SPINAL CORD

INJURY
ORTHOPEDIC NURSING RLE REPORT
BY SIENA KATHLEEN V. PLACINO
BSN III
DEFINITION
SCI is a trauma to the spinal cord that
causes partial or complete disruption of the
nerve tracts and neurons
Can involve:
• contusion,
• laceration
• compression of the cord
ANATOMY
• The spine consists of :
• 7 cervical vertebrae
• 12 thoracic vertebrae
• 5 lumbar vertebrae
• 5 sacrum
• 1 coccyx
INCIDENCE
Most frequently involved vertebrae:
1. Cervical – C5, C6, C7
2. Thoracic – T12
3. Lumbar – L1
CAUSES
Most common causes include
1. Motor vehicle crashes
2. Falls
3. Sporting and industrial accidents
4. Gunshot or stab wounds
5. Diseases (cancer, arthritis, osteoporosis)
6. Alcohol use
RISK FACTORS
• Being male
• Being between the ages of 16 and 30
(increased likelihood of suffering a
traumatic SCI)
• Being older than 65 (risk of falls)
• Engaging in reckless behavior
• Bone or joint disorders
CLINICAL MANIFESTATIONS

DEPENDENT ON THE LEVEL OF

INJURY!!!
1. Cervical Injuries
1. Injury at C2 to C3 usually FATAL.
2. Injury at C4 causes respiratory difficulty
and paralysis of all four extremities
CLINICAL MANIFESTATIONS
(CONT.)
2. Thoracic level Injuries
1. Loss of movement of chest, trunk,
bowel, bladder, and legs may occur.
2. Leg paralysis/ paraplegia may occur.
3. Autonomic dysreflexia with injury
above T6.
4. Visceral distention from noxious stimuli
may cause: sweating, bradycardia, HTN.,
and goose-flesh.
CLINICAL MANIFESTATIONS (CONT.)
3. Lumbar and sacral level injuries
1. Loss of movement & sensation of lower
extremities may occur
2. S2 and S3 control micturition: bladder
will contract but not empty. (a.k.a.
neurogenic bladder)
3. Injury above S2: allows for erection but
NOT ejaculation.
4. Injury between S2 and S4: prevents
BOTH erection and ejaculation
SCI CLASSIFICATIONS
COMPLETE SPINAL CORD INJURY
• Causes complete loss of motor and sensory
function below the spinal cord injury.

INCOMPLETE SPINAL CORD INJURY

• Partial random preservation of motor or
sensory function below the spinal cord injury.
POSSIBLE COMPLICATIONS
• Blood pressure changes ( autonomic hyperreflexia)
• Loss of:
• Bladder & bowel control
• Sensation and motor function
• Sexual functioning (male impotence)
• Complications of immobility/ paralysis
• Deep vein thrombosis
• Pulmonary infections
• Skin breakdown/ Pressure ulcers
• Contractures
• Autonomic Dysreflexia: occurs in lesions above T6;
• Commonly caused by visceral distention from distended bladder
or impacted rectum
• Spinal Shock:
• complete but temporary loss of motor, sensory, reflex and
autonomic function occurring immediately after injury (usually
lasts less than 48 hrs. but can last for several weeks)
• Neurogenic Shock
• in injuries above T6
• Massive vasodilation occurs leading to pooling of blood in vessels
and tissue hypo-perfusion and impaired cellular metabolism.

• MONITOR fecal impaction and distended bladder.

• MONITOR for signs of shock, hypotension and bradycardia
• MONITOR reflex activity and bowel sounds.
DIAGNOSTIC PROCEDURES
1. X-rays.
• X-rays can reveal vertebral problems, tumors,
fractures or degenerative changes in the spine.
2. Computerized tomography (CT) scan.
3. Myelography
• real-time form of x-ray called fluoroscopy and
injection of contrast material
4. Magnetic resonance imaging (MRI).
• Can identify herniated disks, & blood clots that
may be compressing the spinal cord.
MEDICAL MANAGEMENT
• CORTICOSTEROIDS (hydrocortisone)
• Adrenergics (Nor-epinephrine, epinephrine,
dopamine)
• OXYGEN ADMINISTRATION
• DIAPHRAGMATIC PACING
• BRACES:
1. SOMI : STERNO-OCCIPITO-MANDIBULO
IMMOBILIZER
2. FOUR POSTER EXTERNAL IMMOBILIZER
Types of Cervical Spine Traction:
SURGICAL MANAGEMENT

LAMINECTOMY (or DECOMPRESSION

SURGERY)
• Excision of the posterior arches and
spinous processes of a vertebrae.
POSSIBLE NURSING
DIAGNOSES
1. Ineffective airway clearance (related to paralysis of
respiratory, chest and abdominal muscle).
2. Ineffective breathing pattern (related to paralysis of
respiratory, chest and abdominal muscle).
3. Acute pain (related to irritated nerve root and soft
tissue injury)
4. Impaired physical mobility (related to loss of motor
function).
5. Disturbed sensory perception (related to motor and
sensory impairment).
EMERGENCY NURSING
INTERVENTIONS
1. Maintain patent airway
2. Prevent head flexion, rotation, or extension
3. Maintain traction during immobilization and
alignment of head
4. Maintain an extended position
5. Logroll the client
6. No part of the body should be twisted or
turned (NOT allowed to be in a sitting
position)