NURSING MANAGEMENT Perform ongoing assessment of neurologic function to identify existing and progressing dysfunction Pharmacologic and non-pharmacologic

gic measure for pain control (oncologic conditions are usually associated with pain) Prevent complications of immobility from pain and decreased functions (thromboplebitis, skin breakdown, urinary stasis, decreased clearance of pulmonary secretions) Assist patients in doing ROM exercises in collaboration with physical and occupational therapists to maintain muscle tone Institute intermittent urinary catheterization and bowel training programs for bladder or bowel dysfunction of patients with such condition Provide encouragement and support to patient and family coping with pain and altered functioning, lifestyle, roles and independence.

MEDICAL MANAGEMENT Spinal cord injury is a medical emergency requiring immediate attention. The health care provider will perform a physical exam, including a neurological exam. This will help identify the exact location of the injury, if it is not already known. Some of the person's reflexes may be abnormal or absent. Once swelling goes down, some reflexes may slowly recover. The following tests may be ordered:

A CT scan or MRI of the spine may show the location and extent of the damage and reveal problems such as blood clots (hematomas). Myelogram (an x-ray of the spine after injection of dye) may be necessary in rare cases. Somatosensory evoked potential (SSEP) testing or magnetic stimulation may show if nerve signals can pass through the spinal cord. Spine x-rays may show fracture or damage to the bones of the spine.

SURGICAL MANAGEMENT Corticosteroids, such as dexamethasone or methylprednisolone, are used to reduce swelling that may damage the spinal cord. If spinal cord compression is caused by a mass (such as a hematoma or bony fragment) that can be removed or reduced your spinal nerves are completely destroyed, paralysis may improve. Ideally, corticosteroids should begin as soon as possible after the injury

Spinal traction may be recommended. This can help keep the spine from moving. The skull may be held in place with tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body). The spine braces may need to be worn for a long time. Spinal Stereotactic Radiosurgery (SRS) has an investigational role in adult nonsurgical patients with radio-resistant tumor or those with previously irradiated areas. Studies suggest more than 80% improvement in overall neurological function Transarterial embolization is another novel investigational treatment. It is generally used preoperatively for hypervascular spinal tumors causing compression, is safe and effective, and can make radical tumor resection possible at times Extensive physical therapy, occupational therapy, and other rehabilitation therapies are often required after the acute injury has healed. Rehabilitation helps the person cope with disability that results from spinal cord injury. Muscle spasticity can be relieved with medications taken by mouth or injected into the spinal canal. Botox injections into the muscles may also be helpful. Pain killers (analgesics), muscle relaxers, and physical therapy are used to help control pain.