Spinal Cord Injury

-refers to any injury to the spinal cord that is caused by trauma instead of a disease -is an insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function. -Spinal cord injuries are described at various levels of "incomplete" which can vary from having no effect on the patient to a "complete" injury which means a total loss of function. -Spinal cord injuries have many causes, but are typically associated with major injuries from motor vehicle accidents, falls, sports injuries, and violence. It can also be involved in minor injuries, such as whiplash.

Signs and symptoms General -pain -numbness, or a loss of sensation in the relevant areas -problems with voluntary motor control. -muscles may contract uncontrollably, become weak, or be completely unresponsive -atrophy of the muscle and bone degeneration.

Cervical Cervical (neck) injuries usually result in full or partial tetraplegia (Quadriplegia). However, depending on the specific location and severity of trauma, limited function may be retained. Injuries at the C-1/C-2 levels will often result in loss of breathing, necessitating mechanical ventilators or phrenic nerve pacing. C3 vertebrae and above : Typically results in loss of diaphragm function, necessitating the use of a ventilator for breathing. C4 : Results in significant loss of function at the biceps and shoulders. C5 : Results in potential loss of function at the shoulders and biceps, and complete loss of function at the wrists and hands. C6 : Results in limited wrist control, and complete loss of hand function. C7 and T1 : Results in lack of dexterity in the hands and fingers, but allows for limited use of arms. Patients with complete injuries above C7 typically cannot handle activities of daily living and cannot function independently.[citation needed] Additional signs and symptoms of cervical injuries include: Inability or reduced ability to regulate heart rate, blood pressure, sweating and hence body temperature. Autonomic dysreflexia or abnormal increases in blood pressure, sweating, and other autonomic responses to pain or sensory disturbances. Thoracic Complete injuries at or below the thoracic spinal levels result in paraplegia. Functions of the hands, arms, neck, and breathing are usually not affected. T1 to T8 : Results in the inability to control the abdominal muscles. Accordingly, trunk stability is affected. The lower the level of injury, the less severe the effects. T9 to T12 : Results in partial loss of trunk and abdominal muscle control. Lumbarsacral The effects of injuries to the lumbar or sacral regions of the spinal cord are decreased control of the legs and hips, urinary system, and anus. Bowel and bladder function is regulated by the sacral region of the spine. In that regard, it is very common to experience dysfunction of the bowel and bladder, including infections of the bladder and anal incontinence, after traumatic injury. Sexual function is also associated with the sacral spinal segments, and is often affected after injury. During a psychogenic sexual experience, signals from the brain are sent to spinal levels T10-L2 and in case of men, are then relayed to the penis where they trigger an erection. A reflex erection, on the other hand, occurs as a result of direct physical contact to the penis or other erotic areas such as the ears, nipples or neck. A reflex erection is involuntary and can occur without sexually stimulating thoughts. The nerves that control a man's ability to have a reflex erection are located in the sacral nerves (S2S4) of the spinal cord and could be affected after a spinal cord injury.

Central spinal cord syndrome

loss of sensation and flaccid paralysis below lesion flaccid bladder with retention of urine. . while the sacral segments occasionally may show preserved reflexes (eg. Conusmedullaris syndrome is associated with injury to the sacral cord and lumbar nerve roots leading to areflexic bladder. and lower limbs. lax anal sphincter CV complications include bradycardia and hypotension diagnosis of exclusion Caudaequina syndrome is due to injury to the lumbosacral nerve roots in the spinal canal. bulbocavernosus and micturition reflexes). bowel.most frequently seen after spinal injury with acute hyperextension of neck in older patients who have varying degrees of congenital or acquired cervival spine stenosis due to spondylosis motor deficit more marked in upper than lower limbs and most profound in intrinsic muscles of hands extent of sensory deficit varies as does degree of bowel and bladder dysfunction although spontaneous improvement in neurological function is the rule residual neurological deficit is common. Appears to be related to severity of initial injury Brown-Sequard ipsilateral weakness and dorsal column loss contralateral pain and temperature deficit usually due to penetrating injury Spinal shock direct force applied to the spinal cord results in a physiological block to conduction areflexia. causing loss of touch and proprioceptive sensation. usually from infection diseases such as syphilis. Diagnostic Examination -x-ray. TabesDorsalis results from injury to the posterior part of the spinal cord. and lower limbs. leading to areflexic bladder. MRI or CT scan can determine if there is any damage to the spinal cord and where it is located -sensory testing and reflex testing can help determine the motor function of a person with a SCI. bowel.

to reduce secondary injury and to treat complications Airway -Jaw thrust. herniated disc) . An unstable spine may require spinal instrumentation and fusion to build in support. In animals early decompression in the first 6-8 h after injury enhances recovery. chin lift and ventilation with bag and mask can cause displacement of unstable fractures but clinical significance of this is unknown Safest method of intubation controversial and depends in part on skills of operator. or a haematoma can cause spinal cord compression. These procedures correct.4 mg/kg/h for 23 h -3-8 hours: 30 mg/kg IV bolus followed by 5. Cricoid pressure causes subluxation of an unstable cervical spine but there is no evidence that this is harmful Avoid cricothyroidotomy or tracheostomy if possible as their site compromises future anterior decompression LMA and Combitube unproven in spinal injuries Breathing -beware patient with C3.C4 or C5 lesion who initially has adequate respiratory effort who may progress to ventilatory failure Circulation -Shock common but spinal shock is a diagnosis of exclusion -CVP/PAWP monitoring usually unnecessary Immobilization -Cervical spine should be immobilised in neutral position (ie position obtained when looking straight ahead) -Children <8 yrs may require back elevation with padding to achieve this position.4 mg/kg/h for 48 h ->8 hours: no steroid -acute penetrating spinal cord injury: steroid not indicated Penetrating injuries associated with partial lesion: penetrating object should be removed in OT where spinal cord can be visualized Surgery Depending on the circumstances. it may be performed within 8 hours following injury. Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization. -Optimal timing of decompression and surgical stabilization of fractures is controversial -Removal of damaging bone. Methylprednisolone -use in spinal cord injury controversial -acute non-penetrating spinal cord injury -<3 hours after injury: 30 mg/kg IV over 1hour followed by 5.g. join. Different tissue and bony structures including vertebrae misaligned from the force of injury. Not surprisingly decompression between 24 and 72 hours yields unsatisfactory results. Trials are needed to assess the effectiveness of surgery within 8 hours of injury. However early surgery is controversial except when canal integrity is severely compromised. and solidify the level where a spinal element has been damaged or removed (e. In humans early decompression has been defined differently as decompression in the first 72 h after injury. Spinal instrumentation and fusion can be used to provide permanent stability to the spinal column. a herniated disc.Treatment and management Aim is to prevent extension of primary injury. disc and ligament fragments to decompress the swollen cord should limit secondary damage and improve outcome. when surgery is required. If direct laryngoscopy is deemed necessary assistant should hold head to maintain in-line stabilization with minimal traction (vertebral distraction occurs experimentally and may cause further cord injury). The surgeon decides the procedure that will provide the greatest benefit for the patient.

Complete independence with driving also requires the ability to load and unload one's wheelchair from the vehicle. bars. and careful selection is important. . Halo Traction NURSING CARE -Occupational therapy plays an important role in the management of SCI.Independence in daily activities like eating and bowel/bladder management as well as mobility. such as from a wheelchair into bed. This includes an evaluation of limb function to determine what the patient is capable of doing independently. is an important part of therapy. -The next interventions focus on support and education for the individual and caregivers.[24] Individuals who are able to transfer independently from their wheelchair to the driver's seat using a sliding transfer board may be able to return to driving. This process includes teaching of coping skills. Instrumentation is combined with fusion (bone grafts) to permanently join two or more vertebrae.Instrumentation uses medically designed hardware such as rods.[26] Teaching the patient how to transfer from different positions. . -Assistive devices such as wheelchairs have a substantial effect on the quality of life of the patient. and physical therapy. -Techniques for prevention of pressure sores in bed and in wheelchairs are also taught. wires and screws. and teaching the patient self-care skills. and devices such as sliding transfer boards and grab bars can assist in these tasks.

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