Spinal Cord Injury Flashcards
- Major health problem
- Over 200,000 people living w/a SCI in the US
- 12,000-14,000 new injuries each year
- 1/2 of all SCI occur to the cervical spine & another large portion to the T11-L2 area
- Trauma is the leading cause of SCI
- Occurs more in males
> Traumatic injury r/t inc risk-taking behavior - Ages 16-30 account for more than 1/2 of new SCI each yr
- ETOH/substance use
- Warmer mos
Non-traumatic injury etiology incl
- osteoporosis fx’s
- tumors
- infarction & hemorrhage
- myelitis from infection or non-infection
- spondylosis
- syringomyelia
- Spinal nerves exit between vertebrae
- There’s a sensory & a motor axon
- Sensory stimulation from the receptors in the skin/organs send a signal to the brain & back down the motor neuron to illicit a purposeful movement (e.g., writing, catching a ball, putting on clothes, etc.)
Autonomic reflexes
- Peripheral sensory nerve impulses arc around spinal cord & return to the muscles in a particular organ, via motor neuron bypassing the brain
- This is a much faster process but not controlled; e.g., touching a hot pan
- The sensory root sends the signal around the spinal cord & back to the motor neuron to contract the muscle, moving the hand away from the hot pan
Spinal Cord
! W/trauma, fractured pieces may be sharp & sever or crush nerve tissue
Level of injury we need to consider location
- Cervical 1-7
- Thoracic 1-12
- Lumbar 1-5
- Sacral 1-5
Mechanisms of Injury: Primary
- Hyperflexion
- Hyperextension
- Axial loading (vertical compression)
- Excessive rotation
- Penetrating injury
2 Categories of Injury: Primary
- Is c/b the acceleration/deceleration applied to the spine
Secondary
- Is c/b hemorrhage, ischemia, hypovolemia, & general impaired tissue perfusion from neurogenic shock
- Local edema peaks in 2-3 days & subsides in 7; causes pressure on the cord & dec perfusion
- Microvascular destruction causes more neuronal damage
- The manifestations of SCI will depend on the type & lvl of injury
> Incomplete
- Some function preserved below the lesion
> Complete
- Paraplegia & tetraplegia
SCI - Level of Injury
- Area of actual injury, NOT area of function
- Inj classified according to the area of damage
> Central, lateral, anterior, or peripheral - Damage may have occurred @ C4 but able to move muscles below lvl of inj if inj was incomplete
- Neurologic lvl
> The lowest lvl @ which functions are normal
?
Is utilized to determine the highest neurological lvl of normal function & is NOT the lvl of inj; spec neurological function is determined by following the body’s dermatomes
ASIA scale
Dermatomes that map sensation for incomplete injuries
These syndromes are exceptions to sensation & function
- Anterior cord syndrome
- Central cord syndrome
- Posterior cord syndrome
- Brown-Sequard syndrome
- Cauda Equina syndrome
SCI - Anterior Cord
- Usually from the anterior spinal artery syndrome; there’s an artery that feeds the anterior portion of the spinal cord & a problem w/perfusion & circulation to this artery will lead to this
SCI - Central Cord
- Loss of sensation greater in upper extremities
SCI - Posterior Cord
- Damage @ the back of the spinal cord
- Pt may have good muscle power
- Pain & temp sensation
- May have difficulty w/coordination of limbs
SCI - Brown-Sequard
?
Loss of motor/sensory function in various patterns w/the potential for recovery w/regeneration of peripheral nerves; neurogenic bladder/bowel
Etiology
- pressure on nerves r/t trauma, fx, abscess, hematoma, ruptured disc, tumor, foreign object
Sx’s
- Incl lbp, alteration in LE sensation, dec motor strength LE, neurogenic bladder, loss of anal wink (aka anal reflex), saddle area numbness
Treatment = surgical decompression
Cauda equina syndrome
SCI - Diagnostics
- x-ray, CT, MRI
- Myelogram (examines subarachnoid space)
- Continuous ECG monitoring
- Sensory/motor function assessment
- Reflex assessment
Emergency Management
- ABC’s incl signs of hemorrhage
- Think about jaw thrust vs. head tilt technique (CPR)
- Maintain c-spine
- Log rolling
- 1 person must always assume control of the head
- LOC (GCS)
- Determine lvl of inj
SCI - Traction
- HOB raised; bed on casters so that it can be wheeled to x-ray dept; awaiting poss MRI or surgery
- Raise the bed to apply counter traction; skin care as ordered
Halo Fixation w/Jacket
- Often used s/p fx or arthrodesis
- Bone fragments or laminae (discs) laminectomy may be surgically removed to prevent further inj
- Pins are inserted into the skull - monitor for loosening pins or manifestations of infection may lead to osteomyelitis & subdural abscess
- Pin care by hospital policy or physician order
- Do not loosen screws that hold device in place
- Check skin for breakdown = 1 finger breadth
Pressure sores
- Decubiti r/t dec sensation & failure of motor function
- Special air/gel/sand beds
- Repositioning & chair padding
- Electronic chairs may be shifted to lean back to change pressure points
Other problems & treatments
! Spasticity
* baclofen (Lioresal); tizanidine (Zanaflex)
- intrathecal baclofen pump - directly released into CSF & pump placed in abd
s/e: if d/c’d too abruptly, client may have seizures or hallucinate
! if too much circulating systemically, may cause sedation, changes in mental status & fatigue
! Sexual dysfunction
* sildenafil (Viagra)
Cervical injuries
! C2 through C3 usually fatal
- C4 - phrenic nerve disrupted = diaphragm & resp muscles involved
- C5 & below = movement @ shoulder lvl
Thoracic injuries
- Depending on lvl of inj, there may be loss of movement w/chest, trunk, bladder, & legs
- Paraplegia
- Autonomic dysreflexia w/T6 & above
