Spinal Cord Injury - PowerPoint PPT Presentation

Loading...

PPT – Spinal Cord Injury PowerPoint presentation | free to download - id: 408445-NjUzZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Spinal Cord Injury

Description:

Arial Verdana Gulim template-17 1_template-17 Spinal Cord Injury Spinal Cord Injury Slide 3 The Magnitude of the Problem SCI Statistics (2002) Slide 6 ... – PowerPoint PPT presentation

Number of Views:1020
Avg rating:3.0/5.0
Slides: 51
Provided by: mfo83
Learn more at: http://www.mcleishorlando.com
Category:
Tags: cord | injury | spinal

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Spinal Cord Injury


1
Spinal Cord Injury
  • Michael Ford MD FRCSC
  • Sunnybrook HSC

2
Spinal Cord Injury
  • Objectives
  • Magnitude of the problem
  • Patterns of injury
  • Treatment options
  • Literature review
  • Future treatment paths

3
(No Transcript)
4
The Magnitude of the Problem
5
SCI Statistics (2002)
  • 250,000 in USA
  • Paraplegic 52
  • Quadriplegia 47
  • New SCI/yr 11,000
  • Male 82
  • 16yr-30yr 56
  • Causes
  • MVA 37
  • Violence 28
  • Falls 21
  • Sports 6
  • Other 8
  • 89 D/Cd home

6
  • Over 200.00/yr/taxpayer

7
Rick Hansen SCI Registry
8
RHSCIR
9
RHSCIR
10
RHSCIR
11
RHSCIR
12
(No Transcript)
13
Anatomy Review
14
(No Transcript)
15
Anatomy of the Spine
Region Spinal Segment Vertebral Bodies Nerves
Neck Cervical C1-C7 C1-C8
Upper and mid-back Thoracic T1-T12 T1-T12
Low back Lumbar L1-L5 L1-L5
Sacral S1-S5 (fused) S1-S5
16

17
Patterns of Injury
  • Burst fractures
  • Dislocations
  • Fracture/Dislocations
  • Extension Injuries

18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
Pathophysiology of Spinal Cord Injury
  • Primary injury
  • Mechanical and initial ischemic injury
  • Secondary injury
  • release of intrinsic factors which cause
    further injury

25
Treatment
  • The patient
  • ABCs
  • The spine and spinal cord

26
Treatment
  • The patient
  • Avoid hypotension
  • Maintain cord perfusion
  • Watch for secondary neural mediated
    cardiovascular events.neurogenic shock
  • Loss of sympathetic tone.
  • Not to be confused with spinal shock

27
Treatment
  • The Patient
  • Injuries at C5 and proximal results in
    diaphragmatic dysfunction and lack of intercostal
    muscle function. Ventilation dependant on the
    accessory muscles of respiration.
  • Respiratory fatigue an inevitability

28
Treatment
  • The Spine and Spinal Cord
  • Spinal precautionsDo no harm
  • Basic principles
  • Early and rapid reduction of deformity and
    malalignment in all cervical cases independent of
    neuro status.indirect decompression
  • Early surgical stabilization of unstable
    fractures associated with reduced general
    complications, costs, ICU stay, ALOS.

29
Treatment
  • Indirect decompression.Gardner Wells tongs or
    halo

30
(No Transcript)
31
(No Transcript)
32
Treatment
  • Direct decompression
  • Risk vs Benefit analysis
  • Who benefits?
  • Who doesnt benefit?

33
Treatment
  • Best evidence
  • Animal studies suggest that early
    decompression is of benefit but no clinical human
    series have demonstrated the utility of
    decompression especially in those patients with
    complete lesions.
  • On an empirical basis most of us will
    decompress an incomplete cord lesion urgently
    accompanied by a stabilization procedure.

34
Treatment
  • There is very little justification for early
    decompression for complete cord lesions.
  • Why not decompress everybodywhat have you
    got to lose?

35
Treatment
  • Risks of decompression
  • CSF fistula
  • infection
  • increased blood loss especially if an
    anterior approach is utilized.

36
Outcomes
37
1-year Follow-Up Frankel Grade 1-year Follow-Up Frankel Grade 1-year Follow-Up Frankel Grade 1-year Follow-Up Frankel Grade
Admit Frankel A B C D
A 84 8 5 3
B 10 30 29 31
C 2 2 25 67
D 2 1 2 85
38
Recovery After SCI
  • Most neurologic recovery occurs in the first 3-6
    months after injury
  • Some lesser recovery may continue for up to 18
    months to 2 years

39
Recovery of Walking
  • 90 of people with Brown-Sequard
  • 50 with central cord syndrome
  • Very few with anterior cord lesion
  • 70-90 if ASIA B preservation of PP within
    first few weeks
  • Unlikely if ASIA B preservation of LT but not PP

40
Recovery of Walking in Tetraplegia
  • Very likely if ASIA C/D and age lt 50
  • 40 if ASIA C/D and age gt 50
  • 46 of incomplete tetraplegics walk at 1 year
  • Poor prognosis if LE motor score 20/50 at 1
    month
  • Good prognosis if LE motor score 30/50 at 1
    month

41
Recovery of Walking in Paraplegics
  • More difficult to predict
  • Changes from 1 month to 1 year
  • 73 do not change NLI
  • 18 improve 1 level
  • 7 improve 2 levels

42
Recovery of Walking in Paraplegics
  • No neurologic recovery if complete injury above
    T8
  • Some recovery of function
  • 15 of those T9 T11
  • 55 of those T12 and below
  • Incomplete paraplegia has the best potential for
    recovery

43
Prognosis Related to MRI Findings
  • Severe injury associated with
  • Intramedullary hemorrhage
  • Cord edema more than 1 segment
  • Residual spinal cord compression
  • Poor recovery associated with
  • Severe cord compression, swelling, abnormal
    signal on T1 and T2 images
  • No resolution of signal abnormalities

44
Prognosis Related to MRI Findings
  • 4 indicators for poor prognosis
  • Spinal cord hemorrhage
  • Length of hemorrhage
  • Length of edema
  • Spinal cord compression
  • CT spinal canal compromise by 25 or more
    correlates with compression on MRI

45
Prognosis Related to MRI Findings
  • No motor improvement if hemorrhagic lesion
  • 72 had some motor recovery if edema segment

46
Functional Outcomes by LOI
  • C1,2,3- power chair, ECU, ventilator
  • C5 - feeding
  • C6 - tenodesis grasp
  • C7 independent w/ most ADLs
  • mobility - manual W/C, transfers
  • C8/T1 - bladder/bowel independence
  • L 2,3 - Ambulation

47
Treatment
  • Secondary cord injury
  • Methylprednisolone
  • Neuroprotective agents
  • Cooling

48
(No Transcript)
49
  • The Future
  • Will there be a cure?
  • ?

50
Thank You!
www.poweredtemplates.com
About PowerShow.com