spinal cord injury

1. Spinal cord injury

2.  bundle of nerve cells and
fibers
 from the brain stem to the
lower back.
 discs.
 The brain sends electrical
signals through the spinal
cord

3.  World - 250 000 and 500 000 people suffer with SCI.
 Annual global incidence is 40- 80 cases/ million
population.
 Majority are due to preventable causes
 Non-traumatic spinal cord injury appears to be
growing.
 Symptoms - severity & location
 2-5 times more likely to die prematurely
 Most people experience chronic pain

4.  Damage to the spinal cord that causes
temporary or permanent changes in its function.
 Symptoms - below the level of the injury.
 Loss of muscle function
 Sensation
 Autonomic function

5. Causes / Incidence
Motor vehicle clashes account
for 50%.
Falls 24%.
Violence 11%.
Sports injuries 9%.
Miscellaneous 6%.

6.  60%- fall from height
 35% - road traffic accidents.
 5% - miscellaneous
 Fall of heavy object over head and back (10.7%)
 Fall with heavy object over head (3.0%)
 Fall following electric shock (4.0%)

7.  Cervical spondylosis
 Myelitis
 Osteoporosis
 Syringomyelia
 Tumors
 Vascular disease

8. Hemiplegia Paraplegia Quadriplegia Monoplegia

10. a) Mechanism of injury
b) Level of injury
c) Degree of injury.

11. Flexion
Hyperextension
Compression
Flexion-rotation (most unstable)
Extension-rotation

13. b) Level of injury
Skeletal level---it is the vertebral level where there is most
damage to vertebral bones and ligaments.
Neurogenic level---the level of injury may be cervical,
thoracic, lumbar.
if cervical cord involved paralysis of all 4 extremities
occurs (tetraplegia).
if thoracic or lumbar cord is damaged the result is
paraplegia (paralysis & loss of sensation in legs).

14.  Odontoid
process
fracture
 Hangman’s
fracture
 Jefferson
fracture

15. Primary injury: the
initial mechanical
disruption of axons as a
result of stretch or
laceration is referred as
primary injury.
Secondary injury: it
refers to the ongoing
progressive damage
that occurs after the
initial injury.

16. Complete
 complete loss of motor
and sensory function
below the level of the
traumatic lesion
Incomplete
 characterized by
variable neurological
findings with partial
loss of sensory and/or
motor function below
the lesion

17. 1.Central cord syndrome
2.Anterior cord
syndrome
3.Brown-sequard
syndrome
4. Posterior cord
syndrome
5. Cauda equina
syndrome
6. Conus medullaris
syndrome.

18. Edema & hemorrhage- central spinal cord .
commonly in the cervical cord region.
motor weakness and the sensory loss
upper extremities are most commonly affected
than lower extremities.

20.  damage to the anterior spinal artery.
 compromised blood flow to the anterior
spinal cord.
 it typically results from flexion injury.
 manifestations include motor paralysis, loss
of pain and temperature sensation below the
level of injury.

22.  damage to one half of the spinal cord.
 this syndrome is characterized by loss of motor
function and position and vibratory sense as well as
vasomotor paralysis on the same side [ipsilateral] as
the lesion.
 the opposite [contralateral] side has loss of pain and
temperature sensation below the level of the lesion.

24.  compression or damage to the
posterior spinal artery.
 generally dorsal columns are damaged,
resulting in loss of proprioception.

26.  it result from damage to the very
lowest portion of the spinal cord
(conus) and the lumbar and
sacral nerve roots(cauda equina).
 injury to these areas produces
flaccid paralysis of the lower
limbs and areflexic bladder and
bowel.

27. Spinal cord injury can be due to;
 cord compression by bone displacement
 interruption of blood supply to the cord
 traction resulting from pulling on the cord

28.  Cascade of events causing secondary injury
following traumatic spinal cord injury:
Hemorrhage
RBC & platelet Breakdown of Neutrophils
aggregation RBCs
hemoglobin and iron
Production of
leukotrienes,
activation of
kallikrein-kinin
system
Release of
norepinephrine,
serotonin,
dopamine
Free radical
formation
Arachidonic
acid release

29. .
Vasoconstricti
on,
thrombosis
formation
Secondary injury
Tissue hypoxia
Decreased
spinal cord
blood flow
Vasospasm/
edema
Decreased
spinal cord
blood flow

30.  Extreme pain or pressure
 Weakness, incoordination or paralysis
 Numbness, tingling or loss of sensation
 Loss of bladder or bowel control, sexual dysfn
 Difficulty with balance and walking
 Impaired breathing after injury
 An oddly positioned or twisted neck or back

31.  Loss of movement
 Loss or altered sensation
 Loss of bowel or bladder control
 Exaggerated reflex activities or spasms
 Changes in sexual function

32. Diagnostic studies
History and physical examination
 ECG
ABGs, PFTs
X-ray, Myelography, CT scan, MRI, EMG
Urinalysis, Electrolytes
Glucose level
Coagulation profile
Hemoglobin and hematocrit levels.

33. Initial care
• Move out only with help
• Spine immobilization
– Head neutral
– No traction
• Shift
Log rolling
Spine board
• Halter traction
• RS/CVS/NS
• Be with client

35. Methylprednisolone is considered a treatment
option.
given within 8 hrs of injury
30mg/kg over 1st hr
5.4 mg/kg over 23 hrs

36.  Inotropic agents
 H2 receptor blocking agents
 Urinary antiseptics
 Anticoagulants
 Laxative
 Antispasmodics

37.  Immobilization - skeletal traction.
 Maintenance of HR and BP
 Insertion of urinary catheter, NG tube
 Oxygen/ Intubation (if indicated by ABGs and PFTs).
 IVF
 Stress ulcer & DVT prophylaxis.
 Bowel and bladder training.

38. Non-operative stabilization of spine:
--these are focused on stabilization of
the injured spinal segment and
decompression, either through traction
or realignment.

41. Surgical Therapy
Laminectomy
Insertion of rods

42. Scenario
Mr. John, 19-year-old student, who had an
accident when his head hit a sandbank as he dived
into the waves brought to the hospital on 4.12.2020.
John hit his head and was floating for 30 seconds,
later one friend realized something wrong with John.
He called to his other friends and John was turned
face up in the water. He was awake with weak cough,
he had swallowed some water but was breathing.
John was taken out of the water by five lifeguards. he
reported severe pain in his neck and was unable to
move his arms and legs. He was drowsy but, oriented
to his current location, and some details of the
accident.

43. His vital signs revealed a blood pressure of
100 / 72mm Hg, heart rate of 82 beats per
minute, respirations of 22 per minute.The
paramedics applied a cervical collar, placed him
on Ferno Scoop Stretcher, immobilized his head,
provided 100% Oxygen and transported him to
the hospital.
He is in hospital since 4 days, immobilized
using traction, catheterized (14F), IV line started
with 24 G cannula on the left metacarpal vein.
NG tube 16Fr inserted ( taking fluid diet)through
right nostril. O2 through face mask.

44. X-Rays:
• Cervical Spine: Unstable C6 Compression Fracture
• Chest: Mild Pulmonary Oedema
CT Spine:
• C6 Lesion with edema, blood at C5-6 with bone fragments
CT Brain: Mild Frontal Contusion
Blood Gas:
• pH 7.27, PaO2 60 mmHg, PaCO2 70 mmHg, HCO3 25.2
mEq/L
• SpO2 89%
Medication:
• IVF RL, 40ml/hr
• Duolin neb Q4H

45. C6 injury
• Nerves affect wrist extension.
• Paralysis in hands, trunk and legs
• Can speak and use diaphragm, but breathing will be
weakened
• Can move in and out of wheelchair and bed with
assistive equipment
• May also be able to drive an adapted vehicle
• Little or no voluntary control of bowel or bladder

46. 1.Impaired gas exchange related to intercostal muscle and
diaphragmatic fatigue or paralysis & retained secretions as
evidenced by decreased Pao2, diminished breath sounds.
 Breath sounds/ adventitious sound
 Humidified O2
 PFT/ ABG/ SpO2/ Physical examination
 Cough/ suctioning
 Semi fowlers/ head neutral
 ROM
 Fluid / nebulization/ Chest physiotherapy

47.  Side rails
 Bed rest & immobilization
 Traction
 Sandbags
 hard or soft cervical collars
 Log rolling techniques

48. 3. Risk for complications R/Tto prolonged recumbence
(immobility)
• ROM, arms at 90 degree, elevate leg
• Traction off and position change
• Back care, winkle& moisture free bed
• Skin care, alpha bed, comfort devices
• Pulmonary hygiene
• Homan’s sign/ DVT prophylaxis

49. 4. Impaired elimination pattern related to
neurogenic bowel
 Bowel movement
 Foods high in fiber
 Laxative
 Fluid

50. Rehabilitation & home care:
physical therapy: range of motion exercises,
mobility training, muscle strengthening.
occupational therapy (splints, activities of
daily living training)
bowel & bladder training.
autonomic dysreflexia prevention.
pressure ulcer prevention.
recreational therapy
patient & family education.

51. Complications
• Spinal shock
• Neurogenic shock
• Autonomic dyreflexia
• Homothermia
• DVT/ PE
• Pressure sore
• Cardiovascular & Respiratory Dysfunction
• Neurogenic bowel & bladder
• Orthostatic hypotension
• Sexual dysfunction