- vessel of adam kiewicz, the longest radicular component, feeds T9-L4 and some sacral area
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vessel of adam kiewicz
- a segmental radicular artery, the largest radicular component
- feeds T9-L4 and some sacral area
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posterior spinal arteries - where, supply what
- come down post. aspect of spinal cord as a pair along where posterior roots come off
- supply the posterior horns of whole cord
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pial arteries supply what
peripheral lateral cord
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centrifugal system - supplies what, arises from what
- vascular system supplying central spinal cord, the gray matter and the innermost white matter (centripetal system supplies peripheral spinal cord)
- arises from ant spinal artery
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centripetal system - arises from what, supplies what
- arises from ant & post spinal arteries
- supplies peripheral cord - the outher whatie matter
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central cord syndrome - is what?
- centrifugal system is down
- UEs are affected
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3 types of developmental causes for spinal cord troubles
- incomplete closure of spinal cord (spinabifida)
- structural deformities (scoliosis, kyphosis, spondylolysthesis (vert slippage)...)
- familial paralysis
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Klippel-Feyl syndrome
- congenital deformation
- vertebra isn't fully formed and is angulated --> scoliosis
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sacralization or lumbarization
- TP of lumbar vert is fused to sacrum
- the TP is enlarged, like a big wedge
- L5 can be completely fused to sacrum
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spondylolisthesis
- slipping of one vertebrae on another
- grade 4 = dislocation
- grade 1 = asymptomatic
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spinal cord agenisis
- congenital
- it didn't fully develop
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Arnold-Chiari syndrome
- brain (medulla) intrudes inferiorlly into cervical spine
- presents like CP (until MRI)
- treated w decompression laminectomy
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7 non traumatic ways to acquire non-congenital spinal paralysis
- infection
- degenerative
- neoplastic
- vascular
- idiopathic
- iatrogenic (caused by medical exam or tx)
- psychological
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a bunch of infections that can cause spinal paralysis
- bacterial abscess
- Pott's disease (TB of the spine --> bone collapse)
- transverse myelitis (neurological disorder caused by inflam process of spinal cord)
- syphylis (usually affects post. column)
- polio
- herpes
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ankylosing spondylitis
- inflam of the spinal joints, can lead to fusion
- try to get the pt to fuse in an upright pos
- this tarts w sacrolilitis and red iris
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various neoplasms that can cause spinal paralysis
- meningioma (compresses cord)
- neuroma (in meninges)
- extradural
- fibroblastoma
- vascular tumor - hemanioma
- osteosarcoma (agressive malignant bone tumor)
- metastatic tumor - usually from breast or lung
- glioma or glioblastoma - nasty aggressive tumor
may remove a portion of a vertebra to get to the tumor
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2 vascular problems that can lead to spinal paralysis
- hemangioma (these can happen in many places, including on the skin)
- AV malformation in brain or spinal cord
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syringomyeli
- idiopathic
- holes in spinal cord
- can range from asymptomatic to nightmare
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radiation's impact on spinal cord
- causes fibrotic changes
- makes tissues firm and shrunken
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conversion hysteria
- a mental disorder characterized by the conversion of mental conflict into
- somatic forms (into paralysis or anesthesia having no apparent cause)
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