SPINAL CORD INJURY  Complete injuries above C7 typically

- Injury/trauma to the spinal cord cannot handle activities of daily living &
- Most frequently involved: 5th, 6th & 7th cannot function independently.
cervical vertebrae (C5 to C7), 12th thoracic  Reduced ability to regulate heart rate,
vertebra (T12) & the first lumbar vertebra blood pressure, sweating & body
temperature
- Primarily an injury of young adult
males(16-30 yrs old)
Thoracic SCI
- Paraplegia
 Complete injuries at or below the
Tetraplegia
thoracic spinal levels result in paraplegia
 The injury can involve:
 Functions of the hands, arms, neck &
 Contusion
breathing are usually not affected
 Laceration
 T1 to T8 : Results in the inability to
 Compression
control the abdominal muscles.
Cause
 T9 to T12 : Results in partial loss of trunk &
1. Traumatic
abdominal muscle control
 Motor vehicle accidents
 Falls
 Work-related accidents Lumbosacral SCI
 Sports injuries  Injury to lumbar or sacral results to
 Penetrations decreased control of the legs & hips, urinary
2. Non-traumatic origin system & anus.
 Injury to sacral spinal region
Pathophysiology  Dysfunction of the bowel & bladder
 Sexual function
Causes (traumatic injury to the SC)
↓ Anterior Cord Syndrome
Nerve fiber swells  Associated with flexion type injuries to
↓ the cervical spine,
Decrease circulation to SC  Below the level of injury motor function,
↓ pain sensation, & temperature sensation
Hemorrhage & edema are lost
↓  Touch, proprioception & sense of vibration
Ischemia remain intact
↓
Necrosis Posterior cord syndrome;
↓  Damage to the posterior portion of the
Destruction of the spinal cord SC &/or interruption to the posterior
spinal artery
SCI Categories  Causes the loss of proprioception below
Primary injuries- initial insult or trauma the level of injury
Secondary injuries- usually the result of a  Motor function, sense of pain & sensitivity
contusion or tear injury to light touch remain intact.

Clinical Manifestations Brown-Sequard’s Syndrome

Cervical injuries
 C-1/C-2 : often result in loss of breathing
 C3 &above: results in loss of diaphragm
function
 C4 : results in significant loss of function at
the biceps and shoulders
 C5 : results in potential loss of function at
the shoulders & biceps & complete loss
of function at the wrists and hands.
 C6 : results in limited wrist control
& complete loss of hand function
 C7 & T1 : results in lack of dexterity in
the hands & fingers
 Results from penetrating injuries that
cause hemisection of the SC
 Ipsilateral paralysis/paresis with loss of
touch, pressure & vibration & contralateral
loss of pain & temp. sensation
 Cause: knife or missile injury, possibly an
acute ruptured disk.
Conus medullaris syndrome
 associated with injury to the sacral cord
& lumbar nerve roots
Cauda equina syndrome
 due to injury to the lumbosacral nerve
roots in the spinal canal
American Spinal Injury Association
ASIA Impairment Scale (SCI Classification):
A = “COMPLETE"
B= “INCOMPLETE”
C= “INCOMPLETE"
D=
“INCOMPLETE" E
= “NORMAL"
Diagnostics
 Detailed neurologic exam
 X-rays
 CT scan
 MRI
 If contraindicated, Myelogram may be
used to visualize the spinal axis.
 ECG
At the scene of injury……..
 Immobilized on a spinal board, head &
neck in a neutral position
 Control of the pt.’s head to prevent
flexion, rotation, extension;
 Any twisting movement may irreversibly
damage the spinal cord.
Emergency Management
 Proper handling of the pt.
 Direct trauma to the head & neck;
considered to have SCI until such an injury
is ruled out.
Initial care includes:
 rapid assessment
 immobilization & extrication
 stabilization or control of life
threatening injuries
 transportation to the most
appropriate medical facility.
Medical Management (Acute Phase)
Goal:
 to prevent secondary injury
 observe symptoms of progressive
neurologic deficits
 to prevent complications.
 Pt. is resuscitated as necessary
 High dose IV corticosteroids or
methylprednisolone sodium succinate
 O2 is administered
 Cervical fractures are reduced & the cervical
spine is aligned
 Cast
Surgical Management
 Compression of the cord is evident
 The injury results in a fragmented
or unstable vertebral body
 The injury involves a wound that
penetrates the cord
 Bony fragments are in the spinal canal
 The patient’s neurologic status
is deteriorating
Nursing Management
Respiratory System
 Assess respiratory status
 Monitor arterial blood gases and
maintain mechanical ventilation as
prescribed
 Encourage deep breathing and use
of incentive spirometer
 Monitor for signs of infection
Cardiovascular
 Monitor for cardiac dysrhtyhmias
 Assess for signs of hemorrhage or
bleeding around the fracture site
 Assess signs for shock
 Assess the lower extremities for deep
vein thrombosis
 Reposition the patient carefully
Neuromuscular System
 Assess neurological status
 Assess motor and sensory status
 Assess motor ability
 Assess sensation
 Monitor for signs of autonomic
dysreflexia and spinal shock
 Immobilize the client
Gastrointestinal System
 Assess for abdominal distention and
hemorrhage
 Monitor bowel sounds and assess
paralytic ileus
 Prevent bowel retention
 Initiate a bowel control program
as appropriate
 Maintain adequate nutrition and a
high fiber diet
Genitourinary System
 Prevent urinary retention
 Initiate bladder control program
as appropriate
 Maintain F&E balance
 Maintain adequate fluid intake of 2000
mL daily
 Monitor for UTI and calculuses
 Muscle Function Grading

0= total paralysis
1= palpable or visible contraction
2= active movement, gravity eliminated
3= active movement, against gravity
4= active movement, against some resistance
5= active movement against full resistance
5*= normal corrected for pain dissue
NT= not testable

Sensory Grading

0= absent
1= altered
2= normal
NT= not testable