SPINAL CORD INJURY

Causes
Overview of the spinal cord
The SPINAL CORD is a thick length of nerve tissue that Traumatic Causes:
extends from the base of the brain, down the back, • Auto mobile or Motorcycle Accidents
through the spinal column.
• Gun Shot Injuries
The SPINAL COLUMN is made up of bones called • Knife
vertebrae that protect the spinal cord • Wounds
The spinal cord is made up of motor and sensory nerve • Falls
cells called neurons. The motor nerves are grouped • Sport Injuries
together and transmit motor commands from the brain
to the muscles and initiate movement. The sensory
Non- Traumatic Causes:
nerves are also grouped together. They carry information
• Cervical Spondylosis with myelopathy
about sensations, such as pain and temperature, to the
(spinal canal narrowing with progressive
brain.
injury to the cord & roots)
The spinal cord is divided into 4 areas: • Myelitis (infective or non-infective)
• Osteoporosis (causing vertebral
compression fractures)
• Syringomyelia (central cavitation of the
cord)
• Tumors (both infiltrative & Compressive)
• Vascular diseases (usually infarction &
Hemorrhage)

Mechanism Causing Spinal Injury

• Flexion injury
• Compression injury
• Distraction injury
• Hyperextension injury
• Flexion- rotation injury
• Penetration injury

SPINAL CORD INJURY
➢ A spinal cord injury usually begins with a sudden,
traumatic blow to the spine that fractures or
dislocates vertebrae
➢ The damage begins at the moment of injury
when displaced bone fragments, disc material, or
ligaments bruise or tear into spinal cord tissue.
An injury is more likely to cause fractures and
compression of the vertebrae
Risk Factors
• Gender: MALE > FEMALE (80:20)
• Having a bone or joint disorder
• Age: 16- 30 years old and older than 65
years old
• Diving into too shallow water or playing
sports without wearing the proper safety
gear
• Motor vehicle accidents
 Types of Spinal Injury Clinical Manifestations
1. Incomplete Transection Injury CERVICAL (NECK) INJURIES
Anterior Cord Syndrome • Breathing difficulties
• Loss of normal bowel and bladder control
Characteristics: loss of pain, temperature and • Numbness
motor function is noted below the level of the • Sensory changes
lesion; light touch, position and vibration • Spasticity (increased muscle tone)
sensation remain intact.
Cause: the syndrome may be caused by acute THORACIC (CHEST LEVEL INJURIES)
disk herniation or hyperflexion injuries • Loss of normal bowel and bladder control
associated with fracture- dislocation of vertebra. • Numbness
It also may occur as a result of injury to the • Sensory changes
anterior spinal artery, which supplies the •Spasticity (increased muscle tone)
anterior two thirds of the spinal cord. • Weakness, paralysis

Central Cord Syndrome

Characteristics: Motor deficits (in the upper
extremities compared to the lower extremities;
sensory loss varies but is more pronounced in the
upper extremities); bowel/ bladder dysfunction
is variable, or function may be completely
preserved
Cause: Injury or edema of the central cord,
usually of the cervical area
Brown- Sequard’s Syndrome (Lateral Cord
Syndrome)
Characteristics: ipsilateral paralysis or paresis is
noted, together with ipsilateral loss of touch,
pressure, and vibration and contralateral loss of
pain and temperature
Cause: the lesion is caused by a transverse
hemisection of the cord (half of the cord is
transected from north to south), usually as a
result of a knife or missile injury, fracture-
dislocation of a unilateral articular process, or
possibly an acute ruptured disk
Types of Paralysis
LUMBAR SACRAL (LOWER BACK) INJURIES
• Loss of normal bowel and bladder control
(constipation, leakage, and bladder spasms)
• Numbness
• Pain
• Sensory changes
• Weakness and paralysis
EMERGENCY SIGNS AND SYMPTOMS
• Extreme back pain or pressure in your neck,
head or back
• Weakness, incoordination or paralysis in any
part of your body
• Numbness, tingling or loss of sensation in your
hands, fingers, feet or toes
• Loss of bladder or bowel control
• Difficulty with balance and walking
• Impaired breathing after injury
• An oddly positioned or twisted neck or back
Diagnostic Examination
❖ MRI (MAGNETIC RESSONANCE IMAGING)
❖ COMPUTED TOMOGRAPHY (CT SCAN)
❖ MYELOGRAPHY
❖ X-RAY

Medical Management

❖ Corticosteroids
❖ Riluzole (Rilutek)
❖ BA-210 (Cethrin)
❖ Hyperbaric oxygen therapy 1
 Surgical Management ❖ Reposition and turn periodically. Avoid and limit
prone position when indicated.
o Foraminotomy is a type of spine surgery
❖ Encourage fluids (at least 2000 mL per day)
performed to decompress (remove pressure)
on a spinal nerve root Nursing Diagnosis
o Laminectomy is a removal of part or all of the
vertebral bone (lamina)
o Spinal Disk Replacement: Involves replacing • Ineffective breathing patterns related to
a worn or degenerated disk in the lower part weakness or paralysis of abdominal and
of spine with an artificial disk made of metal intercostal muscles and inability to clear
or a combination of metal and plastic secretions.
o Spinal Fusion: surgery to join two or more • Ineffective airway clearance related to
vertebrae into one single structure. The goal weakness of intercostal muscles.
is to stop movement between the two bones • Impaired bed and physical mobility related to
motor and sensory impairments.
and prevent back pain
• Disturbed sensory perception related to motor
Complications and sensory impairment.
• Risk for impaired skin integrity related to
immobility and sensory loss.
IMMEDIATE COMPLICATION
• Impaired urinary elimination related to inability
o RESPIRATORY ARREST to void spontaneously.
o SPINAL SHOCK • Constipation related to presence of atonic
bowel as a result of autonomic disruption.
LONG TERM COMPLICATION
• Acute pain and discomfort related to treatment
o AUTONOMIC DYSREFLEXIA and prolonged immobility
o PRESSURE ULCERS
o CONTRACTURES RESPIRATORY TRACT INFECTION
SPINAL SHOCK
Nursing Interventions ❖ Occurs when blood flow to the spinal column is
affected by injury
❖ Assess respiratory function by asking the patient ❖ The blood vessels dilate (open wide) and blood
to take a deep breath. Note the presence or pressure falls
absence of spontaneous effort and quality of ❖ Sudden depression of reflex activity in the spinal
respirations (labored, using accessory muscles). cord (areflexia) below the level of injury
❖ Auscultate breath sounds. Note areas of absent
or decreased breath sounds or development of
adventitious sounds (rhonchi).
❖ Note the strength or effectiveness of the cough.
❖ Observe skin color for developing cyanosis, and
duskiness.
❖ Assess for abdominal distension and muscle
spasm
❖ Maintain patent airway: keep head in a neutral
position, elevate the head of the bed slightly if
tolerated, and use airway adjuncts as indicated.
❖ Assist the patient in “taking control” of
respirations as indicated. Instruct in and
encourage deep breathing, focusing attention on
steps of breathing.
 Complications
AUTONOMIC DYSREFLEXIA
❖ AD can become chronic and recurrent especially
o AKA Hyperflexia
in light of long- term medical issues like ulcers,
o A condition that emerges after a spinal cord
hemorrhoids, and conditions like Multiple
injury, usually when the damage has occurred
Sclerosis.
above the T6 level. -The higher the level of the
❖ Too, complications of acute, profound
spinal cord injury, the greater the risk, with up to
hypertension can include:
90% of patients with cervical spinal or high
o seizures
thoracic spinal cord injury being susceptible
o pulmonary edema
o a potentially life- threatening condition and
o heart attack
which usually requires immediate medical
o Stroke
attention occurs most often in individual with
spinal cord injuries above T-6.
o commonly associated with an injury of the spinal Treatment
cord in the area of the cervical vertebrae down
to thoracic vertebrae number six. (T-6). Rarely is
AD associated with injuries as far down as T-10 Treatment of AD must be immediate and swift.

Removal of the offending stimulant should be first

priority.
Causes
AD is a reaction of the autonomic (involuntary) nervous
system to overstimulation. It is characterized by
paroxysmal hypertension (the sudden onset of severe
high blood pressure) associated with;
-throbbing headaches
-profuse sweating
▪ Administration of anti- hypertensives is
appropriate
▪ Removal of tight clothing
▪ Regular Catheterization (every 4-6 hrs.)
▪ Manual stool removal
▪ Administration of vasodilators are also
appropriate until the underlying cause is
ascertained

-nasal stuffiness

- flushing of the skin above the level of the lesions

- slow heart rate

- anxiety

- sometimes cognitive impairment

Clinical Manifestations

❖ sudden extreme high blood pressure

❖ intense headaches
❖ profuse sweating
❖ facial erythema
❖ nasal stuffiness
❖ Chills
❖ blurred vision
❖ apprehension