orthopedics notes

Apr 16th, 2015
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By Okell-2006 CLASSSPINAL INJURYDefinitionSpinal cord injury (SCI) is an insult to the spinal cordresulting in a change, either temporary or permanent, in itsnormal motor, sensory, or autonomic functionBackgroundPatients with spinal cord injury (SCI) usually havepermanent and often devastating neurologic deficits anddisability.The goals for the emergency physician are to1.Establish the diagnosis2.Initiate treatment to prevent further neurologic injuryfrom either pathologic motion of the injured vertebrae orsecondary injury from the deleterious effects ofcardiovascular instability or respiratory insufficiencyPathophysiologyAnatomyThe spinal cord is divided into 31 segments, each with apair of anterior (motor) and dorsal (sensory) spinal nerveroots. On each side, the anterior and dorsal nerve rootscombine to form the spinal nerve as it exits from thevertebral column through the neuroforamina.Spinal cord ends at lower margin of the L1 vertebral body.Thereafter, the spinal canal contains the lumbar, sacral, andcoccygeal spinal nerves that comprise the cauda equina.Therefore, injuries below L1 are not considered SCIsbecause they involve the segmental spinal nerves and/orcauda equine.The spinal cord organized into a series of tracts orneuropathways that carry motor (descending) and sensory(ascending) pathways.The corticospinal tracts are descending motor pathwayslocated anteriorly within the spinal cord. Axons extendfrom the cerebral cortex in the

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