Spinal Cord Injury

Definition

 Injury to the spinal cord caused by fractures, contusions, dislocations, subluxation, or

compression of the nerves, bones, or soft tissues surrounding the spinal cord.
 Most common sites; C5, C6, T12, L1, L4-L5, L5-S1 vertebrae
 May result in temporary or permanent neurologic deficits.

Types

Complete

Loss of feeling and movement below the site of injury

Incomplete

Retention of some feeling or movement below the site injury.

 Tetraplegia – cervical spinal cord injury that results in some degree of paralysis in all four
extremities.
 Paraplegia – Spinal Cord injury that occurs in the thoracic, lumbar, or sacral segments an
involves paralysis in the lower half of the body.

 Anterior cord syndrome – usually resulting from a flexion injury causes motor paralysis and
loss of pain and temperature sensation below the level of injury. Touch, proprioception,
vibration sensation are usually preserved.
 Brown-Sequard syndrome – can result from flexion rotation or penetration injury. Its
characterized by unilateral motor paralysis ipsilateral to the injury and loss of pain and temp
sensation contralateral to the injury.
 Central cord syndrome – is caused by hyperextension of flexion injury, Motor loss is variable
and greater in the arms than in the legs; sensory loss is usually slight.
 Posterior cord syndrome – produced by a cervical hyper extension injury, cause only a loss
of proprioception and loss of light touch sensation motor function remains intact.

Causes

 Trauma to the spine (such as motor vehicle crash, falls, acts of violence, and sport-related
injuries)
 Compression of spinal cord Ischemia from damage to spinal arteries 194
Risk Factors

 Motor vehicle crash (most common)  Improper lifting of heavy object

 Diving into shallow water  Neoplastic lesion
 Fall  Osteoporosis
 Gunshot or related stab wound  Vascular disorders
 Extreme flexion or hyperextension of  Hemodynamic instability
the neck  Infection
 Falling on the buttocks  Sports and Electrical shock
 Tumor growth

Incidence

Approximately half of SCIs occur between the age of 15 and 30. Over 80% of SCIs occur in males;
approximately 50% involve the cervical spine. SCIs occur most often in July and are least common in
February. C5 is the most common level of SCI. Motor vehicle crash is the cause of over 50% of SCIs.

Complications

 Bradycardia  Neurogenic  Trauma to spinal

 Paralysis shock/spinal shock cord
 Atelectasis  Depression  Muscle spasm Back
 Pneumonia  Loss of sexual or neck pain
 Pressure injury function  Point tenderness
 Autonomic Incontinence (urinary (with cervical
dysreflexia and/or fecal) fractures)

Patient Data

Name: Buten, Cris

Age: 30

Gender: Male

Occupation: Carpenter

Admitting Diagnosis: SCI complete SC T10 secondary to burst fx. T12

Past History: (-) Hypertension, (-) DM

Allergy: (-) allergy to food and medications

Family History: Father has DVT, DM, Malignant Hyperthermia, Cancer

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Personal and Social History: (-) smoking (-) substance abuse (+) alcohol

Anatomy

SC is located inside the vertebral canal w/c is formed by the foramina of the spine. The SC
extends from the foramen magnum down to the 1 st and 2nd lumbar vertebrae. Cervical cord innervates
the sternahyoid, sternothyroid and emothyoid muscle.

Pathophysiology

Injury Necrosis
caused by Microscopic hemorrhage
compression
, pulling, and
twisting of
the cord.

Edema causes spinal cord

compression
Decrease in blood flow / supply

Long term scaring and

Spinal nerves are blocked or tangled.
menigeal thickening.

Ischemia continues

Sensory and motor deficit

occurs.

Laboratory

Arterial blood gas - analysis may identify respiratory impairment.

Imaging Spinal X-rays, myelography, and computed tomography scanning (spine) - can indicate the
location of the fracture (or multiple fractures) and the site of the compression.

Magnetic resonance imaging - identifies suspected lesions and injury to ligaments or soft tissue.
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Medications
Methylpredinisolone
Glucocorticoid
Reduce inflammation and prevents edema by stabilizing membranes and reducing
permeability of leukocytic cell.
Omeprazole
Proton pump inhibitor
Reduce gastric acid secretion and increase gastric mucus and bicarbonate productive coating on gatric
mucosa and easing discomfort from excess gastric acid
Celecoxib
NSAID
Exhibits anti inflammatory, analgesic and anti pyretic action due to inhibition of cox2 enzyme.
Pregabalin
Anti convlsant
Bind with high affinity to CNS alpha –delta site, possibly resulting in anti seizure effect.
Treatment
 General : Stabilization of the spine and  Bowel and bladder management
prevention of cord damage  Pain management
 Airway management: intubation and  Psychological support
mechanical ventilation, if indicated  Rotation bed with cervical traction (if
Hemodynamic support Application of a appropriate)
hard cervical collar or halo-style  Splinting: thoracic lumbar sacral
orthosis (based on level of injury) orthotics
 Wound care (if appropriate)  Massage therapy for residual muscle
 Aspiration precautions; possible pain or spasm
nasogastric intubation  Venous thromboembolism (VTE)
 Skeletal traction with skull tongs prophylaxis
 Neuroprotection

Diet

Nutritional support based on patient's condition; may include a regular diet or enteral or parenteral
feedings Nothing by mouth if ileus develops Activity Bed rest on a firm surface Physical therapy, as
appropriate, with progressive mobilization Passive or active ROM exercises based on motor abilities
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Raymund Erickson L. Palmas

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