SPINAL CORD INJURY

• A spinal cord injury (SCI) is damage to

the spinal cord that causes temporary or
permanent changes in its function. Symptoms
may include loss of muscle
function, sensation, or autonomic function in
the parts of the body served by the spinal cord
below the level of the injury.
 Causes

• Motor vehicle accidents are the leading cause of SCI

• falls are the leading cause for SCI for people over
65.
• Acts of violence and sports/recreation activities are
other common causes for these injuries.
• Just over half of all SCI occurs in persons age 16-30,
most of whom are male (80%).
• Males also represent nearly all (90%) of sports-
related SCIs.
 Types of Spinal Cord Injury
• Spinal cord injuries can be divided into two types of injury –
complete and incomplete:
• Complete Spinal Cord Injury: A complete injury means there is
no function below the level of the injury – no sensation and no
voluntary movement. Both sides of the body are equally affected.
• Incomplete Spinal Cord Injury: An incomplete injury means there
is some function below the primary level of injury. A person with
an incomplete injury may be able to move one limb more than
another, may be able to feel parts of the body that cannot be
moved, or may have more functioning on one side of the body
than the other. With the advances in acute treatment of spinal
cord injuries, incomplete injuries are becoming more common.
 Other types ofSCI
• CAUDA EQUINA SYNDROME
• CAUDA MEDULLARIS SYNDROME
 Central cord syndrome

• Definition: injury to the central region of the spinal cord  (central corticospinal tracts and

decussating fibers of the lateral spinothalamic tract)
• Epidemiology:
– Most common type of incomplete cord syndrome
– Common in the elderly with preexisting degenerative changes in the cervical spine
• Etiology: syringomyelia, degenerative spine disease, cervical spondylosis, traumatic disc
herniation, various hyperextension injuries (e.g., car crash → whiplash injury) 
• Clinical features
– Bilateral motor paresis (upper > lower extremities; distally > proximally) 
– Variable sensory impairment
• Sometimes burning pain in the arms
• Sometimes loss of pain and temperature in the arms 
• Diagnostics: CT and/or MRI to determine location, cause, and extent of neurological
damage
• Prognosis: relatively good prognosis
 Anterior cord syndrome

• Definition: damage to the anterior two-thirds of the spinal

cord usually as a result of reduced blood flow or occlusion to
the anterior spinal artery (ASA)  → Anterior spinal artery
syndrome (∼ 95% of cases) 
• Etiology
– Arteriosclerosis, vasculitis (e.g., associated with diabetes or
syphillis), thrombosis, embolic occlusion
– Aortic dissection, aneurysm
– Trauma (e.g., penetrating injury, burst fracture, hyperflexion injury
with vertebral instability which is common in young athletes)
– Iatrogenic (e.g., during aortic surgery, spinal angiography, or spinal anesthesia)
– Severe hypotension (e.g., following hemorrhage)
– Pathological compression (e.g., tumors, cervical spondylosis)
• Clinical features
– Acute (within hours)
• Back or chest pain
• Spinal shock
– Bilateral loss of temperature and pain sensation , motor function (flaccid
paraparesis or quadriparesis) , and autonomic function (bladder, bowel,
and sexual dysfunction, orthostatic hypotension) below the level of the lesion
– Absent bulbocavernosus reflex: squeezing the glans penis or pulling on a Foley
catheter while digitally palpating the contraction of the anal sphincter
– Late (after days or weeks)
• Continued sensory and autonomic dysfunction
• Spastic paraparesis or quadriparesis (increased muscle tone) 
• Hyperreflexia
• Diagnostics
– Spinal MRI (best confirmatory tet): excludes soft-tissue lesions (e.g.,
tumors, hematomas), bone lesions, and
detects spinalcord parenchyma abnormalities (e.g., infarction)
– Consider VDRL or RPR if syphilisis suspected
• Therapy
– Treat the underlying condition (if possible)
• Consider surgical repair
• Aspirin  for thrombotic occlusion
• Penicillin for syphillis
• Surgery for vascular abnormalities (e.g., aortic dissection) or
tumors
• Control chronic comorbidities (e.g. diabetes)
• Prognosis: 10–15% functional recovery; if no
recovery is evident and progressive after 24 hours,
prognosis is poor
 Posterior cord syndrome

• Definition: injury of the posterior spinal cord affecting the posterior

column (fine touch, vibration, pressure, and proprioception)
• Epidemiology : very rare
• Etiology: occlusion of the posterior spinal artery   , multiple sclerosis
• Clinical features: ipsilateral loss of vibration and proprioceptive
sensation below the lesion
• Diagnostics: MRI showing infarction of the dorsal columns in the
case of posterior spinal artery occlusion

• Prognosis: patients show functional gain with rehabilitation

 Brown-Séquard syndrome
• Definition: hemisection of the spinal cord; often in the cervical cord 
• Etiology
– Unilateral compression commonly through trauma (e.g., often penetrating injuries,
or crush injury)
– Less commonly disc herniation, spinal epidural hematoma, spinal epidural abscess (rare)
or tumor; multiple sclerosis, complication of decompression sickness
• Clinical features
– Ipsilateral
• Loss of proprioception , vibration, and tactile discrimination below the level of the
lesion 
• Segmental flaccid paresis at the level of the lesion , spastic paralysis  below lesion ,
and ipsilateral Babinski sign
– Contralateral: loss of pain and temperature sensation one or two levels below lesion 
• Diagnostics
– Clinical diagnosis
– Consider CT if trauma has occurred or an MRI if a tumor is suspected
• Prognosis: poor
 According the level of Injury
• Cervical SCI (C1-C7)
– The most severe injury type
– Results in quadriplegia
– Potential loss of sexual function, bladder and bowel control, respiratory function,
sensation, and body temperature regulation
• Thoracic SCI (T1-T12)
– Results in paraplegia
– Potential loss of sexual function, bladder and bowel control, and core strength
• Lumbar SCI (L1-L5)
– Results in paraplegia
– Potential loss of sexual function, bladder, and bowel control
• Sacral SCI (S1-S5)
– May result in a loss of sexual function, bladder, and bowel control, as well as leg
and hip function
 According to function
• Quadriplegia: the most severe form of SCI,
resulting in loss of sensation or function in all
limbs 
• Paraplegia: loss of sensation or function in the
lower half of the body
• Triplegia: loss of sensation or function in one
arm and both legs, usually as a result of an
incomplete SCI
Pathophysiology
 Signs and Symptoms
• A complete SCI produces total loss of all motor and sensory function below the level of injury.
Nearly 50% of all SCIs are complete. Both sides of the body are equally affected. Even with a
complete SCI, the spinal cord is rarely cut or transected. More commonly, loss of function is
caused by a contusion or bruise to the spinal cord or by compromise of blood flow to the
injured part of the spinal cord.
• In an incomplete SCI, some function remains below the primary level of the injury. A person
with an incomplete injury may be able to move one arm or leg more than the other or may
have more functioning on one side of the body than the other.
• SCIs are graded according to the American Spinal Injury Association (ASIA) grading scale,
which describes the severity of the injury. The scale is graded with letters:
ASIA A: injury is complete spinal cord injury with no sensory or motor function preserved.
ASIA B: a sensory incomplete injury with complete motor function loss.
ASIA C: a motor incomplete injury, where there is some movement, but less than half the muscle
groups are anti-gravity (can lift up against the force of gravity with a full range of motion).
ASIA D: a motor incomplete injury with more than half of the muscle groups are anti-gravity.
ASIA E: normal.
• Spinal concussions can also occur. These can
be complete or incomplete, but spinal cord
dysfunction is transient, generally resolving
within one or two days. Football players are
especially susceptible to spinal
concussions and spinal cord contusions. The
latter may produce neurological symptoms,
including numbness, tingling, electric shock-
like sensations and burning in the extremities.
• Cauda equina syndrome (CES) is a condition
that occurs when the bundle of nerves below
the end of the spinal cord known as the cauda
equina is damaged. Signs
and symptoms include low back pain, pain
that radiates down the leg, numbness around
the anus, and loss of bowel or bladder control.
 Causes

• CES most commonly results from a massive herniated disc in the lumbar region
• The following are other potential causes of CES:
• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Violent injuries to the lower back (gunshots, falls, auto accidents)
• Birth abnormalities
• Spinal arteriovenous malformations (AVMs)
• Spinal hemorrhages (subarachnoid, subdural, epidural)
• Postoperative lumbar spine surgery complications
• Spinal anesthesia
 Symptoms and Diagnosis

• Patients with back pain should be aware of the following "red flag"
symptoms that may indicate CES:
• Severe low back pain
• Motor weakness, sensory loss, or pain in one, or more commonly both legs
• Saddle anesthesia (unable to feel anything in the body areas that sit on a
saddle)
• Recent onset of bladder dysfunction (such as urinary retention or
incontinence)
• Recent onset of bowel incontinence
• Sensory abnormalities in the bladder or rectum
• Recent onset of sexual dysfunction
• A loss of reflexes in the extremities
 Diagnosis of CES:

• Magnetic resonance imaging (MRI)

• Myleogram: show displacement on the spinal

cord or spinal nerves due to herniated discs,
bone spurs, tumors, etc.
 Treatment
• Treating the underline causes
 Conus medullaris syndrome
• Conus medullaris syndrome is a collection of
signs and symptoms associated with injury to
the conus medullaris. It typically causes back
pain and bowel and bladder dysfunction,
spastic or flaccid weakness depending on the
level of the lesion, and bilateral sensory loss .
 Diagnosis of SCI
• Radiological Evaluation
• CT or CAT scan as an initial screen to identify
fractures and other bony abnormalities.
• For patients with known or suspected
injuries, MRI is helpful for looking at the actual
spinal cord itself as well as for detecting any
blood clots, herniated discs or other masses
that may be compressing the spinal cord.
 Treatment –Prehospital
• immobilize the entire spine at the scene of the
accident.
• In the emergency department, this immobilization
is continued while more immediate life-threatening
problems are identified and addressed.
• If the patient must undergo emergency surgery
because of trauma to the abdomen, chest or
another area, immobilization and alignment of the
spine are maintained during the operation.
• Emergency actions
• 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.
 Early (acute) stages of treatment

• In the emergency room

• Maintaining ability to breathe
• Preventing shock
• Immobilizing neck to prevent further spinal cord
damage
• Avoiding possible complications, such as stool or
urine retention, respiratory or cardiovascular
difficulty, and formation of deep vein blood clots
in the extremities
 Non-Surgical Treatments
• For cervical spine injury : traction may be
indicated to help bring the spine into proper
alignment.
• Smaintaining a stable blood pressure,
monitoring cardiovascular function, ensuring
adequate ventilation and lung function and
preventing and promptly treating infection and
other complications, is essential so that SCI
patients can achieve the best possible outcome.
• Surgery
• Indication: if the spinal cord appears to be
compressed by a herniated disc, blood clot or
other lesion.
• commonly done for patients with an incomplete
SCI or with progressive neurological deterioration.
• Even if surgery cannot reverse damage to the
spinal cord, surgery may be needed to stabilize
the spine to prevent future pain or deformity.
• indications for surgery in ASCI patients.
1.Progressive neurological deficit in the
presence of cord compression.
2.Dislocation type injury to the spinal column
• Decompressive surgery
• Rehabilitation
 New technologies

• Modern wheelchairs. Improved, lighter weight wheelchairs are making people with

spinal cord injuries more mobile and more comfortable. For some, an electric
wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough
terrain and elevate a seated passenger to eye level to reach high places without help.
• Computer adaptations. For someone who has limited hand function, computers can be
very powerful tools, but they're difficult to operate. Computer adaptations range from
simple to complex, such as key guards or voice recognition.
• Electronic aids to daily living. Essentially any device that uses electricity can be
controlled with an electronic aid to daily living. Devices can be turned on or off by
switch or voice-controlled and computer-based remotes.
• Electrical stimulation devices. These sophisticated devices use electrical stimulation to
produce actions. They're often called functional electrical stimulation systems, and they
use electrical stimulators to control arm and leg muscles to allow people with spinal
cord injuries to stand, walk, reach and grip.
• Robotic gait training. This emerging technology is used for retraining walking ability
after a spinal cord injury.
 Assignment
1.Write a Short note on Cauda Medullaris
Syndrome?
• Marks : 10
• 2.Nursing careplan of patient with SCI (Three
for preoperative and 3 for postoperative )
• Marks : 10
• Date of submission : on the reopening day.