SPINAL CORD INJURY

I: INTRODUCTION

 Spinal Cord: long, gray cylindrical structure of nerve tissue

 Function:
o Conduit for crucial; information from brain to most of the body
o Gives rise to the brachial and lumbosacral plexus

II: EXTERNAL ANATOMY

 Length: 42-45cm long

 Diameter: 10-15mm
 Adult SC ends at L1-L2 level
 Children: L3 level
 Parts:
o Conus Medullaris
 Distal tip of the SC
 Centerof micturition
o Cauda Equina
 Bundle of nerve roots that resembles horsetail
o Filum Terminale
 Part of Pia Mater
 Connects the distal tip of Sc to the distal dural sac
 Keeps the SC in place
o Denticulate Ligament:
 Connects the Pia Mater to the outer dura
 Blood Supply
o Vertebral Bodies
 Anterior Spinal Arteries: supplies anterior upper 2/3
 Posterior Spinal Arteries: supplies posterior upper 1/3
o Radicular Arteries
 Supplies the remaining areas of the SC

III. TYPES OF NEURONS

 Types of Neurons
o Sensory
 First Order
 From sensory organ to Spinal Cord
 Peripheral sensory nerve
 Second Order
 From Spinal cord to thalamus
 Axons are ascending tracts
 Third Order
  Thalamus to sensory cortex
o Motor
 Upper Motor Neuron
 From motor cortex to spinal cord
 Axons are descending tracts
 Lower Motor Neuron
 Spinal cord to the muscles

IV. REXED LAMINA

 Rexed Lamina
o I: Lissauer’s Tract
 Responsible for Pain
o II: Substantia Gelatinosa
 Pain
o III & IV: Nucleus Proprius
 Touch and Pressure
o V: Visceral Nucleus
 Visceral sensation and pain
o VI: Deep Nucleus
 Joint activity and skin sensation
o VII: Clarke’s Column
 For posture and balance
o VIII & IX: Motor Pools
 Motor Function
o X: Central Gray Commisure
 Connects Right and Left sides of gray horn

V. ASCENDING TRACTS

 DORSAL COLUMN
o Funiculus Graciilis: LE below T6
o Funiculus Cuneatus: UE above T6
o Discriminative touch, proprioception, 2-pt. discrimination and epicritic sensations
o Epicritic Sensations
 Barognosis
 Stereognosis
 Graphestesia
 SPINOTHALAMIC TRACT
o Anterior: crude and light touch
o Lateral: Pain and temperature
 SPINOCEREBELLAR TRACT
o Ventral and Dorsal
o Posture, coordination and balance
VI. DESCENDING TRACTS

 CORTICOSPINAL TRACTS
o Motor
o Lateral: 90% decussates
o Anterior: 10% does not decussate
 RUBROSPINAL TRACT
o Controls the tone of the flexor muscle
 VESTIBULOSPINAL TRACT
o Posture and coordination
 RETICULOSPINAL TRACT
o Controls postural muscle
 TECTOSPINAL TRACT
o Bright and sudden movements

VII. REFLEXES

 SUPERFICIAL
o Upper Abdominal: T7-T9/T10
o Lower Abdominal: T10/T11-T12
o Cremasteric: T12-L1
o Plantar: S1-S2
o Gluteal: L4-L5, S1-S3
o Anal: S2-S4, S4-S5
 VISCERAL
o S2-S4
 Bulbocavernosus
 Rectal
 Micturition
 PATHOLOGIC
o Babinksi: L3-L5, S1

VIII: SPINAL CORD CONDITIONS

UMNL LMNL
PARALYSIS SPASTIC FLACCID
BLADDER SPASTIC BLADDER FLACCID BLADDER
INCONTINENCE URGE INCONTINENCE URINARY RETENTION
MX OF
INCONTINENCE SUPRAPUBIC TAPPING CREDE MANUEVER
LOWER ABDOMINAL STROKING VALSALVA MANUEVER
HAIR PULLING
PSYCHOGENIC
ERECTION
REFLEXOGENIC ERECTION ERECTION
EJACULATION POSSIBLE EJACULATION BUT MAY NEED STIMULATION INTACT
IX: AUTONOMIC DYSREFLEXIA

AUTONOMIC DYSREFLEXIA ORTHOSTATIC HYPOTENSION

BLADDER DISTENTION
INGROWN TOE NAIL
CAUSES LABOR PAIN IMMEDIATE POSITIONAL TRANSITION
PRESSURE SORES
AGGRESSIVE STRETCHING
INCREASE BP DECREASE BP
BRADYCARDIA TACHYCARDIA
POUDING HA DIZZINESS
S&SX
FACIAL FLUSHING LIGHTHEADEDNESS
PILOERECTION FAINTING
DIAPHORESIS
MANAGEMENT SIT UP AND GIVE SUBLINGUAL CALCIBLOC ELEVATE LEGS
ANKLE PUMPS
X. SENSORY LEVEL

MOST CAUDAL LEVEL WITH INTACT SENSATION

2/2 FOR LIGHT TOUCH AND PINPRICK

RIGHT SENSORY LEFT SENSORY

LIGHT PIN LIGHT PIN
TOUCH PRICK TOUCH PRICK
C2 2 2 C2 2 2
C3 2 2 C3 2 2
C4 2 2 C4 2 2
C5 2 2 C5 2 2
C6 2 2 C6 2 2
C7 2 2 C7 2 2
C8 2 2 C8 2 2
TI 2 2 TI 1 2
T2 2 1 T2 1 2
T3 1 2 T3 2 1
T4 1 1 T4 1 1
T5 1 2 T5 1 1
T6 1 0 T6 1 1
T7 1 1 T7 1 1
T8 1 1 T8 1 1
T9 1 1 T9 1 1
T10 1 1 T10 1 1
T11 1 1 T11 1 1
T12 1 1 T12 1 1
L1 1 1 L1 1 1
L2 1 1 L2 1 0
L3 1 1 L3 0 0
L4 0 1 L4 0 0
L5 0 0 L5 0 0
S1 0 0 S1 0 0
S2 0 0 S2 0 0
S3 0 0 S3 0 0
S4- S4-
0 0 0 0
S5 S5
XI. MOTOR LEVEL

MOST CAUDAL SEGMENT WITH AT LEAST 3/5 AND THE SEGMENT IMMEDIATELY ABOVE IT
SHOULD BE 5/5

RIGHT MOTOR LEFT MOTOR

C5 5/5 C5 5/5
C6 5/5 C6 5/5
C7 5/5 C7 5/5
C8 5/5 C8 5/5
T1 5/5 T1 4/5
L2 4/5 L2 4/5
L3 3/5 L3 3/5
L4 2/5 L4 2/5
L5 0 L5 0
S1 0 S1 0

XII. NEUROLOGICAL LEVEL

MOST CAUDAL SEGMENT WHERE MOTOR AND SENSORY ARE EQUAL

RIGHT LEFT
SENSORY T1 C8
MOTOR L2 T1
XII. FUNCTIONAL EXPECTATIONS FOR SCI PATIENTS