SPINAL CORD INJURY
Jessica Ryu, T4
Tulane University School of Medicine
Anatomy
• Anterior spinal artery, 2 posterior spinal arteries
• All 3 receive contributions from the radicular
branches
• 4-10 radicular branches which arise from the
vertebral, cervical, intercostal, lumbar arteries
• Anterior spinal supplies 2/3 of spinal cord
(motor function)
• Posterior arteries supply posterior columns and
horns
Anatomy Continued
• Cervical and superior thoracic region: derived
from cervical branches of the vertebral and
ascending and deep cervical arteries
• Middle and lower thoracic cord: radicular arteries
less prominent
• Lower thoracic and lumbar cord: T7-conus blood
supply is artery of Adamkiewicz
• Greatest susceptibility to cord ischemia: thoracic
region
Cervical Spine Injuries
• Spinal shock, immediate, lasts for hours to about a month
• Flaccid paralysis
• Bradycardia, hypotension and EKG changes
• Alveolar hypoventilation, hypoxemia and decreased ability to
protect airway
• Management:
• Induction: awake or IV rapid sequence (awake intubation is
safest)
• Awake: nose is cocainized, oropharynx sprayed with 4%
lidocaine, superior laryngeal nerve blocked by injection,
recurrent laryngeal can be blocked by injection but in full
stomach situation that is probably not advised (if RLN not
blocked, cough ability retained)
Cervical Spine Injuries Continued
• Important levels:
• Diaphragm
• Patients don’t survive with injuries above C2
• Important note: patients should be positioned for
surgery before they are put to sleep if they have
an unstable C-spine
Paralysis
• Two stages: flaccid and spastic
• Flaccid: 1-4 weeks, manifested by total absence of
neuro function below lesion, usually characterized by
spinal shock
• Spastic: occurs after 4 weeks, manigested by motor
hyperreflexia and autonomic hyperreflexia
• Problems experienced by paraplegics: bowel, bladder,
anemia, dehydration
• Spinal anesthesia is a good choice in paraplegics (blocks
afferent impulses)
• To evaluate level of anesthesia in paraplegic test for
sympathogalvanic response
Monitoring
• Motor injury detection
• Evoked potentials: somato-sensory
evoked potentials provide ability to
monitor sensory pathway functional
integrity
• Wake up Test
Important Facts to Remember
• Flaccid paralysis (hypovolemia, bradycardia,
increased sensitivity to anesthetics)
• Ventilation problems and increased risk of gastric
aspiration
• Hyperkalemia (muscle membrane becomes
chemically active – 1 day to 1 year)
• Hypothermia (no temp regulation below level of
lesion)
• Renal insufficiency (risk of infection)
Important Facts to Remember
• Unstable thoracic or lumbar spine injuries:
patients can be put to sleep on their beds and
then moved
• Sux contraindicated for about 1 day- 1 year after
injury (causes release of K+ from motor end plate
membrane and the muscle membrane after
spinal cord injury is abnormal)
Thank you