SPINAL CORD INJURY

DEFINITION
Spinal

cord injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling.

CAUSES:

Bullet or stab wound Traumatic injury Electric shock Extreme twisting of the middle of the body Landing on the head during a sports injury Fall from a great height

RISK FACTORS
Men

Young

adults and seniors who are active in sports with predisposing conditions

People

People

Most Common Causes

Motor Vehicle Accidents

Violence

Falls

Sports Injuries

Clinical Manifestations
Complete Spinal Cord Lesion Incomplete Spinal Cord Lesion

Complete Spinal Cord Lesion

Paraplegia
- paralysis of the lower body

Quadriplegia
- paralysis of all four extremities

 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.

INCOMPLETE SPINAL CORD INJURIES

Anterior

cord syndrome

POSTERIOR CORD SYNDROME

CENTRAL CORD SYNDROME

BROWN-SEQUARD SYNDROME

SIGNS AND SYMPTOMS

CERVICAL (NECK) INJURIES

Breathing difficulties Loss of normal bowel and bladder control

Numbness Sensory changes

Spasticity (increased muscle tone)

THORACIC (CHEST LEVEL) INJURIES

Loss of normal bowel and bladder control

Numbness
Sensory changes Spasticity (increased muscle tone) Weakness, paralysis

LUMBAR SACRAL (LOWER BACK) INJURIES

Loss of normal bowel and bladder control (you may have constipation, leakage, and bladder spasms)

Numbness
Pain Sensory changes Weakness and paralysis

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 patients 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

Tractions

Gardner-Wells Tong

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 patients neurologic status is deteriorating injury results in a fragmented or unstable vertebral body

Planning and Goals

improved 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