PRESENTED TO:TO:DR. S.K SHARMA Vice Principal, CON DMC&H, Ludhiana.  


INTRODUCTION:INTRODUCTION:Patients with Spinal Cord Injuries (SCI) usually have permanent and often devastating neurologic deficits and disability.The injuries ranges from the mild flexion - extention 'wiplash injury ' to complete transection of the cord with permanent quadriplagia.

Anatomy Review  Bone Structure of the Spine  Cervical  Lumbar  Thoracic  Sacral/Coccyx .

Anatomy Review  Cervical 7 Spine vertebrae  very flexible  C1: also known as the atlas  C2: also known as the axis  Thoracic  12 Spine vertebrae  ribs connected to spine  provides rigid framework of thorax .

Anatomy Review  Lumbar 5 Spine vertebrae  largest vertebral bodies  carries most of the body s weight  Sacrum 5 fused vertebrae  common to spine and pelvis  Coccyx 4  fused vertebrae tailbone .

Anatomy Review .

Anatomy Review ‡Blood supplied by vertebral and spinal arteries ‡Gray matter: core pattern resembling butterfly ‡White matter: longitudinal bundles of myelinated nerve fibers .

Anatomy Review  Spinal Cord  Thoracic and lumbar levels supply sympathetic nervous system fibers  Cervical and sacral levels supply parasympathetic nervous system fibers .

Spinal Cord Pathways 

Nerve Tracts (sensory input)

impulses from body structures and sensory information to the brain column (dorsal) 


nerve impulses for proprioception, discriminative touch, pressure, vibration, & twotwopoint discrimination  cross over at the medulla ablongata from one side to the other 

e.g. impulses from left side of body ascend to the right side of the brain

Spinal Cord Pathways 

Tracts (anterolateral)

nerve impulse for sensing pain, temperature & light touch  Impulses cross over in the spinal cord not the brain  Lateral tracts 

conduct impulses of pain and temperature to the brain 



carry impulses of light touch and pressure

Spinal Cord Pathways 

Motor Tracts (motor output)

motor impulses from brain to the

body  Pyramidal tracts: Corticospinal & Corticobulbar
destined to cause precise voluntary movement and skeletal muscle activity  lateral tract crosses over at medulla 

Spinal Cord Pathways  Descending Motor Tracts (motor output) tracts  Extrapyramidal  rubrospinal. reticulospinal. medullary reticulospinal. lateral vestibulospinal and tectospinal Pontine reticular and lateral vestibular have powerful excitatory effects on extensor muscles  brain stem lesions above these two areas below midbrain cause dramatic increase in extensor tone  called decerebrate rigidity or posturing  Reticulospinal: impulses to control muscle tone & sweat Reticulospinal: gland activity  Rubrospinal: impulses to control muscle coordination & Rubrospinal: control of posture  . rubrospinal. reticulospinal. pontine reticulospinal.

Spinal Nerves  31 pairs originate from the spinal cord  Carry both sensation and motor function  Named according to level of spine from where they arise  Cervical 11-8  Thoracic 1-12 1 Lumbar 1-5 1 Sacral 1-5 1 Coccygeal 1 .

Motor & Sensory Dermatomes  Dermatome Specific area in which the spinal nerve travels or controls  Useful in assessment of specific level SCI   Plexus peripheral nerves rejoin and function as group  Cervical Plexus   diaphragm and neck .

T1   motor: diaphragm. fist formation.  C3.wrist flexion & extention sensory: top of shoulder motor:elbow flexion. 4.Dermatomes  C3. motor: level of nipple Sensory: intercoastal muscles. motor: level of umbilicus Sensory: intercoastal muscles.4    C7   motor:shoulder shrug(Trapezium) sensory: top of shoulder  motor: elbow. sensory: thumb   C5. 5   C8. 6   T4    T10   .deltoid abduction. wrist. finger extension sensory: middle finger motor: finger abduction & adduction sensory: little finger.


L1, 2 

motor: knee flexion  sensory: lateral foot 

motor: hip flexion sensory: inguinal crease motor: quadriceps, knee extention sensory: medial thigh, calf motor: great toe, foot dorsiflexion sensory: lateral calf 


S1, 2 

motor: foot plantar flexion 


motor: anal sphincter tone  sensory: perianal 

Definition of Spinal Cord I njuries Spinal cord injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. The spinal cord does not have to be severed in order for a loss of function to occur. In most SCI cases, the spinal cord is intact, but the damage to it results in loss of function.


incidence of spinal cord injury is approximately 40 cases per million population, or about 12,000 patients, per year based on data in the National Spinal Cord Injury database. However, this estimate is based on older data from the 1970s as there has not been any new overall incidence studies completed.

8% Falls Sports 21.7% Violence .16% Vehicular injuries 13% 44.

Mortality/Morbidity  Life expectancies for patients with spinal cord injury continues to increase but are still below the general population.4 years. .  Based on 2003 US Life Tables. whereas a quadriplegic who was injured at age 20 would have a life expectancy of only 60. a healthy 20-year20-year-old would have a life expectancy of 78.

 . while there has been an increasing incidence of spinal cord injury in persons older than 60 years (11.5% occur in children aged 15 years. 3.   About 50% of spinal cord injuries (SCIs) occurred between the ages of 16 and 30.  The male-to-female ratio is approximately 4:1 male-toAge  Since 2005. Of SCIs. Gender. the average age at injury is 35-40 35years.5%). reflecting the rise in the median age of the general population in the United States.

workSports injuries.Traumatic SCI  Road traffic accidents.      Domestic and work-related accidents.Etiology and risk factors. 1. SelfSelf-harm. . Assault Gunshot or knife wounds.

5% Domestic / Industrial Accidents (34%) Sport Injury 15%    Diving 5% Horse Riding 3% Other 7% Self Harm 5% Assaulted 1%  Assault 6%   .5%  Pedestrian 1.Examples of Injury    Accidents (45%)  Car.5%  Helicopter 1.5%  Motorcycle 20%  Bicycle 5. van 16.

rollerblading. motorcycling. or horseback riding especially without helmet.The risk factors for the spinal Factors:cord injuries includes the following. -Recreational activities such as bicycling. -Alcohol consumption while operating motor vehicles. .Risk Factors:. -Occupation that require the use of ladders. climbing or heights usually more than 5 feet above the ground.

Syrinomyelia ( centeral cavitation of the cord) . present since birth) that affect the structure of the spinal column e. interruption of the blood supply to the spinal cord (causing cord damage). Cervical Spondylosis with myelopathy ( spinal canal arrowing with progressive injury to cord and roots).2. Osteopoesis causing vertebral compression fractures.Traumatic:Traumatic:   Infection of the spinal nerve cells (bacterial and viral). congenital medical conditions (i. spina bifida..e.g.Non .     . cysts or tumours pressing on the spinal cord.

.CLASSIFICATION OF SCI:        Flexion injury Flexion .rotation injury vertical compression injury Extension injury FlexionFlexion-distraction injury Direct injury Indirect injury due to violent muscle contraction.

C5 .  Fall from height on the heels or buttocks.Flexion Injury:Injury:This is the commonest spinal injury. a flexion force can result in. compression fracture of the vertebral body. Dislocation of the one vertebra over the another ( commonest C5 over C6 ) . Results: In the cervical supine. Examples:  Heavy blow across the shoulder by a heavy object. a sprain of the ligaments and the muscles of the back of the neck.    .C7.

Type SCI: Hyperflexion injury .

In the dorso-lumbar spine. but due to a wide cannal at this level. this force result in a burst fracture i. this force results in a fracture similar dorsoto that in the cervical spine. neurological deficit rarely occurs.e. RESULTS.Vertical compression injury:injury:It is a common spinal injury. A piece of bone or disc may get displaced into the spinal canal causing pressure on the cord.. In the cervical spine. dimentions.  a fall from height in erect position.  a blow on the top of the head by some object falling on the head.    . Examples. the vertebral body is crushed throughout its vertical dimentions. It is an unstable injury.

Type SCI: Compression Injury .


There is extensive damage to the neural arch and posterior ligament complex. Heavy blow across the shoulder by a heavy object causing the trunk to be in flexion and rotation to opposite side.While dislocating.Flexion . It is highly unstable injury. this force can result in the fracture dorsodislocation of the joint. one vertebra is twisted-off in front of the one twistedbelow it. a blow or the fall on postero-lateral aspect of the head. This is the worst type of the spinal cord injuries because it leaves the highly unstable supine. and is associated with the high degree of the neurological damage. . On the cervical supine this force can result in :      dislocation of the facet joint on one or both of the sides. posteroRESULTS. fracturefracture-dislocation of the cervical vertebra in the dorso-lumber spine. Here.rotation injury . Examples. the upper vertebra takes a slice of body of the lower vertebra with it.

FlexionFlexion-distraction Injury: This is a rcently described spinal spinal injury. Results.  it commonly results in a horizontal fracture extended into the posterior elements and involing a part of the body. being recognsed in Western countries where use of a seat belt is compulsory while driving a car. the upper part of the body is forced forward by inertia while the lower part is tied to the seat by the seat belt. It is an unstable injury. Examples. The flexion force thus generated has a component of distraction with it. With the sudden stopping of a car.  It is termed a 'chance fracture'. .


extending the neck.the forehead striking against the windscreen forcing the neck into hyperextension. Examples. Results: This injury results in a chip fracture of the anterior rim of a vertebra. Sometimes.  motor vehical accident .Extension Injury:Injury:This injury is commonly seen in the cervical spine.  shallow water diving . .the head hitting the ground. these injuries may be unstable.

Type SCI: Hyperextension Injury SCI: .

Examples. . a lathi blow generally causes a fracture of the spinous process only.  a bloe hitting the spinous processes of the cervical vertebrae.Direct Injury:Injury:This is rare type of the spinal cord injury. but . Results.  Any part of the vertebrae may be smashed by a bullet.  Bullet injury.

haematoma. Examples.Violent muscle contractions:contractions:This is the rare injury. It may be associated with a huge retroperitonial haematoma. . Results.  Sudden contraction of the psoas. psoas.  It results in the fractures of the transeverse processes of multiple lumber vertebrae.


inflammatory response takes place and leads to edema nad 2.PATHOPHYSIOLOGY Any of the mechanism of the spinal cord injury leads to the rupturing of the blood capilleries microhemorrhagic area appears in the central grey matter of spinal cord due to which there is. 1. decreased blood supply to the injured area. putts pressure on the surrounding cells effects highly specialised function of the CNS replacement of the normal neuronal cells with the necrosed and fibertic scar tissue if pressure does not relieved or condition does not reverse then the neuronal deficit becomes permanent .

According to extent of injuries:injuries:  1. 2. 5. 4. Complete lesions Incomplete lesions Centeral cord syndrome Anterior cord syndrome Brown sequard syndrome Conus medullaris syndrome Cauda Equina syndrome . 3.

sensory. It is characterised by total loss of motor. A .Complete lesions ::complete lesion means that the cord is completely transected. and reflexes activity below the level of the lesion.

.Incomplete Lesions:Lesions: In this there is preservation of a mixed pattern of motor. sensory and reflex functions.

Upper extremity deficit is greater than lower extremity deficit. which is predominantly occupied by nerve tracts to hands and arms. weakness is caused by edema and hemorrage in the central arc of the cord. because the lower extremity corticospinal tracts are located lateral in the cord.1.   . Frequently found in elderly with underlying spondylosis or younger people with severe extension injury (figure). Central cord syndrome   Most common incomplete cord syndrome.


and viberation remains intact. pain. the sensation of touch. Anterior cord syndrome:syndrome: In this there is damage to the anterior portion of the both white and gray matter of the spinal cord. Seen in flexion injuries e. flexion tear drop fracture . Presents with immediate paralysis. position.g.    .2. and temperature sensations are lost below the level of the injury. burst fracture. because the corticospinal tracts are located in the anterior aspect of the spinal cord. Although motor function.

e. loss of viberatory and position sense. Brown . when a lesion cuts or affects half the cord ) such as with a bullet wound or knife wound. BrownBrown-Sequard syndrome may result from rotational injury such as fracturefracturedislocation or from penetrating trauma such as stab wound.   .3. This result in the ipsilateral motor paralysis. and contralateral loss of pain and temperature sensation.squard syndrome:syndrome: It is caused by lateral hemisection of the cord ( i.



 .4. The client has bowel and bladder areflexia and flaccid lower extremities. Conus medullaris syndrome:syndrome: It follows the damage to the lumber nerve roots and the conus medullaris in the spinal cord.

5.  . The client experience atexia of the bowel. bladder and lower extremities. Cauda equina syndrome:syndrome: Injury to the lumbosacral nerve roots below the conus medullaris is called as the cauda equina syndrome.


The term SCIWORA (spinal cord injury without radiologic abnormality) SCIWORA should now be more correctly renamed as "spinal cord injury without neuroimaging abnormality" and recognize that its prognosis is actually better than patients with spinal cord injury and radiologic evidence of traumatic injury.    .CLINICAL MANIFESTATIONS:MANIFESTATIONS: Longitudinal distraction with or without flexion and/or extension of the vertebral column may result in primary spinal cord injury without spinal fracture or dislocation. Longitudinal distraction of the spinal cord with or without flexion and/or extension of the vertebral column may result in SCIWORA.

and peoprioception (ability to know where body is in space).LEVEL OF INJURY. voluntary movements sensation of pain. there is loss of.  The initial clinical manifestations of acute SCI depends on the level and extent of injury to the cord. Below the level of injury or lesions. Flaccid paralysis of all skeletal muscle below the level of injury.      . pressure. temperature. Bowel and bladder function spinal and autonomic reflexes.


Injuries above the C4 may be fetal because of loss of innervation to the diaphragm and intercostal muscles.. to thoracic or lumber spine produce paraplegia.  Injury to cervical spine and cord produces quadriplegia.  Injury .LEVEL OF INJURY CONTD .

Cervical injuries  Cervical (neck) injuries usually result in full or partial QUADRIPLAGIA. : Results in significant loss of function at the biceps and shoulders.  C3  C4 . limited function may be retained. necessitating the use of a ventilator for breathing. depending on the specific location and severity of trauma. vertebrae and above : Typically results in loss of diaphragm function. However.

but allows for limited use of arms.  C6  C7 . and complete loss of hand function.Contd .. C7 is generally the threshold level for retaining functional independence.  C5 : Results in potential loss of function at the shoulders and biceps. and T1 : Results in lack of dexterity in the hands and fingers. and complete loss of function at the wrists and hands. : Results in limited wrist control.

which supply the phrenic nerves causing the diaphragm. could stop breathing. People with these injuries need immediate ventilatory support. C3. and C5 segments. but breathing is apt to be rapid and shallow and people have trouble coughing and clearing secretions from their lungs due to weak thoracic muscles. the sufferers' diaphragm function is reserved.  . C4. If the injuries are at the C5 level and below.Breathing  Any injury of the spinal cord at or above the C3. C4.

neck. to T8 : Results in the inability to control the abdominal muscles. and breathing is usually not affected. trunk stability is affected. Accordingly. to T12 : Results in partial loss of trunk and abdominal muscle control. the less severe the effects. The lower the level of injury.  T1  T9 .Thoracic injuries  Injuries at or below the thoracic spinal levels result in paraplegia. Function of the hands. arms.

Lumbar and Sacral injuries  The effects of injuries to the lumbar or sacral regions of the spinal cord are decreased control of the legs and hips. and anus. urinary system. .

BP and temperature in denervated areas fall markedly and respond poorly to reflex stimuli.g. are absent in early SCI because of Spinal Cord Edema. but they lack integration with other visceral activities. some body functions may return by reflex (e. control of the urinary bladder). Scratching the skin may cause vasodilation .g.     . For e. Visceral activities may be initiated atypical stimuli. Defective urinary bladder function ( cord bladder ).Changes in Reflexes:Reflexes: Reflexes which normally cross the spinal cord and return to the stimulates limb. sweating and urination. After cord edema subsides.

Reflexes spasms may be triggered by extrinsic or visceral stimuli. prolonged period of sitting or emotionally upsetting events.   . such as distended bladder Muscle spasms vary from mild muscular twitching to vigorous mass reflexogenic states. Muscle spasm are often aggravated by cold weather.Muscle Spasm  Intense and painful muscular spasm of the lower extremities occurs following a traumatic complete transverse spinal cord lesion.

or stimulus to the nervous system below the level of injury. pain.AUTONOMIC DYSREFLEXIA     Autonomic dysreflexia is a life-threatening reflex lifeaction that primarily affects those with injuries to the neck or upper back. Unlike spasms that affect muscles. a reflex action occurs without the brain's regulation. . autonomic dysreflexia affects vascular and organ systems controlled by the sympathetic nervous system. The irritated area tries to send a signal to the brain. but since the signal is not able to get through. It happens when there is an irritation.


People with paraplegia and quadriplegia are susceptible to pressure sores because they can't move easily on their own.Pressure sores  Pressure sores are areas of skin tissue that have broken down because of continuous pressure on the skin. .

Pain  People who are paralyzed often have what is called neurogenic pain resulting from damage to nerves in the spinal cord.  Others are prone to normal musculoskeletal pain as well. pain or an intense burning or stinging sensation is unremitting due to hypersensitivity in some parts of the body.  For some survivors of spinal cord injury. . such as shoulder pain due to overuse of the shoulder joint from pushing a wheelchair and using the arms for transfers.

and urination becomes abnormal. In some cases the bladder releases. or become overover-full without releasing.     . The bladder can empty suddenly without warning. but urine backs up into the kidneys because it is not able to get past the urethral sphincter. Most people with spinal cord injuries use either intermittent catheterization or an indwelling catheter to empty their bladders.Bladder and bowel problems  Most spinal cord injuries affect bladder and bowel functions because the nerves that control the involved organs originate in the segments near the lower termination of the spinal cord and are cut off from brain input. Without coordination from the brain. the muscles of the bladder and urethra can not work together effectively.

Depending on the level of injury. and most will have compromised fertility due to decreased motility of their sperm. men may have problems with erections and ejaculation.Reproductive and sexual function  Spinal cord injury has a greater impact on sexual and reproductive function in men than it does in women. Even those with severe injury may well retain orgasmic function. although many lose some if not all of their ability to reach satisfaction. Most spinal cord injured women remain fertile and can conceive and bear children.    .

Rays  C T Scan  MRI  Laboratory Investigations .DIAGNOSTIC EVALUATION :: History Taking  Physical Examination  X.

 Hemoglobin and/or hematocrit levels may be measured initially and monitored serially to detect or monitor sources of blood loss.Laboratory Studies  Arterial blood gas measurements may be useful to evaluate adequacy of oxygenation and ventilation. .  Lactate levels to monitor perfusion status can be helpful in the presence of shock.  Perform urinalysis to detect associated genitourinary injury.

CT scans are designed to make cross-sectional pictures of body. CT Scan A computerized tomography can provide a clearer picture of any damage caused by accident. such as an injury to vertebrae or bone fragments lodged within spinal cord tissue can be detected with an XXray. The CT uses a high crosspowered computer to show the results of scan.  . Any signs of damage.  X-Rays According to the Mayo Clinic. a CT scan is usually issued because an XXray could not provide a clear enough picture of injury. For example. As a result. it is fairly common to have an X-ray Xconducted on injury. any abnormality such as bone damage or disk damage can be detected by the CT scan.Imaging studies.

An MRI is a machine that uses magnetic forces and radio waves to develop images of organs and tissues. Images taken of spine are created in 3-D on a 3computer screen. or any other material that is possibly compressing spinal cord. It is likely that within a few days of suffering injury.Imaging studies. myelography is conducted when unable to conduct an MRI. will immobilize spine.    MRI According to Spine Universe. herniated discs. or when further information is needed to diagnosis the severity of injury. . Myelography  According to the Mayo Clinic. This dye provides better imaging of spinal nerves. a dye is injected directly into spinal canal. questioning. MRIs. magnetic resonance imaging can examine spinal cord directly. In myelography. patient will undergo a repeat testing of X-rays. or even check for signs of blood clots. and After patient have suffered from injury. or other Xtests to determine how severe injury is and what course of treatment will be. XFurther Diagnosis After undergoing testing. especially when used with an X-ray or CT scan.


Spinal immobilization protocols should be standard in all pre hospital care systems. the backboard may be rapidly rotated while the patient remains fully immobilized in a neutral position. or neurologic symptoms.PrePre-hospital Care  Most pre-hospital care providers recognize the need to prestabilize and immobilize the spine on the basis of mechanism of injury. pain in the vertebral column.   The patient should be secured so that in the event of emesis. Patients are usually transported to the Emergency Department with a cervical hard collar on a hard backboard. .

 Airway..  Breathing. . assessment and treatment starts with maintenance of.  Most patients with spinal cord injuries (SCIs) have associated injuries. In this setting.  and Circulation .Emergency Department Care contd .

intubation may be required in others.  The cervical spine must be maintained in neutral alignment at all times. The modified jaw thrust and insertion of an oral airway may be all that is required to maintain an airway in some cases.. However.   .Emergency Department Care contd . Clearing of oral secretions and/or debris is essential to maintain airway patency and to prevent aspiration.

intra-abdominal.. or intraretroperitoneal injuries and pelvic or long bone fractures.  Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury.  Appropriate investigations. including radiography or CT scanning. are required and ultrasonographic study may be required to detect intra-abdominal hemorrhage. intra- .  The most common causes of occult hemorrhage are chest.Emergency Department Care contd .

   1. Once occult sources of hemorrhage have been excluded. 2. Loss of motor function 2. Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 liters is the initial treatment of choice. . 3. 3..Anaesthesia to all modalities Autonomic Hypotension: skin hyperaemia and warmth (sympathetic) bradycardia  1. Neurogenic shock involves 1. Loss of sensory function 3. initial treatment of neurogenic shock focuses on fluid resuscitation.Emergency Department Care contd . Loss of sympathetic autonomic function SOMATIC MOTOR COMPONENT Paralysis Flaccidity Areflexia SENSORY AND AUTONOMIC Sensory . 2.

Difference between spinal and systemic shock SPINAL SHOCK    Hypotension Bradycardia Warm extremities SYSTEMIC SHOCK (Hypovolaemic) Hypovolaemic)  Hypotension   Tachicardia Cold extremities .

Systolic BPs in this range are typical for patients with complete cord lesions..Emergency Department Care contd . The most important treatment consideration is to maintain adequate oxygenation and perfusion of the injured spinal cord.  Heart rate should be 60-100 beats per minute in 60normal sinus rhythm. .  The therapeutic goal for neurogenic shock is adequate perfusion with the following parameters:  Systolic blood pressure (BP) should be 90-100 mm 90Hg.

Rarely.Emergency Department Care contd . It should be reserved for patients who have decreased urinary output despite adequate fluid resuscitation. inotropic support with dopamine is required. Placement of a Foley catheter to monitor urine output is essential.  Prevent .to 5-mcg/kg/min range 25are sufficient.  Urine output should be more than 30 mL/h.  Hemodynamically significant bradycardia may be treated with atropine (0.5 mg to 1 mg ). mL/h. Usually. low doses of dopamine in the 2. hypothermia..

 Associated head injury occurs in about 25% of patients with spinal cord injury. starting with noncontrast head CT scanning. A careful neurologic assessment for associated head injury is compulsory. associated alcohol intoxication or drug abuse. external signs of head injury or basilar skull fracture. and a history of loss of consciousness mandates a thorough evaluation for intracranial injury.   .Emergency Department Care contd .. focal neurologic deficits. The presence of amnesia.

 Placement of a nasogastric tube is essential..Emergency Department Care contd .  Aspiration  . Antiemetics (Diphenhydramine 10 50mg IV (Diphenhydramine max 400mg. pneumonitis is a serious complication in the patient with a spinal cord injury with compromised respiratory function. ) should be used aggressively.

 The patient is best treated initially in the supine position.  Logrolling the patient to the supine position is safe to facilitate diagnostic evaluation and treatment.  Use analgesics appropriately and aggressively to maintain the patient's comfort if he or she has been lying on a hard backboard for an extended period. .



 Remove the spine board as soon as possible. Pad all 1extensor surfaces.  Undress the patient to remove belts and back pocket keys or wallets.  Denervated skin is particularly prone to pressure necrosis. Prevent pressure sores. .  Turn the patient every 1-2 hours.

Studies have shown limited but significant improvement in the neurologic outcome of patients treated within 8 h of injury. .  Methylprednisolone 30 mg/kg bolus over 15 minutes and an infusion of methylprednisolone at 5.4 mg/kg/h for 23 hours beginning 45 minutes after the bolus.Use of steroids in spinal cord injury  High-dose steroids are thought to reduce the Highsecondary effects of acute spinal cord injury (SCI).

and those can add to pain. NSAIDs (non-steroidal anti(nonantiinflammatory drugs):-COX-2 drugs):-COXInhibitor (cyclooxygenase-2). Valium is a muscle relaxant. Muscle Relaxants: Spinal fractures can cause spinal muscles to work harder as they try to support the spine. .OTHER MEDICATIONS:MEDICATIONS:   Acetaminophen:It's Acetaminophen:It's proven to be a good pain reliever. Overworked muscles can have spasms. such as (cyclooxygenaseCelebrex. A muscle relaxant will help stop the pain.

It's a COXnewer development in the world of NSAIDs.it may need to take medication that specifically targets the nerves. and it doesn't cause as many gastrointestinal side effects. and they should be used only in the most extreme cases and under the careful supervision of doctor. Neurontin (100mg-600 mg) . (100mgOpioids (Narcotics): These are very serious medications. such as Celebrex. over-theprescription NSAIDs work to reduce inflammation. The doctor may recommend a COX-2 Inhibitor.-Fentanyl doctor.Prescription NSAIDs: Like the over-the-counter variety.OTHER MEDICATIONS:MEDICATIONS: Neuropathic Agents: If the fracture is causing nerve problems.eg.   .eg.

Crutchfield and Vinke tongs require predrilled holes in the skull under local anesthesia. Rigid kinetic turning bed to immobilize the patients with thoracic and lumber injuries. . 1. 3.  2. Weight added to traction gradually to reduce the vertebral fracture.use of skeletal tongs.ACUTE PHASE (1-24 Hrs) (1After the maintenance of pulmonary and cardiovascular stability. weight maintained at the level to ensure vertebral alignment. the next step is to maintain the Spinal Cord ImmobilizationImmobilization.

plates .ACUTE PHASE (1-24 Hrs) (11. Fusion . Decompression . Decompression laminectomy). may be accomplished by removing the bony structures and soft tissues ( eg. Stabilization . screws and other fixation devices to prevent movement at the damaged boney site ( eg. involves the use of wires . typically using anterior approach n the cervical instance.   . Harrington rodes). an injury that is incomplete at the onset may become complete if instability exists. Fusion . typically done using the posterior approach . bone grafts . Surgical interventions are considered when the patient has vertebral instability that may result in further neurological damage. Reallignment of the soft tissues and vertebral column is required.

Average length of time in a Halo vest is 12 weeks .Pin site should be cleaned daily with hydrogen peroxide. followed by philabodelphia collar for four weeks.SUBACUTE PHASE(1 WEEK) 1. Some Halos are now can open posteriorly . which reduces the incidence of cervical fracture displacement. Hallo traction is the primary treatment for cervical injuries.     . The ring is attached to stainless steel pins ( two anteriorly and two posteriorly) and attached to a vest by four connecting rodes( MRI compateble and radiolucent) Pins and locking bolts are tightened approximately 24 to 48 hrs after placement and periodically thereafter.


to prevent thromboembolism. BD .000units. is believed to enhance neuronal regeneration. Other measures includes compression boots and inferior vena cava filters are used.  Heparin 5. and continued for 1818-32 days. begun within 72 hrs after injury . thromboembolism.V . .SUBACUTE PHASE( 1 WEEK)  GM-1 GM- Ganglioside sodium salt I.

Pressure ulcers Management of the spasticity with antispasmodic agents Management of the central neuropathic pain with anticonvulsants ( Phenetoin). mechanical ventilation. minor sedatives(lorazepam). Treatment of the respiratory complications phrenic nerve pacing. antidepressants(immiprazine and chlorpromazine) .CHRONIC PHASE ( BEYOND 1 WEEK) 1. Treatment of infections with antibiotics . Management of the complications may include. used in conjunction with body jackets . nerve block . 3.      . 2. To prevent thrombophlebitis in the chronic phase . compression boots should be used for 2 weeks. and other methods. are used for patients with thoracolumber injuries . Harrington rods.

.  Maintain calm. physical therapy. stress-free environment . smooth movements. baclfen. Spasticity should be managed by .  Administering muscle relaxants such as baclfen. 4. occupational therapy. 5. Rehabilitation includes medical and psychological support. . stress Allowing ample time for activities such as positioning and transferring. diazepam as prescribed.  Perform joint ROM exercises with slow.CHRONIC PHASE CONTD .

Cardiac arrest may results from the initial trauma.in 15% of patients. pneumonia.motor . and autonomic activity below the level of lesion. pressure ulcers . 2. atelectasis requiring mechanical ventilation with cervical injury.COMPLICATIONS 1. 5.respiratory urinary. Respiratory arrest . complicationsInfectionsInfections. 4. sepsis. Spinal shock lasting few hours to few weeks noted by loss of all reflex. . Thromboembolitic complications. sensoray . 3.

Syringomyelia cyatic formation in spinal cord may occur any time after SCI. 9. Amenorrhea occurs in the 60% of women with SCI . Paralytic ileus common in the acute and subacute phase. Autonomic dysreflexia exaggerated autonomic response to stimuli below the level of the lesion in patients with lesions at or above the T6 is medical emergency and can result in dangerous elevation of the BP. 10. and patients with the indwelling catheters may have UTI. usually temporary.6. 11. Spasticity may results in the contractures. Urologic neurogenic bladder. 8. . 7.


6. possible and preventable complications. Ventilatory effort adequate for individual needs. Condition/prognosis. Promote mobility/independence. 4. 5. Beginning to cope with current situation and planning for future. Maximize respiratory function. 4. Prevent further injury to spinal cord. Self-care needs met by self/with assistance.NURSING PRIORITIES 1. treatment needs. and possible complications understood. 5. . 2. 3. 2. DISCHARGE GOALS 1. Support psychological adjustment of patient/SO. prognosis and expectations. therapeutic regimen. 6. 7. Provide information about injury. Prevent or minimize complications. Complications prevented/controlled. Plan in place to meet needs after discharge. Spinal injury stabilized. 3. depending on specific situation.

but not against gravity  3 .Active movement against full resistance . The American Spinal Injury Association recommends use of the following scale of findings for the assessment of motor strength in SCI: 0 .Minimal movement  2 .Active movement against resistance  5 .No contraction or movement  1 .Active movement.Active movement against gravity  4 .

Nursing Diagnosis: Impaired Gas Exchange . Nursing Diagnosis:. Ventilation or Perfusion Imbalance r/t inadequate ventilation. NURSING DIAGNOSIS:-Inability to clear secretions or DIAGNOSIS:obstructions from the respiratory tract to maintain airway patency r/t Spinal Cord Injury.Risk for Aspiration r/t regurgitation of Diagnosis:gastric content.Ineffective Breathing Pattern r/t DIAGNOSIS:altered level of consciousness.     . NURSING DIAGNOSIS:. Nursing Diagnosis: Risk for Impaired Skin Integrity r/t immobility.

According to Arizona Spinal Cord Injury Association ::- "Improving Orthostatic Tolerance after Spinal Cord Injury . are studying if exercise can help avoid or reduce sudden drops in blood pressure that sometimes occur after a change in posture.  This study seeks to determine if people with spinal cord injury (SCI) can benefit from an at-home exercise atprogram.  In particular. such as a move from lying down to a seated position.  .  Participation in this study involved completion of a 1212week exercise program involving electrical stimulation of legs muscles (five 45-minute sessions per week) in 45wheel chair sitting position.

edpublishers.com/health/spinal-cordhttp://www.172.28 P Wilkins.vol-2.2010.com/article/793582-diagnosis http://emedicine..medscape.Spinal Cord Injuries.  Perry potter.Joyce.ed-9.com/article/793582 http://emedicine.Foundation of Nursing.  Keen Janet hicks.Spinal Cord Injuries.co.medscape.Critical Care Nursing Consultant(1997):Mosby publishersvol-1st.mayoclinic.318.Swearingen Pulmelal.com/article/793582-treatment http://emedicine.ed-1st.P-279-85.Ppublishersvol.P 1194-1196 1194 William & Lippincott ..medscape.ed.Williams.ed-9.medscape.Bibliography: Black M.com/article/793582 http://emedicine.P366.Medical Surgical Nursing(2008):Elsevier publishers.google.108.medscape.com/article/793582-overview http://emedicine.mayoclinic.New Delhi. P-515 .vol-2.Lippincott Manual of Nursing Practice.P-279Kluner.New Delhi.P 802-803 802References:References: http://www.9th edition.com/health/spinal-cordinjury/DS00460/DSECTION=coping-andinjury/DS00460/DSECTION=coping-and-support  http://emedicine.in/#hl=en&biw=897&bih=335&q=DIAGRAM+OF++a utonomic+dysreflexia&aq=f&aqi=&aql=&oq=&fp=68b2ac9bfcc08c02  .medscape.ed-8th.Mannual of Nursing Practice(2009):Wolter Kluner.com/article/793582 http://www.Harcourt Private limited publishers.


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