Spinal Injury



Spinal Injury






Epidemiology

Annual incidence of spinal injury: 15 to 50/1,000,000. Prevalence about 900/1,000,000.

Mortality >50% at scene of accident; about 13% at one year for those who survive acute hospital care.

Peak incidence at age 20 to 24 years, during summers and weekends. M:F ratio 4:1.

Most common level of injury C5, followed by C4 and C6.


Etiology

Most common causes: road accidents (48%), falls (21%; especially in elderly), sports (13%), industrial (12%), violence (16%).


Mechanism of Injury

Most common: indirect force to vertebral column (e.g., sudden flexion, hyperextension, vertebral compression or rotation of vertebral column).

Secondary injury: ongoing injury after initial insult. May continue for years. Mechanism poorly understood.


Pathology

Hyperemia, edema, inflammatory exudate within first few hours. Resolves in weeks or months. Hemorrhage may occur (hematomyelia).

Cavity (syringomyelia) or area of tissue softening (myelomalacia) may form in months, with slowly progressive neurologic deterioration.


Neurologic Assessment and Classification


ASIA/IMSOP Impairment Scale

Published by the American Spinal Injury Association (ASIA) and International Medical Society of Paraplegia (IMSOP).




  • Complete: No motor or sensory function in sacral segments S4/S5.


  • Incomplete: Sensory but not motor function preserved below level, extending through sacral segments S4/S5.


  • Incomplete: Motor function preserved below neurologic level; key muscles below level have power grade <3.


  • Incomplete: Motor function preserved below neurologic level; key muscles have power grade >3.


  • Normal: Motor and sensory function normal.


Clinical Patterns

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Jul 27, 2016 | Posted by in NEUROLOGY | Comments Off on Spinal Injury

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