Spinal Cord Injuries

What is SCI?
• 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
SCI:
• Most SCIs result from motor vehicle
crashes. Other causes include falls,
violence, and recreational sporting
activities. Half of the victim are between
16 and 30 years of age; most are males.
Another risk factor is substance abuse:
• Alcohol
• Drugs
Type of Injury
• Transient concussion - is due to extreme vibration of the
cord and may cause temporary loss of function lasting 24
to 48 hours. No neuropathologic changes are present.
• Contusion - is a bruising that includes bleeding,
subsequent edema, and possible necrosis from the
edematous compression.
–– The
The neurological
neurological involvement
involvement depends
depends on
on the
the severity
severity of
of
contusion
contusion and necrosis
• Laceration
• Compression of cord substance
• Complete transection of the cord
Pathophysiology
• Hemorrhage: Blood flows into the extradural,
subdural, or subarachnoid spaces of the spinal cord
• Injury to spinal cord vasculature causes nerve fibers
to swell and disintegrate
• Blood circulation to the gray matter of the spinal
cord is impaired
• Secondary chain of events: Ischemia, hypoxia,
edema, and hemorrhagic lesions
• These secondary events result in destruction of
myelin and axons.
Pathophysiology Cont’d
• These secondary reactions, are believed to be the
principal causes of spinal cord degeneration .
• The damage may be reversible within the first 4 to 6
hours after the injury.
• The consequence of spinal cord injury depends on
• The type of injury (concussion, contusion,
laceration, compression, transection)
• The neurologic level (lowest level at which
sensory and motor functions are normal)
The Effects of SCI
• The exact effects of a SCI vary
according to the type and level
injury, and can be organized into
two types:
–Complete injury
–Incomplete injury
COMPLETE INJURY:
• There is no function below the "neurological" level,
defined as the lowest level that has intact neurological
function.
• If a person has some level below which there is no motor
and sensory function, the injury is said to be "complete".
• Recent evidence suggest that less than 5% of people
with "complete" SCI recover locomotion.
INCOMPLETE INJURY:
• The person retains some sensation or movement below
the level of the injury.
• The lowest spinal cord level is S4-5, representing the
anal sphincter and perianal sensation.
• So, if a person is able to contract the
anal sphincter voluntarily or is able to feel peri-anal
pinprick or touch, the injury is said to be "incomplete".
• Recent evidence suggest that over 95% of people with
"incomplete" SCI recover some locomotors ability.
clinical syndromes associated
with incomplete SCIs.
• The Central cord syndrome is associated with greater
loss of upper limb function compared to lower limbs.
• The Brown-Séquard syndrome results from injury to one
side with the spinal cord, causing:
– Weakness & loss of proprioception on the side of the
injury
– loss of pain & thermal sensation of the other side.
• The Anterior cord syndrome results from injury to the
anterior part of the spinal cord, causing:
– Motor Weakness
– loss of pain &thermal sensations below the injury site
clinical syndromes associated
with incomplete SCIs.
• Tabes Dorsalis results from injury to the posterior part of
the spinal cord, usually from infection diseases such as
syphilis, causing:
– loss of touch
– proprioceptive sensation.
• Conus medullaris syndrome results from injury to the tip
of the spinal cord, located at L1 vertebra.
• Cauda equina syndrome is, strictly speaking, not really
spinal cord injury but injury to the spinal roots below the
L1 vertebra.
CLINICAL MANIFESTATIONS:
The consequences of SCI depend on the type and level
of injury of the cord.
 Neurologic level
refers to the lowest level at which sensory and motor
functions are normal. Signs and symptoms include the
following:
–– Total
Total sensory and motor paralysis below the neurologic level.
–– Loss
Loss of of bladder
bladder and
and bowel
bowel control.
control.
–– Loss
Loss of of sweating
sweating and
and vasomotor
vasomotor tone.
tone.
–– Marked
Marked reduction of BP from loss of peripheral vascular
resistance.
resistance.
–– IfIf conscious, pt. reports acute pain in the back or neck: pt. may
speak
speak of of fear
fear that
that the
the neck
neck or
or back
back is
is broken.
broken.
CLINICAL MANIFESTATIONS:

Respiratory Problems
– Related to compromised respiratory function:
severity depends on level of injury.
– Acute respiratory failure is the leading cause
of death in high cervical cord injury.
DIAGANOSTIC METHODS:
– x-ray examinations (lateral cervical
spine x-rays)
– computed tomography (CT)
– magnetic resonance imaging (MRI)
– ECG (bradycardia and asystole are
common in acute spinal injuries) are
common assessment and diagnostic
methods.
Emergency Management

• Immediate management at the scene is crucial.

Improper handling can cause further damage and
loss of neurologic function.
• Always assume there is a spinal cord injury in
vehicle crash, a diving or contact sports injury, a fall,
or any direct trauma to the head and neck as having
an SCI until ruled out.
• Initial care includes rapid assessment,
immobilization, extrication, stabilization or control of
life threatening injuries, and transportation to an
appropriate medical facility.
• Maintain pt. in an extended position(not sitting): no
body part should be twisted or turned
Management of Spinal Cord Injuries
• Management is aimed at preventing further injury
and observing for progression of neuro deficits
• Consists of emergency treatment following an A-B-
C-D-E sequence.
Airway Management
• First priority.
• Open airway with jaw-thrust maneuver.
• Use bag-valve-mask devise initially for airway
compromise and if necessary to prepare for
intubation.
• High concentration of 02 will prevent bradycardia or
asystole for patients exhibiting signs of neurogenic
shock.
Breath Management
• Lesions above C5 level will cause partial to complete
diaphragmatic paralysis (the diaphragm is
innervated at C3-5 levels).
• Any lesion above T12 may cause some airway
compromise.
• Lesions at C5 and below will allow full diaphragmatic
movement, but intercostal muscles (innervated at
T1) and abdominal muscles (innervated at T12) are
affected.
Circulation Management
• Cardiac output is affected by external or internal
hemorrhage and neurogenic shock.
• Two signs of internal bleeding from abdominal
trauma are abdominal pain and muscular rigidity.
However, these signs may be masked in a patient
with sensory and motor deficits.
• Other usual signs of shock from internal bleeding
are absence of urine and/or classic signs of shock
(decreased BP and increased HR)
Disability Management
• Neurological Examination
• Lateral C-Spine X-ray
• CT scan
• MRI
• ECG - bradycardia and asystole are common with
acute cervical injury
• Search for other injuries - spinal trauma is often
accompanied by other injuries, particularly of the
head and chest.
Exposure Management
• Patients with SCI become poikilothermic, meaning
that their body temperature will increase and
decrease with the temperature of the environment.
• Because they lose the ability to regulate core body
temperature through vasodilatation and
vasoconstriction, they can become dangerously
hyperthermic or hypothermic.
Nursing Diagnosis
• Ineffective breathing pattern related to weakness
or paralysis of abdominal and intercostal
muscles and inability to clear secretions.
• Impaired urinary elimination related to inability to
void spontaneously
• Acute pain and discomfort related to treatment
and prolonged immobility
• Impaired bed and physical mobility related to
motor and sensory impairment
Thank you