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MMUH SHO teaching spinal cord feb 2014


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Slideset from SHO teaching session. For further info on anatomy of spinal cord, try this.

Published in: Healthcare, Health & Medicine
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MMUH SHO teaching spinal cord feb 2014

  1. 1. Spinal Cord Injuries
  2. 2. Who to immobilise
  3. 3. Immobilisation “we argue that fully alert, stable and co-operative trauma patients do not require the application of a semi-rigid cervical collar, even if they are suspected of underlying cervical spine fracture, unless their conscious level deteriorates or they find the short-term support of a cervical collar helpful
  4. 4. When to image?
  5. 5. v
  6. 6. NEXUS
  7. 7. Canadian
  8. 8. What are you looking at?
  9. 9. Vertebral Body Pedicle Lamina Spinous Process
  10. 10. Ligaments
  11. 11. AnteriorLongitudinalLigament PosteriorLongitudinalLigament LigamentumFlava
  12. 12. AnteriorLongitudinalLigament PosteriorLongitudinalLigament LigamentumFlava
  13. 13. 3 Columns in Spinal Injury AntMidPost
  14. 14. What type of injuries to expect
  15. 15. •Young male •Fall 10 m on building site •Not able to mobilise on scene •Back pain, but no other apparent injuries
  16. 16. Examination •Below T11 •Flaccid Paralysis •Absent sensation to pain •Fine touch present at all levels
  17. 17. Posterior Columns Cortico Spinal SpinoThalamic
  18. 18. Touch Motor Pain
  19. 19. Anterior Cord Syndrome Touch Motor Pain
  20. 20. Touch Motor Pain
  21. 21. Text Touch Motor Pain Incomplete Cord Injury
  22. 22. History •60 year old male •Fall from waterski - fairly low speed Symptoms •Complaining of neck and arm pain •Arms feel weak Examination •Sore - but all in the arms and neck •Legs moving fine •Power 3/5 in the upper limbs, esp proximally
  23. 23. Touch Motor Pain Central Cord Syndrome
  24. 24. Arms Trunk Legs Arms Trunk Legs The Upper limbs lie more centrally in the tracts Why the upper limb distribution?
  25. 25. Spinal Stenosis
  26. 26. •50M chronic LBP •significant increase in low back pain •Some weakness in both legs but variable between sides and levels. •Similar picture regarding sensation Is his neurology inconsistent and functional?
  27. 27. L3 L5 L1 L2 L4
  28. 28. CES Red Flags •Urinary incontinence/ retention •Saddle anaesthesia •Decreased anal tone/faecal incontinence •Bilateral neurological symptoms/deficit •Major motor/sensory impairment
  29. 29. End