PHI LI PPI NE ORTHOPEDI C CENTER

GROUP1 SECTI ON B
REYDI BADI
Spinal Cord Injury
Definition of Disease
Most spinal cord injuries causes permanent
disability or loss of movement (paralysis) and
sensation below the site of injury. Paralysis that involves the
majority of the body, including the arms and the legs, is called
quadriplegia or tetraplegia. When a spinal cord injury affects only
the lower body, it is called paraplegia


Interest, awareness and research funding for spinal cord injury was
raised because of the upset brought by the incident which left
Christopher Reeve paralyzed from his neck down. Many
scientists are optimistic that advances in the technology will be
made for the repair of the injured spinal cords. Treatments and
rehabilitation allows many people with SCI to live productively and
independent lives

Symptoms:
Mainly symptoms of SCI depends on 2 factors.

LOCATION- indicates that the higher the location
of injury the more paralysis would take place


SEVERITY- PARTIAL and COMPLETE

Partial: maybe called incomplete injury, cord can
sometimes transmit messages to the brain, so people with
partial injury can retain some sensation and possibly some
motor function below the affected area.

Complete: total or near total loss of motor function and
sensations below the area of injury.

Signs and symptoms

Pain- caused by extreme damage to nerve fibers in
your spinal tract
Loss of movement
Loss of sensation, including heat, cold, and touch
Exaggereated spasms
Loss of bowel and bladder control
Changes in sexual function, sexual sensitivity and
fertility

Diagnostic exams:

Spinal x-ray - used to rule out back pain resulting
from: Instability (such as spondylolisthesis),
Tumors,Fractures.
Myelography- type of radiographic examination
that uses a contrast medium to detect pathology of
the spinal cord
Ct-scan- series of X-ray views taken from many
different angles

PATHOPHYSIOLOGY:
TRAUMA/ INJURY
VERTEBRAL
DISLOCATION/
FRACTURE
HEMORRHAGE ->
SWELLING
CIRCULATORY
IMPAIRMENT
ISCHEMIA/ HYPOXIA/
EDEMA/HEMORRHAGIC
LESION
MYELIN SHEATH
DESTRUCTION
SPINAL CORD INJURY
TREATMENT:
PHARMACOLOGICAL: DEXAMETHASONE, METHYLPREDNISOLONE ARE
USED TO REDUCE THE SWELLING PRODUCED BY THE INJURY/ TRAUMA

SURGERY: MAYBE NECESSARY . REMOVAL OF TISSUE OR FLUID THAT
PRESSES ON THE SPINAL CORD, BONE FRAGMENTS, DISK FRAGMENTS OR
FOREIGN OBJECTS OR TO STABILIZE THE FRACTURED VERTEBRAE

BEDREST

TREATMENT OF MUSCLE SPASMS, SKIN CARE, AND BOWEL/BLADDER
DYSFUNCTION

PHYSICAL THERAPY , OCCUPATIONAL THERAPY AND OTHER
REHABILITATIONAL INTERVENTIONS ARE REQUIRED AFTER AN ACUTE
INJURY HAS HEALED

PAIN RELIEVERS

Drug therapy:

High doses of steroids - Methylprednisolone (Solu-
Medrol) no longer first line of treatment but offered as an
option
Naloxone to promote neurologic improvement
(Narcan).Naloxone and thyrotropin-releasing hormone
(TRH)-improve spinal cord blood flow
Atropine for Bradycardia
Dextran-to increase blood flow to the spinal cord and
treat hypotension
Dantrolene(Dantrolene) and baclofen (Lioresal)-
control muscle spasticity

Nursing care:

Nutrition- IV- N/G feedings. solid foods patients have to
eat prone or supine-
good skin care
urinary - bladder care prevent distention may have foley
observe for UTI and calculi long term bladder training
and intermittent catheterization.
Bowel- bowel retraining program.
Positioning, and exercise-
regular assessment of status and development of
complications
emotional and psychological support for patient and
significant others.

References:
http://www.ncbi.nlm.nih.gov/pubmed/20737770

http://www2.sunysuffolk.edu/thorntj/NR%2040/Lectur
e%20Notes/Neuro/SPINAL%20CORD%20INJURY.pdf

http://nursing.advanceweb.com/Continuing-
Education/CE-Articles/Spinal-Cord-Injury-2.aspx

http://www.umrehabortho.org/rehabilitation/spinal_co
rd_care.htm