1. 骨科國考班 SC 吳俊賢

2. Sacral sparing 是代表不完全脊髓損傷 (Incomplete spinal cord injury) ，下列何者不屬 於 Sacral sparing ？ A. 肛門周圍有感覺 (Perianal sensation) B. 肛門可自主收縮 (Voluntary anal contraction) C. 大拇趾可屈曲 (Great toe flexion) D. 大拇趾可伸展 (Great toe extension)

3. Complete & Incomplete Complete spinal cord injury Complete spinal cord injury No function below level of injury No function below level of injury Less than 5% recover locomotion Less than 5% recover locomotion Incomplete spinal cord injury Incomplete spinal cord injury Some sensation or movement below the level of the injury Some sensation or movement below the level of the injury Over 95% recover some locomotion ability Over 95% recover some locomotion ability

4. Sacral sparing might be the only finding for incomplete SCI

5. Approach to Spinal Cord Injury Determine sensory level Determine sensory level Most caudal level with normal light touch & pin-prick sensation Most caudal level with normal light touch & pin-prick sensation Determine motor level Determine motor level Lowest key muscle ≥ 3 Lowest key muscle ≥ 3 All key muscle above = 5 All key muscle above = 5 Determine the neurological level Determine the neurological level Lowest level with normal sensory & motor level Lowest level with normal sensory & motor level Zone of injury: 2~3 levels below neurological level Zone of injury: 2~3 levels below neurological level Sacral sparing or not Sacral sparing or not Anal examination Anal examination Superficial anal sensation Superficial anal sensation Anocutaneous (AC) reflex Anocutaneous (AC) reflex Bulbocavernosus (BC) reflex Bulbocavernosus (BC) reflex Voluntary anal contraction Voluntary anal contraction Deep anal sensation Deep anal sensation

6. Sacral Sparing Sensory Sensory Heel Heel Popliteal area Popliteal area Perianal area Perianal area Deep anal sensation Deep anal sensation

7. Sacral Sparing Motor Motor S1: gastrocnemius & soleus S1: gastrocnemius & soleus Ankle plantarflexion Ankle plantarflexion S2~S4: external anal sphincter S2~S4: external anal sphincter Voluntary anal contraction Voluntary anal contraction Anocutaneous (AC) reflex Anocutaneous (AC) reflex Bulbocavernosus (BC) reflex Bulbocavernosus (BC) reflex

8. Sacral sparing 是代表不完全脊髓損傷 (Incomplete spinal cord injury) ，下列何者不屬 於 Sacral sparing ？ A. 肛門周圍有感覺 (Perianal sensation) B. 肛門可自主收縮 (Voluntary anal contraction) C. 大拇趾可屈曲 (Great toe flexion) D. 大拇趾可伸展 (Great toe extension)

9. Key Muscle Groups Level Muscle Group C5 Elbow flexors (biceps, brachialis) C6 Wrist extensors (extensor carpi radialis longus and brevis) C7 Elbow extensors (triceps) C8 Finger flexors (flexor digitorum profundus to the middle finger) T1 Small finger abductors (abductor digiti minimi) L2 Hip flexors (iliopsoas) L3 Knee extensors (quadriceps) L4 Ankle dorsiflexors (tibialis anterior) L5 Long toe extensors (extensor hallucis longus) S1 Ankle plantarflexors (gastrocnemius, soleus) Deep peroneal nerve Tibial nerve

10. Movements of Great Toe Flexion Flexion Flexor hallucis longus Flexor hallucis longus Innervated by tibial nerve Innervated by tibial nerve Extension Extension Extensor hallucis longus Extensor hallucis longus Innervated by deep peroneal nerve Innervated by deep peroneal nerve

11. Sacral sparing 是代表不完全脊髓損傷 (Incomplete spinal cord injury) ，下列何者不屬 於 Sacral sparing ？ A. 肛門周圍有感覺 (Perianal sensation) B. 肛門可自主收縮 (Voluntary anal contraction) C. 大拇趾可屈曲 (Great toe flexion) D. 大拇趾可伸展 (Great toe extension)

12. Thanks for your attention.