SPINAL CORD

INJURY

S C I

> is damage or trauma to the spinal cord that results in a loss or impaired function causing reduced mobility or feeling and resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function..

Most Common Causes

Motor Vehicle Accidents

Falls

Violence

Sports Injuries

Pathophysiology

transient concussion contusion

laceration

Compression of the cord

substance

Complete Transection of the

cord

Damages to the Spinal Cord ranges from:

Transection of Cord

The vertebral column provides structural support for the trunk and surrounds and protects the spinal cord. The vertebral column also provides attachment points for the muscles of the back and ribs. The vertebral disks serve as shock absorbers during activities such as walking, running, and jumping. They also allow the spine to flex and extend.

Clinical Manifestations

Incomplete Spinal Cord Lesion

Complete Spinal Cord Lesion

Incomplete Spinal Cord Lesion Anterior Cord Syndrome

- is when the damage is towards the front of the spinal cord, this can leave a person with the loss or impaired ability to sense pain, temperature and touch sensations below their level of injury. Pressure and joint sensation may be preserved. It is possible for some people with this injury to later recover some movement.

Central Cord Syndrome- is when the damage is in the centre of the spinal cord. This typically results in the loss of function in the arms, but some leg movement may be preserved. There may also be some control over the bowel and bladder preserved. It is possible for some recovery from this type of injury, usually starting in the legs, gradually progressing upwards

Brown-Sequard Syndrome- is when damage is towards one side of the spinal cord. This results in impaired or loss of movement to the injured side, but pain and temperature sensation may be preserved. The opposite side of injury will have normal movement, but pain and temperature sensation will be impaired or lost.

Posterior Cord Syndrome- is when the damage is towards the back of the spinal cord. This type of injury may leave the person with good muscle power, pain and temperature sensation, however they may experience difficulty in coordinating movement of their limbs.

Complete Spinal Cord LesionParaplegia - paralysis of the lower body

Quadriplegia - paralysis of all four extremities

Diagnostic Tests

X-ray - for lateral cervical spine

CT Scanner - performed initially

MRI - if a ligamentous injury suspected even absence of bony injury

Electrocardiographic Machine – for cord injury bradycardia and asystole

Emergency Management

the patient must be in a neutral position

control the patient’s head to prevent flexion, extension, or rotation

slide the victim carefully into a board when transferring to avoid any twisting movement

maintain the extremities in an extended position

patient can be moved to a conventional bed or placed in a cervical collar and on a firm mattress with a bed board under it

Management of Spinal Cord

Injuries (Acute Phase)

Regeneration Therapy - transplanting of fetal tissue into the injured spinal cord in hopes of regenerating the damaged tissue

Pharmacologic Therapy

Methylprednisolone - improve motor and sensory outcomes at 6 weeks, 6 months, and 1 year if given within 8 hours of injury

Respiratory Therapy

Skeletal Fracture Reduction and Traction

Cones Caliper Cervical or neck Traction

Gardner-Wells Tong

Tractions

Surgical Management

Surgery is indicated in the following instances:

compression of the cord is evident

injury involves a wound that penetrates the cord

there are bony fragments in the spinal canal

patient’s neurologic status is deteriorating

injury results in a fragmented or unstable vertebral body

Planning and Goalsimproved breathing pattern and airway clearance

improved mobility

improved sensory and perceptual awareness

maintenance of skin integrity

relief of urinary retention

improved bowel function

promotion of comfort

absence of complications

Nursing Interventions

Promoting Adequate Breathing and Airway Clearance

Improving Mobility

Promoting Adaptation to Sensory and Perceptual Alterations

Maintain Skin Integrity

Maintaining Urinary Elimination

Improving Bowel Function

Providing Comfort Measures

Monitoring and Managing Potential Complications

Promoting Home and Community-Based Care