WEEK 6 - Spinal Injury
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What is the pathophysiological cascade associated with spinal cord injury?
• Haemorrhage within pia mater & grey matter. • Oedema in the white matter which impairs circulation • Reduced vascular perfusion & development of ischaemic areas • Accumulation of endogenous opioids • Release of toxic excitatory aa (glutamate) & ROS • Massive swelling response leads to swelling of the cord - contributes to its dysfunction • Within first few days of injury progressive axonal changes, development of necrotic zones, proliferation of microglia, changes in astrocytes • Cord is replaced by collagenous tissue in 3-4 weeks
What are the clinical manifestations associated with spinal cord injury?
Paraplegia (T1) & quadriplegia, depending on level of injury Spinal shock with cessation of all motor, sensory reflex (bladder/bowel/sexual) & autonomic functions linked to complete transection of the spinal cord. Neurogenic shock - cervical or upper thoracic injuries Less severe acute spinal cord injury Loss of voluntary movement, loss of sensations in body parts below the injury level; loss of autonomic reflexes below the level of injury. Return of spinal neuron excitability can occur depending on degree of damage
What are the common causes/triggers for lower back pain?
Unknown aetiology Risk factors: heavy lifting, obesity Affects men & women equally Secondary causes: Disc prolapse, degenerative disc disease, osteoporosis Sprain, fracture, inflammation
What are the common types of injuries that can result in spinal cord trauma?
Vertebral injuries such as simple fractures, compressed/burst fractures, dislocations Vertebral injuries occur mostly in the cervical and lumbar regions.
What are the common types of accidents that can result in spinal cord trauma?
Traumatic - MVA, falls, sporting activities, surgical complications Non-traumatic - tumours, degenerative diseases, ageing, infection
What is the goal of managing an acute spinal cord injury?
Reduce neurological deficit & prevent additional damage eg. hypoxia, shock Immobilise, stabilise, support
Were do intramedullary tumours occur and what do they do?
Arise: Neural tissue Produce dysfunction by invasion & compression Cord enlarges as a result of growing tumour, causing distortion of adjacent white matter tracts. Ependymomas = derived from ependymal cells lining ventricles & spinal cord Astrocytomas = most common intramedullary spinal cord tumours in children & adults, develop from astrocytes, 90% are low grade tumors.
Where do extramedullary tumours occur?
Outside spinal cord
Where do extramedullary extradural tumours arise and what do they do?
Arise: The vertebral structure Cause compression of the spinal cord & nerve roots, destroy white matter tracts Early symptoms = weakness Pain at site is common & appears before signs of spinal cord dysfunction
Where do extramedullary intradural tumours arise and what do they do?
Arise: From the meninges or nerve roots. Meningioma - most common in thoracic area, onset middle/late years, usually benign (encapsulated) Schwannoma - most common intradural primary tumours which arise from the nerve roots
What is degenerative disc disease?
Caused by biochemical alterations of the disc Fibrocartilage replaces nucleus pulposus; nucleus pulposus shrinks, break in the annulus fibrosus, disc prolapse/herniation. Common in adults >30 yo