CEDRIC MUCEROS BSN 3C

SPINAL CORD INJURY

o What is SCI?

 A spinal cord injury — damage to any part of the spinal cord or nerves at the end of
the spinal canal (cauda equina) — often causes permanent changes in strength, sensation and
other body functions below the site of the injury.

o Etiology and risk factors

 Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow
water, cause about 10% of spinal cord injuries.
 Alcohol. Alcohol use is a factor in about 1 out of every 4 spinal cord injuries.
 Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal
cord injuries.

 RISK FACTORS

 Being older than 65. Falls cause most injuries in older adults.

 Engaging in risky behavior. Diving into too-shallow water or playing sports without wearing the
proper safety gear or taking proper precautions can lead to spinal cord injuries. Motor vehicle
crashes are the leading cause of spinal cord injuries for people under 65.
 Having a bone or joint disorder. A relatively minor injury can cause a spinal cord injury if you
have another disorder that affects your bones or joints, such as arthritis or osteoporosis.

o CAUSES

 The most common cause of spinal cord injury is trauma. Nearly half of the injuries are caused by
motor vehicle accidents. Other types of trauma include: falls from heights, violence (stabbing or
gunshot wounds to the spine), and sporting injuries (diving, football, rugby, equestrian, etc.).
 Spinal cord injury can also be caused by compression of the cord by a tumor, infection, or
inflammation. Some patients have a smaller than normal spinal canal (called spinal stenosis) and
are at a higher risk of injury to the spinal cord. All tissues in your body including the spinal cord
require a good blood supply to deliver oxygen and other nutrients. Failure of this blood supply to
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the spinal cord can cause spinal cord injury. This can be caused by an aneurysm (ballooning of a
blood vessel), compression of a blood vessel or a prolonged drop in blood pressure.

o TYPES OF SCI

 Complete: A complete injury causes total paralysis (loss of function) below the level of the
injury. It affects both sides of the body. A complete injury may cause paralysis of all four limbs
(quadriplegia) or the lower half of the body (paraplegia).
 Incomplete: After an incomplete injury, some function remains on one or both sides of the body.
The body and brain can still communicate along certain pathways.

o DIAGNOSTIC EXAMS

 CT scan, to see broken bones, blood clots or blood vessel damage.

 MRI, to see the spinal cord or soft tissues.
 X-ray, to show broken bones or dislocations (bones knocked out of place).

o CLINICAL MANIFESTATIONS

 Loss of movement
 Loss or altered sensation, including the ability to feel heat, cold and touch
 Loss of bowel or bladder control
 Exaggerated reflex activities or spasms
 Changes in sexual function, sexual sensitivity and fertility
 Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
 Difficulty breathing, coughing or clearing secretions from your lungs

o EMERGENCY MANAGEMENT

 Urgent medical attention is critical to minimize the effects of any head or neck trauma.
Therefore, treatment for a spinal cord injury often begins at the scene of the accident.
 Emergency personnel typically immobilize the spine as gently and quickly as possible using a
rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.
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o MEDICAL MANAGEMENT

 Intravenous (IV) methylprednisolone (Solu-Medrol) has been used as a treatment option for an
acute spinal cord injury in the past. But recent research has shown that the potential side effects,
such as blood clots and pneumonia, from using this medication outweigh the benefits. Because of
this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.

o SURGICAL MANAGEMENT

 Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or
fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to
stabilize the spine to prevent future pain or deformity.

o NURSING INTERVENTIONS

 Immobilize the entire spine of any patient with known or potential SCI
 Immobilize neck with a hard collar. See guideline for cervical spine assessment
 Use log roll with adequate personnel to turn patient while maintaining spine alignment
 For children < 8 years of age use an airway pad to promote neutral cervical spine
position 
 Remove from spinal board on arrival in ED or as soon as resuscitation allows 
 Maintain neck in neutral position by use of a hard collar, but change to two-piece collar
for comfort and avoidance of complications (e.g. pressure area, venous obstruction,
aspiration) within 6 hours of admission. 

o COMPLICATIONS
 May cause circulatory problems ranging from low blood pressure when you rise (orthostatic
hypotension) to swelling of your extremities. These circulation changes may also increase your
risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.
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