Classification of SCI

1. SPINALCORDINJURY
BY SACHIN DWIVEDI
KING GEORGE’S MEDICAL UNIVERSITY, COLLEGE
OF NURSING, LUCKNOW

2. ANATOMY AND PHYSIOLOGY
• Originates in the brainstem,
passes through the foramen
magnum, and continues through to
the conus medullaris near the L2
before terminating in filum
terminale.
• Contains cerebrospinal fluid.
• 45 cm (18 in) in men ,43 cm (17 in)
long in women.
• 13 mm (1⁄2 in) in the cervical and
lumbar regions to 6.4 mm (1⁄4 in)
in the thoracic area.

3. Cont.…
• 31 pairs of spinal Nerve.(C1–C8),(T1–
T12), (L1–L5), (S1–S5) and Co1.
• Spinal meninges: Dura, Arachnoid. And
Pia matter.
• External surface: Conus medularis(L1-
L2) cauda equina (L3-L5)
• Spinal Tissue: Gray Matter(neuronal
cell bodies, dendrites, axons and glial
cells)
• White Matter (Myelinated Axon)
• Dorsal Root (afferent sensory root)
• Ventral Root(Efferent motor root).
Important Function:
• Conduction pathway for
impulses.(Efferent and Afferent Root)
• Serving as a reflex center.(Reflex Arc)

4. Nerve Plexus
• Nerve plexus is a
network of
intersecting nerves.
Cervical Plexus(C1-C4)—
Serves the Head, Neck and
Shoulders.
Brachial Plexus(C5-T1)—Serves
the Chest, Shoulders, Arms and
Hands.
Lumbar Plexus(L1-L4)—Serves
the Back, Abdomen, Groin,
Thighs, Knees, and Calves.
Sacral Plexus(L5-S4)—Serves
the Pelvis, Buttocks, Genitals,
Thighs, Calves, and Feet.
Coccygeal Plexus(S5-Co1)—
Serves a Small Region over the
Coccyx.

5. DEFINITION
• Spinal cord injury (SCI) is damage to the spinal cord that
results in a loss of function such as mobility or feeling.
• 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 by the spinal cord below the level of the injury.

6. Incidence
• SCI is highest among persons age 16-30, in whom 53.1
percent of injuries.
• Males represent 81.2 percent of all reported SCIs and
89.8 percent of all sports-related SCIs.
• Among both genders, auto accidents, falls and gunshots
are the three leading causes of SCI.
• Sports and recreation-related SCI injuries primarily affect
people under age 29.

7. Causes
Road Traffic accidents.
Bullet or stab wound
Traumatic injury
Electric shock
Extreme twisting of the middle of the body
Landing on the head during a sports injury
Fall from a great height

8. TYPES OF SPINAL CORD INJURY
SCI
COMPLETE
SCI
Tetraplegia Paraplegia

9. INCOMPLETE SCI

10. Complete Spinal Cord Injuries
• Tetraplegia(Quadriplegia):-Spinal cord injury above the first
thoracic vertebra, or within the cervical sections of C1-C8. result
is some degree of paralysis in all four limbs—the legs and arms.
• Paraplegia: Spinal cord injuries below the first thoracic spinal
levels (T1-L5). Paraplegics are able to fully use their arms and
hands, but the degree to which their legs are disabled depends on
the injury.
• Complete paraplegia: It is described as permanent loss of
motor and nerve function at T1 level or below, resulting in loss
of sensation and movement in the legs, bowel, bladder, and
sexual region.

11. CENTRAL CORD SYNDROME
• Cause: Injury or edema of
the central cord, usually of
the cervical area and
cervical lesions .
• Characteristics: Motor
deficits (in the upper
extremities sensory loss
varies in the upper
extremities).

12. ANTERIOR CORD SYNDROME
• Cause: acute disk
herniation associated with
fracture-dislocation of
vertebra and also occur
injury to anterior spinal
Artery and lesion.
• Characteristics: Loss of
pain, temperature, and
motor function is noted
below the level of the
lesion or injury; light touch,
position, and vibration
sensation remain intact.

13. POSTIRIOR CORD SYNDROME
• Cause: an infarct in the
posterior spinal artery and
is caused by lesions on the
posterior portion of the
spinal cord,
Characteristics: loss of
proprioceptive sensation,
fine touch, pressure, and
vibration below the lesion;
deep tendon areflexia.

14. Brown- Sequard syndrome
• Known as Lateral Cord
Syndrome.
• Cause: The lesion is caused
by a transverse hemisection
of the cord, as a result of a
knife or missile injury, fracture
dislocation of a unilateral
articular process.
• Characteristics: Ipsilateral
paralysis or paresis is noted,
together with ipsilateral loss of
touch, pressure, and vibration
and contralateral loss of pain
and temperature.

15. Conas Medularis syndrome
• Known as Lateral Cord
Syndrome.
• Cause: blow to the back-
such as Gunshot and
spinal tumor.
• Characteristics:
• Bowel and bladder
dysfunction,
• Flaccid lower extremities.
• Sexual dysfunction.

16. Cauda Equina Syndrome
• Known as Horse tail
Syndrome.
• Cause: Injury or lesion at the
lumbosacral nerve root below
the conus medulararis.
• Characteristics: Areflexia
loss of reflexes(Lower
Extremities). Leg weakness
• Bladder/bowel dysfunction

18. PATHOPHYSIOLOGY

19. SIGNS AND SYMPTOMS

20. CLINICAL MANIFESTATION
• Spinal Shock
• Autonomic Dysreflexia
• Pain
• Breathing difficulty
• Sensitivity to stimuli
• Muscle spasms
• Loss of sensation
• Loss of reflex function
• Loss of autonomic activity
• Loss of bowel control
• Loss of bladder control
• Sexual dysfunction
• Loss of function, such as mobility or sensation

21. CERVICAL (NECK) INJURIES
Breathing difficulties
Loss of normal bowel and bladder
control
Numbness
Sensory changes
Spasticity (increased muscle tone)

22. THORACIC (CHEST LEVEL) INJURIES
Loss of normal bowel and bladder control
Numbness
Sensory changes
Spasticity (increased muscle tone)
Weakness, paralysis

23. LUMBAR SACRAL (LOWERBACK) INJURIES
Loss of normal bowel and bladder control (you may
have constipation, leakage, and bladder spasms)
Numbness
Pain
Sensory changes
Weakness and paralysis

24. ASSESSMENT

25. DIAGNOSTIC TESTS
 Complete blood count (e.g. Hb, RBC,
WBC)
 Arterial blood gas level
PaO2:85-95 mm of Hg
PaCO2:35-45 mm of Hg

26. X- RAYS:

27. COMPUTERIZED TOMOGRAPHY (CT)
SCANS

28. MAGNETIC RESONANCE
IMAGING (MRI):

29. MYELOGRAPHY:

31. MEDICAL MANAGEMENT:
 Whole blood
NS
RL
Hydrocortisone:
Action : steroids

32. Nor epinephrine
action: adrenergic drug
Epinephrine
action: α and β adrenergic drug
Dopamine
action: adrenergic, anti shock drug

33. EMEGENCY MANAGEMENT
• Initial treatment of patients with cord injury focuses on two
aspects -preventing further damage and resuscitation.
• Immobilization with a hard cervical collar (in case of
cervical spine injuries) and care in transportation of
patient is of paramount importance if the spine is
unstable.
• Resuscitation is aimed at airway maintenance,
adequate oxygen saturation of peripheral blood, restoring
blood pressure to acceptable limits, preventing
bradycardia, done simultaneously to prevent any ischemic
damage to the already compromised cord.

35. SURGICAL MANAGEMENT

37. NURSING MANAGEMENT:

38. NURSING DIAGNOSIS
 Impaired physical mobility related to loss of
motor function
 Fluid volume deficit related to decrease LOC
 Risk for injury related to loss of motor function.
 Urinary retention related to level of injury
 Risk for Impaired skin integrity related to
trauma
 Knowledge deficit regarding the treatment
modalities and current situation.
 Anxiety related to outcome of diseases as
evidenced by poor concentration on work,
isolation from others, rude behavior

39. NURSING MANAGEMENT OF PATIENT
WITH SPINAL CORD INJURY
Goal
• Resuscitation according to ATLS guidelines
• Determination of neurological injury
• Prevention of neurological deterioration
• Ongoing assessment and treatment of associated injuries
• Prevention of complications
• Initiation of definitive management for vertebral column
injury.

40. Respiratory management
Closely monitor the patient’s respiratory rate, depth, and
pattern, staying alert for paradoxical breathing.
Maintain continuous pulse oximetry; when possible, use
end-tidal capnography as part of routine monitoring.
Intubation. Patients with respiratory failure require
mechanical ventilation. If your patient needs intubation,
take care to maintain spinal alignment by using a cervical
collar, manual inline traction,
Many patients with injuries at the C3 vertebral level or
higher are ventilator dependent. Those with an
intact phrenic nerve may qualify for diaphragmatic pacer
implantation, which may allow weaning from
mechanical ventilation.

41. Cardiovascular management
Patients with significant cervical and high thoracic injuries
(T6 level and above) may develop
Neurogenic shock. Caused by loss of sympathetic tone,
this distributive shock state results in vasodilation,
profound bradycardia, and hypothermia.
Hypotension, temperature dysregulation, venous stasis,
and autonomic dysregulation (AD) may occur.

42. GI management
• Acute GI problems in SCI patients may include paralytic
ileus with associated abdominal distention,
gastric ulcers, and constipation.
• Monitor the patient’s bowel sounds and abdominal
distention at least every 4 hours. If indicated and ordered,
insert a decompressive gastric tube to reduce aspiration
risk and restore diaphragm position and lung size to
normal.
• To aid bowel regulation, the patient may need a bowel
regimen of stool softeners and a high-fiber diet along with
low-volume enemas, glycerin, or bisacodyl
suppositories or digital rectal stimulation to cause
reflexive evacuation after the morning meal.

43. Genitourinary management
• A patient in neurogenic shock experiences abrupt loss of
voluntary muscle control and reflexes, resulting in acute urinary
retention.
• An indwelling urinary catheter must be placed to
decompress the bladder and allow close urinary output
monitoring.
• SCI can cause neurogenic or aneurogenic bladder.
• • In neurogenic bladder, reflex-initiated voiding may occur
when the patient has a full bladder.
• • In aneurogenic bladder, such voiding doesn’t occur,
potentially causing overflow urine leakage.
• Planned intermittent catheterization can reduce
incontinence. Longterm bladder management varies with the
patient’s bladder type, needs, and lifestyle.

44. Musculoskeletal management
• Patients with SCIs typically experience muscle spasticity
as spinal shock recedes and reflexes return.
• Nonpharmacologic strategies to manage spasticity
include
Range-ofmotion exercises,
Positioning techniques,
Weight-bearing exercises,
electrical stimulation, and orthoses or splinting to
prevent loss of muscle length and contractures.
Pharmacologic therapy may include
baclofen, benzodiazepines, alpha2-adrenergic
agonists, and regional botulism toxin or phenol
injection.

45. Dermatologic management
• Prevention and early detection are the cornerstones of
pressureulcer management. an established skin risk
assessment tool, such as the Braden scale.
• turning the patient every 2 hours or more (depending
on risk assessment findings)
• avoiding positioning the patient on bony
prominences, such as the trochanters, sacrum,
and heels
• minimizing moisture
• frequently inspecting the skin under braces and
splints
• establishing a pressure-release regimen (manual or
automated) for wheelchair sitting

46. REHABILITATION
Cognitive Rehabilitation Therapy
• Speech Therapy
• Mental Rehabilitation
• Physical Exercise
• Occupational Therapy

47. POSSIBLE COMPLICATIONS
 Blood pressure changes - can be extreme
(autonomic hyperreflexia)
 Chronic kidney disease
 Complications of immobility:
Deep vein thrombosis
Pulmonary infections
Skin breakdown
 Contractures

48.  Increased risk of urinary tract
infections
 Loss of bladdercontrol
 Loss of bowel control
 Loss of sensation
 Loss of sexual functioning (male
impotence)
 Muscle spasticity
 Paralysis of breathing muscles
 Paralysis (paraplegia, quadriplegia)
 Pressure sores

49. THANK YOU