SPINAL CORD

INJURY
PREPARED BY:
 SPINAL CORD ANATOMY AND PHYSIOLOGY

• Spinal Cord originates in the brainstem, passes through the

foramen magnum, and continues through to the conus
medullaris near the L2 before terminating in filum terminale.
• • Contains cerebrospinal fluid.
• • 45 cm (18 in) in men ,43 cm (17 in) long in women.
• • 13 mm (1⁄2 in) in the cervical and lumbar regions to 6.4
mm (1⁄4 in) in the thoracic area.
• 31 pairs of spinal Nerve.(C1–C8),(T1– T12), (L1–L5), (S1–
S5) and Co1.
 SPINAL CORD ANATOMY AND PHYSIOLOGY

• 31 pairs of spinal Nerve:

• (C1–C8)
• (T1– T12
• (L1–L5)
• (S1–S5)
• Co1.
 SPINAL CORD ANATOMY AND PHYSIOLOGY

• • Spinal meninges: Dura, Arachnoid. And Pia matter.

• • External surface: Conus medularis (L1- L2)
cauda equina (L3-L5)
• • Spinal Tissue: Gray Matter(neuronal cell bodies,
dendrites, axons
and glial cells)
• • White Matter (Myelinated Axon)
 SPINAL CORD ANATOMY AND PHYSIOLOGY

• • Dorsal Root (afferent sensory root)

• • Ventral Root(Efferent motor root).
Important Function:
• • Conduction pathway for impulses.(Efferent and
Afferent Root)
• • Serving as a reflex center.(Reflex Arc)
 NERVE PLEXUS

• • Nerve plexus is a network of intersecting nerves.

• Cervical Plexus(C1-C4)— Serves the Head, Neck and Shoulders.
• Brachial Plexus (C5-T1) —Serves the Chest, Shoulders, Arms and
Hands.
• Lumbar Plexus(L1-L4)—Serves the Back, Abdomen, Groin, Thighs,
Knees, and Calves.
• Sacral Plexus(L5-S4)—Serves the Pelvis, Buttocks, Genitals, Thighs,
Calves, and Feet.
• Coccygeal Plexus(S5-Co1)— Serves a Small Region over the
Coccyx.
 DEFINITION

• Spinal cord injury (SCI) is damage to the spinal cord

that results in a loss of function such as mobility or
feeling.
• • 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.
 INCIDENCE OF SPINAL CORD INJURY

• SCI is highest among persons age 16-30, in

whom 53.1 percent of injuries.
• • Males represent 81.2 percent of all reported
SCIs and 89.8 percent of all sports-related SCIs.
• • Among both genders, auto accidents, falls and
gunshots are the three leading causes of SCI.
• • Sports and recreation-related SCI injuries
primarily affect people under age 29.
 CAUSES OF SPINAL CORD INJURY

• Causes:
• Road Traffic accidents
• Bullet or stab wound
• Traumatic injury
• Electric shock
• Extreme twisting of the middle of the body
• Landing on the head during a sports injury
• Fall from a great height
TYPES OF SPINAL CORD INJURY
 COMPLETE SPINAL CORD INJURIES

• • Tetraplegia(Quadriplegia):-Spinal cord injury above the first

thoracic vertebra, or within the cervical sections of C1-C8. result is
some degree of paralysis in all four limbs—the legs and arms.
• • Paraplegia: Spinal cord injuries below the first thoracic spinal
levels (T1-L5). Paraplegics are able to fully use their arms and hands,
but the degree to which their legs are disabled depends on the injury.
• • Complete paraplegia: It is described as permanent loss of motor
and nerve function at T1 level or below, resulting in loss of sensation
and movement in the legs, bowel, bladder, and sexual region.
 CENTRAL CORD SYNDROME

• • Cause: Injury or edema of the central cord, usually of the cervical area and cervical
lesions .
• • Characteristics: Motor deficits (in the upper extremities sensory loss varies in the
upper extremities).
 ANTERIOR CORD SYNDROME

• • Cause: acute disk herniation associated with fracture-dislocation of vertebra and also
occur injury to anterior spinal Artery and lesion.
• • Characteristics: Loss of pain, temperature, and motor function
is noted below the level of the lesion or injury; light touch, position,
and vibration sensation remain intact.
 POSTERIOR CORD SYNDROME

• • Cause: an infarct in the posterior spinal artery and is

caused by lesions on the posterior portion of the spinal
cord,
• Characteristics: loss of proprioceptive sensation, fine
touch, pressure, and vibration below the lesion; deep
tendon areflexia.
 LATERAL CORD SYNDROME

• Also known Brown- Sequard syndrome

• . • Cause: The lesion is caused by a transverse
hemisection of the cord, as a result of a knife or missile
injury, fracture dislocation of a unilateral articular process.
• • Characteristics: Ipsilateral paralysis or paresis is noted,
together with ipsilateral loss of touch, pressure, and
vibration and contralateral loss of pain and temperature.
 CONE MEDULLARIS SYNDROME

• • Cause: blow to the back- such as Gunshot and spinal tumor ,

Herniated disc: - 90% at L4-L5 and L5-S1
• • Characteristics:
• • Bowel and bladder dysfunction,
• • Flaccid lower extremities.
• • Sexual dysfunction
 CAUDA EQUINA SYNDROME

• • Known as Horse tail Syndrome.

• • Cause: Injury or lesion at the lumbosacral nerve root below
the conus medulararis.
• • Characteristics:
Areflexia loss of reflexes(Lower Extremities).
Leg weakness
Bladder/bowel dysfunction
 CLINICAL MANIFESTATION

• • Spinal Shock • • Loss of reflex function

• • Autonomic Dysreflexia
• • Pain • Breathing difficulty
• • Sensitivity to stimuli
• • Muscle spasms
• • Loss of sensation
• • Loss of autonomic activity
• • Loss of bowel control
• • Loss of bladder control
• • Sexual dysfunction
• • Loss of function, such as mobility or
sensation
 CERVICAL (NECK) INJURIES

• Breathing difficulties
• Loss of normal bowel and bladder
control
• Numbness
• Sensory changes
• Spasticity (increased muscle tone)
 THORACIC (CHEST LEVEL) INJURIES

• Loss of normal bowel and bladder

control
• Numbness
• Sensory changes
• Spasticity (increased muscle tone)
• Weakness, paralysis
 LUMBAR SACRAL (LOWER BACK) INJURIES

• Loss of normal bowel and bladder control

(you may have constipation, leakage, and
bladder spasms)
• Numbness
• Pain
• Sensory changes
• Weakness and paralysis
 DIAGNOSTIC TESTS

• Complete blood count (e.g. Hb, RBC,

WBC)
• Arterial blood gas level
PaO2:85-95 mm of Hg
PaCO2:35-45 mm of Hg
• X-Rays
 DIAGNOSTIC TESTS

MRI
 EMERGENCY MANAGEMENT

• • Initial treatment of patients with cord injury focuses on

two aspects -preventing further damage and resuscitation.
• • Immobilization with a hard cervical collar (in case of cervical spine injuries)
and care in transportation of patient is of paramount importance if the
spine is unstable.
• • Resuscitation is aimed at airway maintenance, adequate oxygen saturation
of peripheral blood, restoring blood pressure to acceptable limits, preventing
bradycardia, done simultaneously to prevent any ischemic damage to the already compromised cord.
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
 NURSING DIAGNOSIS

• Impaired physical mobility related to loss of motor function

• Fluid volume deficit related to decrease LOC
• Risk for injury related to loss of motor function.
• Urinary retention related to level of injury
• Risk for Impaired skin integrity related to trauma
• Knowledge deficit regarding the treatment modalities and current situation.
• Anxiety related to outcome of diseases as evidenced by poor concentration on work,
isolation from others, rude behavior
 NURSING MANAGEMENT OF PATIENT WITH
SPINAL CORD INJURY
• Goal • Resuscitation according to ATLS guidelines
• •Determination of neurological injury
• • Prevention of neurological deterioration
• • Ongoing assessment and treatment of associated
injuries
• • Prevention of complications
• • Initiation of definitive management for vertebral
column injury.
 RESPIRATORY MANAGEMENT

• Closely monitor the patient’s respiratory rate, depth, and pattern,

staying alert for paradoxical breathing.
• Maintain continuous pulse oximetry; when possible, use end-tidal
capnography as part of routine monitoring.
• Intubation. Patients with respiratory failure require mechanical
ventilation. If your patient needs intubation, take care to maintain spinal
alignment by using a cervical collar, manual inline traction,
• Many patients with injuries at the C3 vertebral level or higher are
ventilator dependent.Those with an intact phrenic nerve may qualify
for diaphragmatic pacer implantation, which may allow weaning from
mechanical ventilation.
 CARDIOVASCULAR MANAGEMENT

• Patients with significant cervical and high thoracic

injuries (T6 level and above) may develop Neurogenic
shock. Caused by loss of sympathetic tone, this
distributive shock state results in vasodilation,
profound bradycardia, and hypothermia.
• Hypotension, temperature dysregulation, venous
stasis, and autonomic dysregulation (AD) may occur.
 GASTRO INTESTINAL MANAGEMENT

• Acute GI problems in SCI patients may include paralytic ileus with

associated abdominal distention, gastric ulcers, and
constipation.
• • Monitor the patient’s bowel sounds and abdominal
distention at least every 4 hours. If indicated and ordered, insert a
decompressive gastric tube to reduce aspiration risk and restore
diaphragm position and lung size to normal.
• • To aid bowel regulation, the patient may need a bowel regimen of
stool softeners and a high-fiber diet along with low-volume enemas,
glycerin, or bisacodyl suppositories or digital rectal stimulation to cause
reflexive evacuation after the morning meal.
 GENITO URINARY MANAGEMENT

• • A patient in neurogenic shock experiences abrupt loss of voluntary muscle control and reflexes,
resulting in acute urinary retention.
• • An indwelling urinary catheter must be placed to decompress the bladder and allow close urinary
output monitoring.
• • SCI can cause neurogenic or aneurogenic bladder.
• • In neurogenic bladder, reflex-initiated voiding may occur when the patient has a full bladder.
• • In aneurogenic bladder, such voiding doesn’t occur, potentially causing overflow urine leakage.
• • Planned intermittent catheterization can reduce incontinence.
• Longterm bladder management varies with the patient’s bladder type, needs, and lifestyle.
 MUSCULOSKELETAL MANAGEMENT

• • Patients with SCIs typically experience muscle spasticity as spinal shock recedes
and reflexes return.
• • Nonpharmacologic strategies to manage spasticity include
• Range-of motion exercises,
Positioning techniques,
Weight-bearing exercises,
electrical stimulation, and orthoses or splinting to prevent loss of muscle length
and contractures.
Pharmacologic therapy may include baclofen, benzodiazepines, alpha2-
adrenergic agonists, and regional botulism toxin or phenol injection..
 DERMATOLOGIC MANAGEMENT

• • Prevention and early detection are the cornerstones of pressure ulcer management.
an established skin risk assessment tool, such as the Braden scale.
• • turning the patient every 2 hours or more (depending on risk assessment findings)
• • avoiding positioning the patient on bony prominences, such as the trochanters,
sacrum, and heels
• • minimizing moisture
• • frequently inspecting the skin under braces and splints
• • establishing a pressure-release regimen (manual or automated) for wheelchair
• sitting
 REHABILITATION

•• Cognitive Rehabilitation Therapy

•• Speech Therapy
•• Mental Rehabilitation
•• Physical Exercise
•• Occupational Therapy
 POSSIBLE COMPLICATIONS

• Blood pressure changes - can be extreme

(autonomic hyperreflexia)
• Chronic kidney disease
• Complications of immobility: Deep vein
thrombosis Pulmonary infections Skin breakdown
• Contractures
 POSSIBLE COMPLICATIONS

• Increased risk of urinary tract infections

• Loss of bladder control
• Loss of bowel control
• Loss of sensation
• Loss of sexual functioning (male impotence)
• Muscle spasticity
• Paralysis of breathing muscles
• Paralysis (paraplegia, quadriplegia)
• Pressure sores