Spinal injury
Z. Rozkydal


•Causes
•
•Fall from height
•Motor vehicle accident
•
•Damage to vertebrae, discs, ligaments, spinal cord
•
•Lesion of spinal cord
•- without fracture of vertebral column
•- with fracture of vertebral column
•Temporary damage
•Permanent damage

•Spinal shock
•
•Loss of all functions of spinal cord
•Complete loss of motor function, sensation, reflexes
•and sincter function
•
•Symptoms:
•Complete paraplegia, absent reflexes, no muscle  tonus,
•loss of sensation
•
•Appears in   incomplete or complete transverse lesion
•of spinal cord. It resolves after 24- 48 hours
•
•It is changing into spastic paraplegia after 3 weeks
•
•The end of spinal shock:
•Annal reflex or bulbocavernosus reflex

•Transversal lesion of spinal cord
•
•Anatomic disruptin of spinal cord with irreparable damage
•
•
•Complete:
•Loss of motor function, sensation, reflexes,
•loss of control of bowels
•It is apparent after resolving of spinal shock
•Paraplegia changes into spastic one
•
•Incomplete:
•Loss of motor function of different stage
•Disturbance of sensation (pain, termic, vibration, tactil).

•Concussion of spinal cord
•
•Reversible and functional
•
•Short period of loss of  function
•
•Improvement after some hours or days

•Contusion of spinal  cord
•
•Anatomic  disturbance of spinal cord
•(necrosis, oedema, bleeding, exsudation, trombosis
•- increasig  pressure to the spinal cord)
•
•
•Symptoms: paraplegia, areflexia,
•                   loss of sensation, bowel dysfunction

•Hematomyelia
•
•Localised bleeding into the spinal cord
•
•
•Symptoms: paraplegia, areflexia,
•                   loss of sensation, bowel dysfunction

•Compression of spinal cord
•
•Disturbance of circulation in spinal cord
•by mechanical and reflectoric  forces
•Disturbance of circulation of cerebrospinal fluid.
•
•Symptoms: according to the level of damage
•                   paraplegia, areflexia,
•                   loss of sensation, bowel dysfunction
•
•

•Level of damage of spinal cord
•
•C1 - C4:      immediate death
•C5 - T1:      quadruplegia, quadruparesis
•Bellow T1:   upper extremities- no loss of function
•                    lower extremities- paraplegia or paraparesis
•
•Cauda equina- involves lumbar and sacral roots L1-L5, S1-S5.
•Cauda equina syndrom: by compression bellow L1 vertebra:
•-  spinal claudication, palsy of lower extremities
-  parestesia in lower extremities, nerve roots pain
-  disturbance of sfincter function and of reflexes
•
•Spinal cord epiconus-  roots S1, S2
•
•Conus medullaris – roots S3 - S5:
•                                   loss of sfincter functions

Bolesti zad- C páteř2
•Cervical spine
•Roots C1-C8
BOlesti zad- C páteř1

Bolesti zad - L kořeny 2
•Roots of lumbar spine  L1-L5


•Symptoms of spinal cord lesion
•and fracture of vertebral column
•
•Disturbance of sensation in extremities
•Disturbance of motor function in extremities
•Strange position of the body
•Pain in the back region
•Parestesias in extremities

•First aid
•
•Examine function of extremities
•Check the pain, oedema or hematoma
•Make a note about the function
•No change of position- do not move the casualty
•from the previous position, support the head in the
•neutral position
•Check the casualty´s breathing, if not - start CPR
•Use log-roll technigue
•Vacuum immobilisator, Philadelphia collar
•Urgent careful transport
•Corticoids
•