SPINAL CORD INJURY

SPINAL CORD INJURY

• Possible causes:
o MVC
o Falls
o Industrial accidents
o Sporting activities

SPINAL CORD’S PURPOSE AND FUNCTION

• Serves as a 2-way conduction pathway between brain and peripheral nervous system
• Contains the reflex centers for those activities which don’t require control by brain
o Knee jerk: simple reflex arch

VERTEBRAL INJURIES
• Prevent cord damage

• Definition
o Involve the vertebrae of the spinal column

• Fractures
o Simple

o Compressed

o Communuted

o Dislocation

SPINAL CORD INJURY

• Definition
o Refers to injury of spinal cord itself
o Usually associated with vertebral injuries
o However, can result from an interruption of the cord’s blood supply
SIGNS AND SYMPTOMS – DEPEND ON
• Level of Injury
o Cervical
 Most common type; C2 – C3 injury is rapidly fatal
 Complete transcection quadriplegia
 Swelling tow segment above / below

o Thoracic
 Less frequent; requires violent injury transection – ribs protect
 @ T12 – L1 Paraplegia

o Lumbar Injury
 L4-L5 most common – Hit or bending over

o Sacral and Coccygeal

 Usually result from falls or direct trauma; nerves somewhat protected

SYMPTOMS OF LUMBAR – SACRAL INJURY

 Flaccid paralysis of lower extremities
 Loss of deep tendon reflexes
 Urinary retention
 Fecal Incontinence
 Loss of sensation
 Severe lower back pain

• Extent Of Injury
o Concussion – Cord bump lose function

o Contusion

o Compression

o Transection

 Complete – Loss of everything below lesion

 Incomplete – Varying degrees of loss; assess wk with remaining

o Laceration – Cutting cord; ischemia with cord tissue death

o Hemorrhage – Due to trauma with ischemia of tissue

• Mechanism Of Injury
o Hyperflexion – Neck down

o Hyperextension – Neck up

o Compression – Fall flat on feet / head

 o Rotational Forces – Twisting neck
SPINAL SHOCK
• Occurs immediately after spinal cord trauma – Lasts from few days to months
• Cessation of all motor, sensory, reflex and autonomic functions below level of injury
• Everything shuts down
• Observe patient closely for Hypotension, Bradycardia, Hyperthermia and flaccid paralysis
during the spinal shock stage
• Recovery occurs with return of some reflex activity
o Anal wink: not shock

EMERGENCY MANAGEMENT
• Goals to preserve life and prevent further damage
o At Accident Site
 ABC’s, transportation
o In Emergency Room
 Assess, evaluate, obtain history, provide necessary support

MEDICAL MANAGEMENT
• Nonsurgical
o Controlling cord edema
 Medications
• Ex. Solu-Medrol

o Immobilization if a fracture present in addition to cord damage

 Cervical
• Tongs with traction
• Halo device
o Early mobilization

 Thoracic or Lumbar
• Body casts
• Positioning

 Sacral or Coccygeal
• Bed rest
• Girdles

• Surgical
o Spinal Cord Cooling
 Not done a lot anymore because steroids  R/F infection. Irrigate with cool
saline
 o Laminectomy
-Provide Stability
o Spinal Fusion -Paralysis will stabilize spine so have
o Harrington Rods quality and  R/F complications

NURSING MANAGEMENT
Goals: Prevent further injury
Maintain intact functions
Prevent complications
Rehabilitation (Starts the minute the pt comes in)

• Disuse Syndrome

• Respiratory
o  R/F Pneumonia
o Injury above C4
o Respiratory status

• Cardiovascular
o  R/F Thrombus, orthostatic HTN
o No dangle b/c  R/F stroke; lay down
o Pain, swelling, redness
o TED, Lovenox

• Integumentary
o R/F pressure ulcers, breakdown, and decreased sensation

• Musculoskeletal
o Prevent contractures
 ROM, Valium
 Spaccidity major problems with quads
 Loose Ca because increased stress bones muscle atrophy

• Nutrition
o Fluid volume overload
o Dehydration, NG, Keofeed
 IV fluids
 Bowel sounds
 Gag/swallow reflex
 Self care feeding devices

• Genitourinary Tract
o Neurogenic Bladder
o During spinal shock the bladder is atonic – MUST have a cath
o As spinal shock subsides you will see one of two things with total cord transection
 1-Upper Motor Neuron Bladder: Occurs above T12; bladder becomes
hypertonic and spastic.
• Bladder empties reflex
• Bladder training because have reflex
  2-Lower Motor Neuron Bladder: At or below T12; bladder becomes atonic with
increased bladder capacity
• Large amount of urine – Leaking urine – need cath

• Bowel
o Upper Motor Neuron
 Bowel empties reflexively – Bowel training
o Lower Motor Neuron
 Loss of reflex action with external sphincter relaxation
 Bowel incontinence; bowel training (enema, stimulation)

• Nervous System
o Autonomic Hyperreflexia or Dysreflexia
 Sit Up Immediately –  ICP and  BP
• Occurs 6 years post injury
• Flag Chart
• Vasodilator because BP will bottom out
 Occurs after spinal shock phase in patients with injury at or above T6
 Very serious emergency
 Results from distended bladder, distended bowel, skin (pressure, heat and
cold)
• Uninhibited response
• Possible UTI’s
 Signs and Symptoms:
• Hypertension, H/A, Flushing, Sweating, Nasal congestion, bradycardia
 Management
• Key is prevention
• Treatment consist of elevating the HOB and removing cause – speed
is essential
• Safety
o Increased R/F Injury

• Pain
o Comfort and Rest
o Pain at point of injury
o Addiction problem with management
o Surgery cut nerve:  function,  Pain

• Sexuality
o Males – Complete transactions - Primary area of concern
 Upper Motor Neuron – C1 – T12; large percentage experience reflexogenic
erections due to intact reflex arc.
 Lower Motor Neuron - T12-S4; no reflex response; Small percentage able to
experience psychogenic erections
• Stimulates higher than brain levels
o Females
 Can get pregnant nothing wrong with reproductive system
  Lack Sensation
 Can become Pregnant
 Problems with lubrication – KY Jelly

REHABILITATION – Begins on admission to hospital

PSYCHOSOCIAL CONSIDERATIONS – Major life change; may be angry or bitter