01 Spinal Cord Injury

Spinal cord injury
Mohd Hafiz Idlan Bin Radzali
0910683
Mr Zamzuri
outline
• Anatomy
• Pathophysiology
• Diagnosis
• Management
• Complication

Anatomy
Spinal vertebrae
• Composed of 33
vertebrae
• 7 cervical
• 12 thoracic
• 5 lumbar
• 5 sacral
• 4 coccygeal

Vertebral columns
Spinal cord
• Runs through the vertebral canal
• Extends from foramen magnum to
second lumbar vertebra
• Regions
– Cervical
– Thoracic
– Lumbar
– Sacral
– Coccygeal
• Gives rise to 31 pairs of spinal
nerves
– All are mixed nerves
• Not uniform in diameter
– Cervical enlargement: supplies
upper limbs
– Lumbar enlargement: supplies
lower limbs
• Conus medullaris- tapered inferior
end
– Ends between L1 and L2
• Cauda equina - origin of spinal
nerves extending inferiorly from
conus medullaris.


Protective layers
• Connective tissue membranes
– Dura mater: outermost layer; continuous with epineurium of the spinal nerves
– Arachnoid mater: thin layer
– Pia mater: bound tightly to surface
• Forms the filum terminale
– anchors spinal cord to coccyx
• Forms the denticulate ligaments that attach the spinal cord to the dura
• Spaces
– Epidural: external to the dura
• Anesthestics injected here
• Fat-fill
– Subdural space: serous fluid
– Subarachnoid: between pia and arachnoid
• Filled with CSF

Cross section
• Anterior median fissure and posterior median sulcus
– deep clefts partially separating left and right halves
• Gray matter: neuron cell bodies, dendrites, axons
– Divided into horns
• Posterior (dorsal) horn
• Anterior (ventral) horn
• Lateral horn
• Intermediate column
• White matter
– Myelinated axons
– Divided into three columns (funiculi)
• Ventral
• Dorsal
• lateral
– Each of these divided into sensory or motor tracts


Root of spinal nerves

• Roots
– 31 pairs of Spinal nerves arise as rootlets then combine to form dorsal
and ventral roots
– Dorsal and ventral roots merge laterally and form the spinal nerve

Ventral(Motor) roots
Each Joint: typically by 4 spinal nerves

• Hip flexion: L2,L3 extension: L4,L5
• Knee extension: L3,L4 flexion: L5, S1
• Dorsiflexion: L4, L5 plantar flexion: S1,S2
• Inversion: L4 Eversion: L5, S1
• Shoulder Abd: C5 Adduction: C6, C7
• Elbow flexion: C5, C6 Extension: C6, C7
• Wrist: C6, C7 Fingers: C7, C8
• Pronation
& Supination: C6

Dorsal(sensory)
Blood supply
• Anterior spinal artery
• Posterior spinal artery
• Radicular artery
• Internal vertebral
venous plexus
Neurological injuries


UMNL vs LMNL
UMNL
• Cerebral cortex (pyramidal tract) –> Precentral gyrus (motor
strip) → internal capsule (posterior limb) → brainstem →
spinal cord
• Interruption of the corticospinal and corticonuclear tract
along its course
LMNL
• Anterior horn cells in spinal cord→nerve roots→nerve plexus
→peripheral nerves
• Degeneration of the motor neuron & peripheral nerves
UMNL vs LMNL
UMNL
• Weakness in all muscle
group
• Very little muscle wasting
• No fasciculation
• Hypertonia
• Hyperreflexia
• Positive Babinski
LMNL
• Weakness of individual
muscles
• Muscle wasting prominent
feature
• Fasciculation
• Hypotonia
• Hyporeflexia
• Normal or absent babinski

Thank you

References
• Apley’s System of Orthopaedics and Fractures,
9
th
edition.
• Pocketbook of Ortho and Fractures,McRae, 2
nd

Edition
• Netter’s Concise Ortho Anatomy
• Clinical Anatomy by regions 8
th
edition