-SPINAL CORD INJURY-

27 Oktober 2020
Overview
 Definition
 Epidemiology  Spinal Cord syndrome
 Anatomy  Complete transection of SC
 Corpus Vertebrae  Anterior Cord Syndrome
 Spinal cord  Posterior Cord syndrome
 Mechanism of injury
 Central cord syndrome
 Hemilesion SCI or brown Sequard
 Sign & symptoms
syndrome
 According to level of lesion
 Clasification
 Severity scale
Definition

 Partial or complete
disruption of spinal cord
resulting in paralysis,
sensory loss, altered
autonomic and reflex
activities
Epidemiology

 Occurs primarily in young males (> 75% of cases)

 Half of these injuries result from MVAs and stabbing wound
 2/3 of patients are < 30 years old
 Male:Female Ratio = 3 – 4:1
 Other sources of SCI: Falls, sporting and industrial
accidents, gunshot wounds.
 Most common vertebrae involved are C5, C6, C7, T12, and
L1 because they have the greatest ROM.
Anatomy
Vertebrae consists of:
 Cervical (7): flexion, Medula Spinalis:
extension, side rotation
 Cervical (8)
 Thoracic(12): chest rotation
 Thoracic (12)
 Lumber (5): support the
weight  Lumber (5)
 Sacral (5): fusion  Sacral (5)
 Coccygeal (4): rudimenter &  Coccygeal (1)
fusion

 45 cm long in male
 Columna vertebrae is 70 cm  43 cm long in female
long
Anatomi Axial Spinal Cord
Mechanism of Injury (MOI)

 High speed: Traffic accident Risk factor:

 Altitude: fall from height > 3x patient  Usia ekstrem (anak
height  Down syndrome: atlanto aksial
 Diving instability
 Trauma: stab / gunshot  Spina bifida
 Sport Injury  Degeneratif
 Tumor: pathologic fracture
Sign & Symptoms cervical lesion
 C1-C3:
 Function: rotation / flexion /
cervical extension ; talking and
swallowing
 Often in Hangman’s Fracture 
bilateral fraktur in the pars
interarticularis of the axis (C2)
followed with C2-C3 anterior
dislocation
 Clinical:
 Tetraplegic
 Inabilty to perform ADL
 Dependent ventilator
 C4:
 Function: inspiration (diaphragma)
 cllinical: identical with C1-C3
lesion, sometimes dependent
ventilator
 C5
 Clinical: defecate and urinate is
partially assisted
 C6:
 Clinical: independent defecate and
urinate
 C7
 Clinical: all hand movements can be
performed except elbow flexion & extension
 C8-Th1
 ADL is still good
Sign & symptoms thoraric lesion
 Motoric: Flaccid paralysis
 Sensibility: Impaired sensibility below the level of the lesion
 Otonom: impaired autonomic function ; ileus paralitik
 ADL: generally good
Sign and symptoms of lumbosacral
lesion
 L1-L5 lesion:

the function of flexion, flexibility, dorsiflexion

Motoric:

of the ankle, extensor of the big toe is not affected

 Lesi S1-S5:

plantar function of ankle flexion, bowel

Motoric:

movements & sexual impairment

ADL: generally good
 American Spinal-cord Injury Association (ASIA) Classification

Level Jenis Gangguan Medula Spinalis

No sensory or motor function is preserved in the sacral segments S4-5.
A Complete

Sensory but not motor function is preserved below the neurological

Sensory level and includes the sacral segments S4-5 (light touch or pin prick at
B
Incomplete S4-5 or deep anal pressure) AND no motor function is preserved more
than three levels below the motor level on either side of the body
Motor function is preserved at the most caudal sacral segments for
voluntary anal contraction (VAC) OR the patient meets the criteria for
sensory incomplete status (sensory function preserved at the most
caudal sacral segments (S4-S5) by LT, PP or DAP), and has some sparing
Motor
C of motor function more than three levels below the ipsilateral motor
Incomplete
level on either side of the body (This includes key or non-key muscle
functions to determine motor incomplete status.) For AIS C – less than
half of key muscle functions below the single NLI have a muscle grade ≥
3.
Motor incomplete status as defined above, with at least half (half or
Motor
D more) of key muscle functions below the single NLI having a muscle
Incomplete
grade ≥ 3.
If sensation and motor function as tested with the ISNCSCI are graded
as normal in all segments, and the patient had prior deficits, then the
E Normal
AIS grade is E. Someone without an initial SCI does not receive an AIS
grade.
 Acute Spinal Cord Injury

1. Complete transection of SC
2. Anterior Cord Syndrome
3. Posterior Cord syndrome
4. Central cord syndrome
5. Hemilesion SCI or brown Sequard syndrome
Anterior Cord Syndrome
Posterior Cord Syndrome
Central Cord Syndrome
Brown Sequard Syndrome
Hemilesion Spinal Cord Injury
Complete transection of Spinal Cord
Pemeriksaan Penunjang
X-Ray Spinal: menentukan lokasi
dan jenis cedera tulang (fraktur
atau dislokasi)

Dislokasi Cervical 5 dan 6

 Imaging
CT SCAN: to determine the site of injury / injury, evaluate structural disorders

There were small spots on the surface of the bone, but no fractures were seen.
So this photo only shows the hyperflexion of the soft tissue injury.
MRI: to identify spinal
nerve damage, edema
and compression

Terlihat Luka tusuk

Management

Primary
Post care &
Transportat Emergency Survey & conservativ
Pre Hospital Rehabilitati
ion Department Secondary e / Surgical
on
Survey
 Pre Hospital

Identification &
Imobilization Transportation
 Hard Cervical Collar  Cervical immobilization &
thoracal
 Hard backboard
 Tilt stretcher 90˚
 Supine position with slight
hyperextension
Emergency Department (ED)

 Anamnesis:
 quality & pain distribution
 Physical examination:
 Primary survey: ABCDE
 Secondarysurvey: AMUST (Altered mental state –
Mechanism – Underlying Condition – Symptoms –
Timing)
 Supportif
 Pain management
Conservative Care

 Pain management  Bowel:

 Bed rest with firm back board  Installing NGT
 NASCIS II/III:
 Prevent peptic ulcer
 MP 30 mg/KgBW IV Bolus (15’)  after 45’
 Bolus
 Bladder:
5,4 mg/KgBW/hour for 23 hours
(if MP given in 3 hour onset)
 Bladder training  CIC
 Bolus 5,4 mg/KgBw/hour for 47 hour  Complication prevention:
(if MP given in 4-7 hours onset)  Decubitus
 In C3 lesion:  Spasm  contractur
 support ventilator
 DVT  heparin 5000 UI @
 Supportif:
12 hours
Management of shock due to sympathetic lesions
 Medical rehabilitation
Surgical management

Depending on the circumstances, when surgery is required.

 Surgery may be considered if the spinal cord is compressed and
when the spine requires stabilization.
 The surgeon decides the procedure that will provide the greatest
benefit for the patient.
 The common procedures which we perform are-
a. Surgical Decompression
b. Surgical Stabilization
o Spinal fusion
o Fixation of Spine
 Discectomy, foramenotomy and laminectomy (Some times
needed).
 Artificial disc implantation.
Internal fixation of ver
tebral fracture 
Artificial Disc Implantation
Surgical Care

Surgical indications:
 Spinal stabilization
 Instrument removal
 Root decompression
 Decompression syringe
 Unstable fracture / dislocation
 Bone fragments press on the spinal cord
 Clinical neurological deterioration progressively
 Intervertebral disc herniation pressing on the spinal cord
PROGNOSIS

 Patients with complete spinal cord lesions have only a 5% chance of

improving
 In complete lesions (persist> 72 hours)
 there is almost no chance of recovering
 Incomplete lesions have a better prognosis
 Main causes of death:
Pneumonia
Pulmonary embolism
Septicemia
Thankyou