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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 cordnerve rootsnerve 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
Apleys System of Orthopaedics and Fractures,
9
th
edition.
Pocketbook of Ortho and Fractures,McRae, 2
nd

Edition
Netters Concise Ortho Anatomy
Clinical Anatomy by regions 8
th
edition