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9.transection of sc kjg
- 1. Dr.K.Jaiganesh, MD Professor ofPhysiology MGMCRI
- 2. Objectives 1. Complete transectionof spinal cord 2. Incomplete transection of spinal cord
- 3. Spinal Cord Injuries Causes(in order of frequency) Motor Vehicle Accidents Gunshot wounds/acts of violence Falls Sports injuries
- 4. Classification of SCI 1.Flexion: Head is suddenly & forcefully accelerated forward causing extreme flexion of the neck “Kiss the Chest
- 5. Classification of SCI 2.Hyperextension Automobile accidents
- 6. Classification of SCI 3.Vertical compression Blow to the top of the head Often begins with a sudden, traumatic force
- 7. Classification of SCI 4.Excessive Rotation (either flexion- or extension-rotation)
- 8. Classification of SCI 5.Penetrating injuries
- 9. Types of CordInjury 1. Concussion Similar to cerebral concussion Temporary and transient disruption of cord function 2. Contusion Bruising of the cord Tissue damage, vascular leakage, and swelling 3. Compression - Secondary to: Displacement of the vertebrae Herniation of inter vertebral disk Displacement of vertebral bone fragment Swelling from adjacent tissue 4. Laceration Direct damage to cord with associated bleeding, swelling and potential disruption of cord 5. Hemorrhage Associated with contusion, laceration, or stretching 6. Transection Partial or complete severing of cord
- 10. Common sites ofSpinal Injury C-1/C-2: Delicate vertebrae C-7: Transition from flexible cervical spine to thorax T-12/L-1: Different flexibility between thoracic and lumbar regions
- 11. Complete spinal cordinjury Most severe form of injury All sensations & motor functions will be lost beneath the level of the injury Depend on the level of the injury! Tetraplegia (formerly quadriplegia) occurs with C-1 to C-8 injuries. Paraplegia occurs with T-1 to L-4
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- 13. Complete spinal cordinjury Stages 1. Stage of spinal shock 2. Stage of reflex activity 3. Stage of reflex failure Spinal shock: Begins within hour of injury & Lasts from few minutes up to several months & Ends with return of reflex activity: Hyper reflexia, Muscle spasticity, Reflex bladder emptying.
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- 15. Stage of spinalshock 1.Spinal Shock - Temporary loss of reflex function (a reflexia) below level of injury beginning immediately after complete transection of spinal cord Temporary insult to the cord Affects body below the level of injury Cramp like pains at the level of lesion Loss of all sensations below the lesion Muscles are paralyzed Muscle tone is lost Reflexes are lost Bladder & the rectum are paralyzed Sphincters paralyzed but recover their activity faster Vasomotor tone lost, so BP falls Skin becomes cold & blue- bed sores may develop
- 16. Effects of sectionat various levels At C1 segment level Quadriplegia Maximum fall in BP Anaesthesia Paralysis of respiratory muscles Death At C5 segment level Quadriplegia Maximum fall in BP Anaesthesia below the lesion Diaphragm is not paralysed. So, respiration is maintained Horner’s syndrome develops
- 17. Effects of sectionat various levels At C8 Miosis No sweating on the face and the neck Ptosis due to paralysis of the Muller’s muscle Enophthalmos Loss of ciliospinal reflex – (stimulation of skin over the neck produces reflex dilatation of the pupil) Other features remain the same At upper thoracic level Paraplegia Maximum fall in BP Anaesthesia below the lesion No Horner’s syndrome
- 18. Effects of sectionat various levels At lower thoracic level BP fall is less Other features remain the same At or below 2nd lumbar Minimum or no fall in BP Paraplegia Anaesthesia below the lesion Other features remain the same
- 19. Site Sensory MotorBP RS Other C1 Anaesthesia Quadriplegia Max Fall Paralysis of RS muscles Death C5 Anaesthesia below Quadriplegia Max Fall No Horner‘s develops C8 SAME Full Horner‘s Upper Thoracic Anaesthesia below Paraplegia Max fall No Horner”s Lower thoracic SAME Less BP fall At or below II lumbar SAME No BP fall
- 20. Stage of reflexactivity Sensations remain lost Voluntary movements absent Skeletal muscle tone increases in flexors first then in extensors Functional activity of smooth muscle returns Reflexes appear – Babinski reflex positive Micturition & Defaecation reflex reappear Mass reflex - Stroking the inner thigh – flexor spasm,contraction of abdominal muscles & evacuation of bladder BP increases & skin sweats
- 21. Stage of reflexfailure Reflexes become functionless Loss of muscle tone Muscle wasting (degenerative changes) General infection – bedsores, UTI, sepsis ----Death
- 22. Incomplete (partial transection) Mixedloss of voluntary motor activity and sensation below level of injury as pathways are only partially interrupted Four patterns or syndromes Central cord syndrome Anterior cord syndrome Posterior cord syndrome Brown-Sequard syndrome
- 23. Cord Syndrome Brown-Sequard syndrome Centralcord syndrome Anterior cord syndrome Posterior cord syndrome
- 24. Brown-Sequard’s Syndrome Incomplete TransectionCord Injury Brown-Sequard’s Syndrome Damage to one half of the cord on either side Penetrating injury that affects one side of the cord Ischemia,infectious or inflammatory diseases (tuberculosis,multiple sclerosis)& spinal cord tumor Ipsilateral sensory and motor loss Contralateral pain and temperature sensation loss
- 25. Brown Sequard Syndrome Belowthe level of lesion: Impairment of ipsilateral light touch, proprioception and vibration (dorsal columns) from site of lesion, caudally Impairment of contralateral pain and temperature (spinothalamic tract) below level of lesion Impairment of ipsilateral voluntary movements (UMN type of paralysis) below level of lesion Temporary loss of vasomotor tone
- 26. Brown Sequard Syndrome Abovethe lesion Small area of cutaneous hyperaesthesia on the same side No motor involvement on both sides At the level of lesion Complete sensory loss on the same side LMN paralysis – same side Vasomotor paralysis – same side No sensory motor & vasomotor involvement on the opposite side
- 28. Brown Sequard’s Syndrome SiteFunction Same side Opp. side Above the level Sensory Motor Vasomotor Normal Normal Normal Normal Normal Normal At the level Sensory Motor Vasomotor Total sensory loss LMN type palsy Vaso dilatation Normal Normal Normal Below the level Sensory Motor Vasomotor Dorsal column lost UMN type palsy Vaso dilatation Spino thalamic lost Normal Normal