GROUP 4 THE OVERVIEW OF SPINAL CORD INJURY.pptx

SPINAL CORD INJURY

1. GROUP 4 SPINAL INJURIES

2. GROUP FOUR MEMBERS DOREEN BANDA VERONICA MBALWE TRUST KANTIKI CHAWEZI MVULA PEMPHERO MCHENGA ZAKEYO THINDWA MEMORY PHIRI

3. Objectives The spinal anatomy Spine mechanism of injury Initial management of spinal injuries (protection before detection) Primary and secondary Spinal cord injury Movement of spine injury patient Diagnosis of cervical spine injury Sciwora - meaning Physical examination Neurologic injury Investigation Spine stability Management of cervical spine injury

4. Spinal Anatomy The spinal cord is a long, cylindrical structure that runs inside the vertebral column (spinal canal). It extends from the base of the brain (brainstem) down to the lower back, roughly from the foramen magnum to the L1 to L2 vertebral level. It is divided into 31 segments; 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. Each segment gives rise to a pair of spinal cord nerves. It is about 45cm long in adults and slightly thicker in the cervical and lumbar regions due to nerve roots supplying limbs.

5. Diagram

6. Cont ’ The spinal cord has external features such as the conus medullaris, cauda equina and filum terminale . The conus medullaris is the tapered end of the spinal cord around L1-L2; the cauda equina is a bundle of nerve roots hanging below the conus medullaris and the filum terminale is a fibrous thread extending from the conus to the coccyx, anchoring the spinal cord. The spinal cord is protected by three meninges namely; dura mater ( outer ), arachnoid (middle) and pia mater (inner).

7. The cerebrospinal fluid (CSF) surrounds the cord within these layers for cushioning. The gray matter and white matter in the spinal work together to process and transmit sensory information and motor signals, enabling reflexes, movement and communication between the body and brain. It also has dorsal roots which carry sensory information to the brain and ventral roots which carry motor commands from the spinal cord to muscles. Cont ,

8. Diagram of spinal cord

9. The meaning of spinal injury Spinal injury is the damage to the spinal cord or to the nerves at the end of the spinal canal which disrupts the signals between the brain and the body.

10. The mechanisms of spinal Injury The mechanism of spinal injury is the process by which a damaging force leads to compromise of the spinal column. This can be categorized into Traumatic spinal injury Non- traumatic spinal injury

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12. Traumatic injury These involve external forces that cause mechanical injury to the spinal structures including the spinal cord, vertebrae, ligaments and discs. Common traumatic mechanisms are as follows: Flexion injuries; This is the forward bending causing anterior compression fractures, ligament tears and possible anterior spinal cord injury. Extension injuries; This is the backward bening leading to posterior ligament rupture, facet dislocations and possible posterior cord injury.

13. Cont ’ Flexion- rotation injuries; it combines forward, bending and twisting potentially causing dislocations or fractures. Axial compression; vertical force producing burst fractures or vertebral body comminution.

14. Non-traumatic injuries Definition; A condition unrelated to an external force or events that affect the spinal cord and or roots within the spinal canal. It is different from traumatic spinal injury . Affects the older population Higher percentage are females Thoracic and lumber levels are more common

15. Cont , Common non-traumatic injuries include the following; tumors Infections Inflammations Vascular abnormalities

16. Symptoms of non-traumatic spinal cord injury sensory (numbness, tingling), weakness, spasticity, pain, fatigue, bladder dysfunction, sexual dysfunction, bowel dysfunction, respiratory physiologic changes, mood issues, and cognitive issues.

17. Initial Management 1. Primary survey; Protection before Detection" call for emergency medical assistance. Keep the person still Immobilize the neck and the head. Check ABC Control serious bleeding Keep them warm Reassure the person Move them only if necessary 2. resuscitation

18. Primary vs Secondary Cord Injury Primary injury; this is immediate mechanical damage that occurs at the time of the trauma and it can be caused by compression, flexion/ extension, rotation, rotation, penetrating injury, and distraction. Secondary injury ; this is cascade of cellular and biochemical events that occurs after the initial trauma. The primary injury triggers a destructive process that can cause more damage that initial. For instance ischemia, the reduced blood flow to the spinal cord due to damage to blood vessels .

19. Moving the spinal injury-patient

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27. Diagnosis of Cervical Spine Injury Diagnosing a cervical spine injury involves thorough physical and neurological examination, including assessing posture, palpating for tenderness, checking range of motion, and testing sensation and muscle strength in the limbs. Diagnosis imaging Include the following; X-rays : a minimum of two view cervical spinal x-ray (lateral view is most informative ) is a first step in the emergency setting to look for vertebral fractures.

28. Cont , CT scan: this imaging test provides detailed picture of the bony structures , useful for confirming fractures and other osseous injuries. MRI: an MRI is crucial for visualizing the spinal cord, herniated discs, blood clot or any other soft tissue that could compress the spinal cord.

29. Sciwora - Meaning The term SCIWORA originally referred to as Spinal Cord Injury Without Radiographic or CT evidence of fracture or dislocation. However with the advert of MRI, the term has become ambiguous. Finding on MRI such as interverbal disk rupture, spinal epidural hematoma, cord contusion, and hematomyelia have all been recognized as causing primary or secondary spinal cord injury. SCIWORA should now be more correctly renamed as “Spinal Cord Injury Without Neuro-Imaging Abnormality” and recognize that its prognosis is actually better than patients with spinal cord injury and radiologic evidence of traumatic injury.

30. Physical Examination Spinal cord Injury physical exam include the following; Mental status; asses the patient’s level of consciousness and cognitive function using tools like GSC. Respiratory and circulatory assessment : you check breathing and heart function, as high spinal cord injuries can significantly impact these systems. Sensory exam : test right touch and pinprick sensation on the both sides of the body to map out sensory loss across the dermatomes .

31. Cont , Motor exam: evaluate muscle strength in specific muscle groups in the arms and legs. Each key muscle movement corresponds to a particular spinal cord level, helping to define the extent of the injury. Reflexes : test deep tendon reflexes. You also check for anogenital reflexes, including the bulbocavernosus reflexes, anal wink reflex, to assess nerve function below the injury. The Babinski may also be positive.

32. Neurologic Injury

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35. Investigations

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37. Spine Stability Spine stability: is the spine’s ability to maintain its normal structure and alignment under physiological loads without damaging the spinal cord. Its stability involves the following 3 pillars ; The passive system; this include the rigid structures of the spine such as vertebral bodies, intervertebral discs, and facet joints, as well as the ligament that connect them. These components provide inherent stiffness to the spine. The active system; it consist of the muscles that moves and support the spine, including the abdominal muscles ( transversus abdominis) and the deep back muscles ( erector spinae).

38. Cont , 3. The neuro control system ; it involves the nervous system receiving information about the spinal position and central signals to the muscles to initiates contractions. Without stability the following can occurs; Neurological deficit Deformity pain

39. Management of Cervical Spine Injury

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44. References Tortora, G. J., & Derrickson, B. H. (2023). Principles of anatomy and physiology (16th ed.). Hoboken, NJ: John Wiley & Sons. Marieb , E. N., & Hoehn, K. (2022). Human anatomy & physiology (12th ed.). Pearson Education. Snell, R. S. (2019). Clinical neuroanatomy (8th ed.). Wolters Kluwer. Hall, J. E. (2021). Guyton and Hall textbook of medical physiology (15th ed.). Elsevier. Adams, R. D., Victor, M., & Ropper, A. H. (2018). Adams and Victor’s ‘ principles of neurology’ (11th ed.). McGraw-Hill Education.6.