Spinal Cord Injury Four General Types of SCI Major Classifications of SCI Signs and Symptoms Different Forms

of Paralysis Pathophysiology Diagnostic Examination

Treatment and Management Nursing Management References

- Damage to the spinal cord that result in either temporary or permanent change to normal motor, sensory or autonomic function. - Usually begins with sudden, traumatic blow to the spine that fractures or dislocates vertebrae. - Vertebrae most frequently involved in SCI are 5th, 6th, 7th cervical vertebrae, 12th thoracic vertebrae and 1st lumbar vertebrae.

1.

Cord Maceration

2. 3.

The morphology distorted.

of

the

cord

is

Cord Lacerations Contusion Injury

Gun shot or knife wound

4.

Leads to a central hematomyelia that may evolve to syringomyelia

Solid Cord Injury

There is no central focus of necrosis as in contusion injury.

1. Complete

2.

Characterized as complete loss motor and sensory function below the level of traumatic lesion Characterized by variable neurologic findings with partial loss of sensory and/or motor function below the lesion

Incomplete

Subjective

Loss of sensation below the level of injury Inability to move

Objective

a. Early symptoms of spinal shock Absence of reflexes below the level of lesion Flaccid paralysis (immobility accompanied by weak, soft, flabby muscles) below the level of injury Hypotonia (caused by disruption of neural impulses) results in bowel and bladder distention Inability to perspire in affected parts Hypotension b. Later symptoms of SCI Reflex hyperexcitability paralysis

(spastic

 State of diminished reflex excitability (flaccid paralysis) c. In total cord damage Sacral region: paraplegia accompanied by atonic bladder and bowel with impairment of sphincter control. Lumbar region: paralysis of the lower extremities that may extend to the pelvic region accompanied by a spastic bladder and loss of bladder and anal sphincter control. Thoracic region: Same symptoms as in lumbar region except extends to trunk below level of the diaphragm. Cervical region: same symptoms as in the thoracic region except extends from the neck down and includes paralysis of all extremities, if injury is above C4, respirations are depressed.

d. In partial cord damage Destruction of lower motor neurons: atrophy and flaccid paralysis of the involved muscles Destruction of upper motor neurons: distended bowel or bladder, severe hypertension, headache, flushed skin, diaphoresis, and nasal congestion. Monoplegia Paralysis of one limb Diplegia Paralysis of both upper and lower limbs Paraplegia Paralysis of both lower limbs Hemiplegia Paralysis of upper limb, torso and lower leg on one side of the body Quadriplegia Paralysis of all four limbs

Predisposing Factor Trauma Excessive use of automobile Increased time spent in recreation and sport activities Age

Precipitating Factor Contusion Lifestyle Accidents Occupation

Damage to the spinal cord Localized hemorrhage Seeping of blood to the epidural and subarachnoid spaces Nerve fiber swells Impaired blood circulation Reduced vascular perfusion Ischemia and hypoxia Oxygen tension in tissue and the site of injury Edema Destruction of myelin and axons

SPINAL CORD INJURY

 X-ray Reveal vertebral problems, tumors, fractures or degenerative changes in the spine CT scan Provide better look at abnormalities seen on X-ray Magnetic Resonance Imaging (MRI) Extremely helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord Myelography Used when MRI is not possible yield important additional information that is not provided by other test.

There is no way to reverse the damage to the spinal cord and treatment focuses on preventing further injury. Traction and cast needed to stabilize the spine and bring it into proper alignment during healing Surgery necessary to remove fragments of bone, foreign objects, herniated disk or fractured vertebrae that appear to be compressing the spine Methylpredrisolone (MEDROL) reduces damage to the nerve cells and decrease inflammation near site of the injury Analgesic reduces pain

Written reports at the POC Library Orthopedic Nursing Book

1. Neurologic assessment. 2. Maintenance of vertebral column by use of the following: a. Bed rest with supportive devices (bed board, sand bags) b. Bed rest with total immobilization. c. Traction (skeletal or skin traction) d. Corsets, braces, and other devices when mobility is permitted 3. Surgery to reduce pain or pressure and/or stabilize the spine (laminectomy, spinal fusion). 4. Mechanical ventilation as needed. 5. Temperature control via hypothermia or tepid baths. 6. High doses of steroids to reduce the inflammatory process at the site of injury. 7. Extensive rehabilitation medicine.