Intro to SCI

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Spinal Cord Injury (SCI):

University of St. Augustine for Health Sciences Spinal Cord Injury (SCI) projectwalk.com

Learning Objectives:

Learning Objectives Be familiar with current epidemiological statistics re: spinal cord injury Describe mechanisms of injury and potential deficits to present based on neuroanatomy of the spinal cord Describe pathological responses after spinal cord injury and predictors of recovery Understand how to interpret the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), aka, ASIA exam, to identify neurological level of injury, as well as potential syndromes University of St. Augustine for Health Sciences

Demographics in US:

University of St. Augustine for Health Sciences Demographics in US Incidence: 40 cases per million ~12,000 new cases/year Prevalence: 270,000 living with SCI (2012) https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts%202012%20Feb%20Final.pdf

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University of St. Augustine for Health Sciences Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2013 Annual Statistical Report 42.5% MVA 15.1% Violence (primarily GSW) 7.6% Sports 26.7% Falls 2 8.6% Other

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University of St. Augustine for Health Sciences Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2013 Annual Statistical Report

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University of St. Augustine for Health Sciences Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2013 Annual Statistical Report

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University of St. Augustine for Health Sciences Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2013 Annual Statistical Report

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University of St. Augustine for Health Sciences International Perspectives on Spinal Cord Injury 2013

Sports Injuries:

Sports Injuries University of St. Augustine for Health Sciences

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University of St. Augustine for Health Sciences International Perspectives on Spinal Cord Injury 2013

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University of St. Augustine for Health Sciences Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2013 Annual Statistical Report

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University of St. Augustine for Health Sciences Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2013 Annual Statistical Report

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University of St. Augustine for Health Sciences Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2013 Annual Statistical Report

Basic Anatomy:

Basic Anatomy University of St. Augustine for Health Sciences

Vertebral Column:

University of St. Augustine for Health Sciences Vertebral Column 7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 4 coccygeal (fused)

Spinal Cord & Spinal Nerves:

University of St. Augustine for Health Sciences Spinal Cord & Spinal Nerves 8 cervical 1-7 exit above 8 exits below C7 12 thoracic 5 lumbar 5 sacral

Vascular Supply:

University of St. Augustine for Health Sciences Vascular Supply Anterior Spinal Artery Posterior Spinal Arteries Centrifugal central portion of sc Centripedal outer surface & periphery of sc

Spinal Cord:

University of St. Augustine for Health Sciences Spinal Cord Gray Matter Cell bodies, dendrites, initial segments and terminals of axons, glial cells White Matter Ascending & descending axons of sensory and motor neurons

Major Tracts:

University of St. Augustine for Health Sciences Major Tracts Ascending : Dorsal Column Spinothalamic Descending : Lateral Corticospinal Tract

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Ascending Pathways

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Descending Pathways

Relationship between the cord and column:

University of St. Augustine for Health Sciences Relationship between the cord and column Spinal cord is shorter than vertebral column Spinal column elongates with growth, cord is drawn upward Nerve roots assume an oblique/downward direction Roots travel caudally before exiting vertebral canal

Relationship between the cord and column:

University of St. Augustine for Health Sciences Relationship between the cord and column Spinal Nerve and Cord Segment Vertebral Level C1 C1 C8 C7 T6 T5 T12 T8 L2 T10 L5 T11 S3

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University of St. Augustine for Health Sciences https://www.inkling.com/read/essential-orthopaedics-and-trauma-dandy-edwards-5th/chapter-10/paraplegia

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University of St. Augustine for Health Sciences This schematic shows how the spinal cord segment location is not always directly correlated with the location of the corresponding vertebra

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University of St. Augustine for Health Sciences

Root Escape:

University of St. Augustine for Health Sciences Root Escape Peripheral nerve roots at the level of lesion escape injury Usually occurs in low cauda equina segments What is important clinically? What signs and symptoms will you see? Hint: LMN vs. UMN

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