Table Of ContentHANDBOOK OF
SPINAL CORD MEDICINE
Handbook of
Spinal Cord
Medicine
DAVID C. BURKE, M.B., B.S., D.P.R.M.,
Medical Director, Spinal Injuries Unit, Austin Hospital, Heidelberg,
Victoria, Australia
D. DUNCAN MURRAY, M.D., F.R.C.P.(c.),
Assistant Medical Director (Acting), Spinal Injuries Centre,
and Lecturer in Rehabilitation Medicine,
Dalhousie University, Canada
M
ISBN 978-1-349-02700-2 ISBN 978-1-349-02698-2 (eBook)
DOI 10.1007/978-1-349-02698-2
©D. C. Burke and D. D. Murray 1975
Reprint of the original edition 1975
All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means,
without prior permission.
First published 1975 by
THE MACMILLAN PRESS LIMITED
London and Basingstoke
Associated companies in New York Dublin
Melbourne Johannesburg and Madras
SBN 333 18711 3
PREFACE
This handbook is designed as a pocket companion for new
doctors working in a Spinal Unit or Rehabilitation Depart
ment. It serves as an introductory text for the young
resident or house doctor who has had no previous experience
with the specialised problems of the spinal paralytic,
providing a brief overview of the whole subject. A sample of
more detailed texts are referred to in the Bibliography for
further reading.
The handbook should also quickly gain acceptance
amongst medical students as it provides a concise source of
information about a specialised topic which is not found in
standard student texts. It will also have a useful place in
the orientation of new nursing staff, physiotherapists,
occupational therapists and other paramedical staff who are
called upon to treat paraplegics and tetraplegics. As such,
it should also have a useful place in schools of nursing,
physiotherapy, etc.
Physicians treating patients with spinal cord injuries will
quickly realise the value of this pocket handbook when new
staff of all disciplines commence work in their Centres, just
as the authors have in their respective Units in Melbourne
and Halifax.
D.C.B.
D.D.M.
v
CONTENTS
Preface v
1. Functional Anatomy of the Spinal Column 1
General description 1
Cervical vertebrae 1
Thoracic and lumbar vertebrae 2
Arterial supply of the spinal cord 3
2. Functional Anatomy of the Spinal Cord
General description 4
Ascending tracts 5
Descending tracts 6
Spinal segments 8
3. Spinal Column Injuries 12
Classification of injuries 13
Cervical spine 13
flexion-rotation dislocation or fracture
dislocation 13
compression fracture 13
hyperextension injuries 15
Thoraco-lumbar spine 15
flexion-rotation dislocation or fracture
dislocation 15
compression fractures 16
hyperextension injuries 16
Open injuries 16
Treatment of vertebral column injuries 16
Conservative management 16
cervical spine 16
VI
thoraco-lumbar spine 17
Surgical management 18
4. Spinal Cord Injuries 20
Complete lesions 20
Motor deficit 20
upper motor neuron 20
lower motor neuron 20
mixed 21
inappropriate flaccid lesions 21
Sensory deficit 21
Autonomic deficit 22
vasomotor control 22
temperature control 22
bladder and bowel 23
Incomplete lesions 23
Acute anterior cervical spinal cord syndrome 23
Acute central cervical spinal cord syndrome 23
Brown-Sequard syndrome 23
Sacral sparing 24
Cauda equina lesions 24
Root escape 24
Spinal concussion 24
s.
Aetiology of Non-Traumatic Spinal
Paralysis 25
Developmental 25
Acquired 25
6. Management of the Acute Spinal Cord
Patient 26
Emergency treatment 26
Spinal shock 27
Gastrointestinal complications
Paralytic ileus 29
Acute gastric dilatation 30
vii
Acute peptic ulceration 30
Bowel obstruction 31
Acute abdomen 31
Respiratory management in the acute
quadriplegic 32
Hypoventilation 33
Tracheostomy 34
Metabolic management 34
Venous drainage complications 36
Deep vein thrombosis 36
Pulmonary embolus 37
Gravitational oedema 37
7. The Neurogenic Bladder 38
Normal bladder 38
Anatomy 38
Neuroanatomy 39
Physiology 39
Neurogenic bladder 40
Spinal shock 40
Upper motor neuron lesions 40
Lower motor neuron lesions 40
Mixed lesions 40
Bladder training 41
Investigation 41
Early bladder management 42
Upper motor neuron bladder 43
Lower motor neuron bladder 43
Other neurogenic bladders 44
Residual urine 44
Collecting devices 45
Outlet obstruction 45
Balanced bladder 46
Complications of catheter drainage 47
Catheters 47
Infection of urine 48
Vlll
Bladder calculi 49
Other complications 50
Autonomic hyperreflexia 50
Vesicoureteric reflux 51
By-passing 53
8. The Neurogenic Bowel 53
Normal bowel function 53
Neurogenic bowel 54
Bowel training 54
9. Pressure Sores 56
Pathophysiology 56
Treatment 58
Prophylaxis 58
Conservative management 59
Surgical management 60
10. Sexual Function in the Spinal Cord Patient 61
Normal physiology 61
Sexual function in the male spinal patient 62
Reproduction 63
Sexual function in the female spinal patient 64
Pregnancy 64
11. Spasticity 65
Physiology of the stretch reflex 65
Afferent arc 65
Efferent arc 66
Spasticity 67
Treatment 68
Prevention 68
Conservative management 69
Surgical management 70
12. Ascending Myelopathy 70
IX
B
13. Chronic Pain 71
Aetiology 71
Treatment 72
14. Para-articular Heterotopic Ossification
(P.A.O.) 73
15. Osteoporosis and Pathological Fractures 74
16. Aims in Rehabilitation 75
Paraplegia 76
Quadriplegia 77
17. Psychological Profile of a Spinal Patient 78
General 78
Immediate reactions 78
Long-term reactions 79
18. Mortality 81
Early mortality 81
Delayed causes of death 82
19. Social Aspects of Rehabilitation 83
Litigation 83
Family 83
Finances 83
Employment 84
Home 84
Tertiary placement 84
Selected Bibliography 85
Journals 85
Reference texts 89
X
