T9 Spinal Cord Problems

• What minimum systolic pressure is the target for neurogenic shock?

  85 - 90 mmHg.
• What are signs of neurogenic shock?

  Hypotension, normal to bradycardia, and warm, dry skin.
• What is treatment for neurogenic shock?

  Epinephrine.
• Why does neurogenic shock cause the manifestations?

  Damage to the spinal cord causes sympathetic nervous system damage which prevents the heart rate from increasing and leads to vasodilation, which then leads to warm and dry skin.
• What are signs of autonomic dysreflexia?

  Vasoconstriction below the level of injury and massive vasodilation above the injury. Dangerously high hypertension, bradycardia, diaphoretic, severe headache, JVD above level of injury, below injury will be pale, cool and dry.
• What is a primary spinal injury?

  Initial physical disruption of the spinal cord.
• What is secondary spinal injury?

  Small hemorrhages in white and grey matter, damage to axons, and cell membrane destruction.
• What happens weeks after a spinal injury?

  Glial scars restrict cells in the spinal cord from migration and regeneration causing irreversible damage and permanent deficit.
• Does spinal shock have hemodynamic instability?

  No.
• What are signs of neurogenic shock?

  Hypotension, bradycardia, and warm, dry skin.
• Where can neurogenic shock occur?

  At T5 or above.
• How is neurogenic shock treated?

  Spinal stability, treat hypotension and bradycardia with vasopressors and atropine, fluids infused cautiously, monitor for hypothermia.
• If the anterior ligament of a spine is ruptured, what kind of mechanism of injury is this?

  Hyperextension.
• If the posterior ligaments of the spine are injured what kind of mechanism of injury is this?

  Flexion injury.
• What kind of injury crushes the vertebrae and forces bony fragments into the spinal canal?

  Compression fracture.
• What kind of spinal injury causes a tearing of ligamentous structures that stabilize the spine?

  Flexion-rotation.
• What happens to an injury at C4?

  Tetraplegia, complete paralysis below the neck.
• What happens with a C6 injury?

  Partial paralysis of hands and arms as well as lower body.
• What happens with a T6 injury?

  Paraplegia, results in paralysis below the chest.
• What happens with an L1 injury?

  Paraplegia, paralysis below the waist.
• What happens for injuries between C1-T1?

  Tetraplegia.
• Below T2 what happens if it is injured?

  Paraplegia.
• What 5 major syndromes are incomplete injuries?

  1. Anterior cord syndrome
  2. Central cord syndrome
  3. Brown-Sequard syndrome
  4. Cauda equina syndrome
  5. Conus medullaris syndrome
• What is a complete spinal injury?

  Total loss of sensory and motor function below the level of injury.
• What is an incomplete spinal injury?

  Mixed loss of voluntary motor activity and sensation.
• What happens with central cord syndrome?

  Damage to central spinal cord. Motor weakness and altered sensation in upper extremities not lower, dysesthetic burning pain in upper extremities.
• What happens with anterior cord syndrome?

  Damage to anterior spinal artery. Motor paralysis, loss of pain and temperature below injury level.
• What happens with Brown-Sequard syndrome?

  Damage to one half of the cord. Ipsilateral loss of motor function and pressure, position, vibration. Contralateral loss of touch, pain, temperature.
• What happens with Cauda Equina syndrome?

  Damage to cauda equina. Complete loss of sensation in saddle area, flaccid bladder and bowel.
• What happens with Conus Medullaris syndrome?

  Damage to conus medullaris (lowest portion of the spinal cord). Impotence, pain is uncommon, motor function may be preserved, weak, or flaccid, decrease or loss of sensation in perianal area.
• What is dermatome?

  Area of skin innervated by a single spinal nerve.
• What is useful for recording changes in neurologic status and helping identify rehabilitation goals?

  ASIA impairment scale.
• What happens to the respiratory system if the injury is above C3?

  Total loss of respiratory muscle function.
• What happens to the respiratory system if injury happens to C3-C5?

  Respiratory insufficiency, decreased strength in chest and abdominal wall, requires intubation like C3 and above.
• How high should PaO2 be for cervical and thoracic spinal injuries?

  Higher than 92%.
• How high does pCO2 need to be for someone to be intubated?

  Greater than 20 mmHg above baseline.
• What happens to the cardio system after an injury above T6?

  Neurogenic shock.
• What does an overactive (spastic) detrusor muscle do?

  Urinary incontinence due to reflex emptying.
• What happens if there is no reflex (hypotonic) detrusor contractions?


  Urinary retention due to over distention.
• What is dyssynergia for neurogenic bladder?

  Incoordination between detrusor contraction and urethral relaxation.