Spinal Cord Injuries

1. Prof.Kavitha.P, M.Sc (N)
Vice Principal,
Ganga College of Nursing ,
Coimbatore.

2. SUBJECT:
UNIT NO :3
TOPIC :

3. INTRODUCTION
 Spinal cord injury is a low incidence disease
 High cost disability
 Requiring tremendous changes in individual’s life
style.
 40% of Trauma patients with neuro deficits will have
permanent or temporary spinal cord injury.
 Most common injury is at cervical Level.

4. OBJECTIVES
At the end of the class, the students are able to
 review anatomy and physiology of Spinal cord Injury
 define Spinal cord Injury
 state the incidence of Spinal cord Injury
 enlist the causes and risk factors of Spinal cord Injury
 explain the types of Spinal cord Injury
 narrate the pathophysiology of Spinal cord Injury
 state the clinical manifestations of Spinal cord Injury
 discuss the diagnostic measures of Spinal cord Injury
 State the complications of Spinal cord Injury
 enumerate the management of patient with Spinal
cord Injury
 explain the nursing management of patient with
Spinal cord Injury

9. DEFINITION
It is a trauma to the spinal cord that results either
temporary or permanent in changes in its motor,
sensory function and autonomic function.
Can have Spinal Column
Injury
But no Spinal Cord Injury.

10. INCIDENCE
 10,000-20,000 cases Per Year
 82% occurs In Men
 61% occurs Between the Age 16 Years -30
Years.

11. CAUSES
Traumatic
Non
Traumatic

12. NON TRAUMATIC
Degeneration
Inflammation
VascularCongenital
Neoplasm

13. TRAUMATIC

14. MECHANISM OF SPINAL CORD INJURY

15. MECHANISM OF SPINAL CORD INJURY

16. TYPES
PRIMARY INJURY :
Occurs at the time of injury may result in direct spinal
cord injury, cord compression, interruption in spinal
cord blood supply.
SECONDARY INJURY:
Occurs after initial injury due to result of Inflammation,
Ischemia.

17. TYPES
 Complete
 Incomplete
A complete spinal cord injury causes permanent
damage to the area of the spinal cord that is affected.
Paraplegia or tetraplegia are results of complete
spinal cord injuries.
A complete injury is indicated by a total loss of
sensory and motor function below the level of injury.

18. INCOMPLETE SPINAL CORD INJURIES
 An incomplete injury means that the ability of the
spinal cord to convey messages to or from the
brain is not completely lost.
 Additionally, some sensation (even if it’s faint)
and movement (motor function) is possible
below the level of injury.

19. INCOMPLETE SPINAL CORD INJURY
 Central Cord Syndrome,
 Anterior Cord Syndrome
 Posterior Cord Syndrome
 Brown-sequard Syndrome
 Cauda Equina syndrome
 Conus medullaris syndrome

20. CENTRAL CORD SYNDROME
Central cord syndrome (CCS)
is the most common
form of cervical spinal cord
injury.
It is characterized by
loss of motion and sensation
in arms and hands due to
trauma on central cortico
spinal tract of the spinal cord.

21. BROWN SEQUARD CORD SYNDROME
Brown-Sequard syndrome
(BSS) is a rare neurological
condition characterized by a
lesion in the spinal cord
which results in
weakness or paralysis
(Hemi paraplegia) on one
side of the body and a
loss of sensation
(Hemi anesthesia) on the
opposite side.

22. ANTERIOR CORD SYNDROME
Anterior spinal cord syndrome
involves complete motor paralysis
and loss of temperature and
pain perception distal to the lesion.
This syndrome is caused by
compression of the anterior
spinal artery, which results in
anterior cord ischemia or
direct compression of the
anterior cord.

23. POSTERIOR CORD SYNDROME
Posterior cord syndrome (PCS),
Also known as posterior spinal
artery syndrome (PSA),
is a type of incomplete spinal
cord injury.
These lesions can be caused by
trauma to the neck, occlusion
of the
spinal artery, tumor,
disc compression,
vitamin B12 deficiency, syphilis,
or multiple sclerosis.

24. CAUDA EQUINA SYNDROME
Cauda equina syndrome (CES)
is a condition that occurs
when the bundle of nerves
below the end of the
spinal cord known as the
cauda equina is damaged.
Signs and symptoms include low back pain, pain
that radiates down
the leg, numbness around the
anus, and loss of bowel
or bladder control.

25. CONUS MEDULLARIS SYNDROME
It is a type of incomplete
spinal cord injury that is
less likely to cause
paralysis than many other
types of spinal cord
injuries. Instead, the most
common symptoms
include: Severe back
pain. Strange or jarring
sensations in the back,
such as buzzing,
tingling, or numbness.

26. TYPES BASED ON LEVEL OF INJURY
• CERVICAL INJURY 40%
• THORACIC INJURY 10%
• LUMBAR INJURY 3%
• DORSO LUMBAR 35%
• ANY OTHER 14%

27. STAGE

28. SPINAL CORD
INSULT DUE TO
ETIOLOGY
PRIMARY INJURY
IMPACT WITH
PERSISTING
COMPRESSION
CELL DAMAGE
LACERATION
COMPRESSION
LOCAL MICRO
CIRCULATORY
DAMAGE
DUE TO CAPILLARY
DAMAGE,THROMBO
SIS
PROFOUND
HYPOTENSION
BRADY CARDIA
SECONDARY
INJURY
SYSTEMIC
CHANGES
BIOCHEMICAL
CHANGES DUE TO
EXCITI TOXIN
RELEASE
FREE RADICAL
PRODUCTION,ELECT
ROLYTES AND
CYTOKINES SHIFT
VASO SPASM AND
ENDOTHELIAL
SWELLING
LOCAL
&SYSTEMIC
EFFECT
PATHOPHYSIOLOGY

29. Numbness
or tingling in
the
extremities.
Headache
Lethargy
Breathing
difficulty
pain, pressure,
and stiffness
in the back or
neck area.
Changes In
Conscious
CLINICAL MANIFESTATIONS

30. Sexual
dysfuncti
on
Motor
Weakness
loss of control of
the bladder or
bowels.
Problems in
walking
Shock
Hypothermia
CLINICAL MANIFESTATIONS

31. Paralysis:
It is a State of Loss of Motor and Sensory Function
Types of Paralysis
Monoplegia
Diplegia
Hemiplegia
Paraplegia
Inverse Paraplegia
Tetraplegia

33. DIAGNOSTIC EVALUATION
 History collection
 Physical examination/Neurological examination
 Complete blood count &Urine test
 Spine xray
 CT/MRI

34. COMPLICATIONS
Autonomic
dysreflexia/
Spinal shock
Pressure
ulcer/
pulmonary
infections
Deep vein
thrombosis
unconscious
Paralysis

35. TREATMENT
 Pre hospitalisation:
Monitor Airway Breathing, Circulation
Cervical alignment is important at all times.
Maintain airway patency to prevent aspiration
clearing of oral secretions.
Modified jaw thrust if cervical injury is suspected
Control bleeding
Position –Neutral position

36. HOSPITAL CARE
• ATLS PRINCIPLE:
• A: AIRWAY
• B:BREATHING
• C:CIRCULATION
• D: DISABILITY/DRUGS
• E:EXAMINE

37. Hospital care
 Corticosteroids(dexamethasone)-Inflammation
 Oxygenation/Intubation if unconscious, Respiratory
paralysis
 Analgesics. Nutrition support,
 Administration of Intravenous fluids-NS/RL
 Administration of Epinephrine &Dopamine-
 Spine immobilisation-log roll position
 Cervical collar-cervical injury
 Chest physiotherapy/Quad Coughing

38. ADVANCEMENT
GM-1 Ganglioside-preventing secondary injury
Lozaroid-potent inhibitor of lipid perioxidation
without glucocorticoid activity is desirable.
Functional electrical stimulation is electrical
stimulation to innervating nerves helps in extremities.
Neural Prosthesis: allows rudimentary hand control
Vibratory stimulations
Electro Ejaculation

39. SURGICAL MANAGEMENT
• Surgical Decompression
• Spine Fixation
• Rhizotomy
• Indications
• If Any Incomplete Spinal Cord Injury,extra Dural
Lesions (Epidural Haematoma),facet
Dislocation,
• Cauda Equina Syndrome

40. REHABILITATION
Aim: cope up with physical, psychological social
challenges
Activities of daily living& Mobility
Physical therapy
Occupational activities by therapist
Speech and language therapy
Lighter weight wheelchairs
Video assisted technology-ADL
Activities
Tread mill assisted walking
Nutritional support
Counselling-Emotional Support

41. NURSING MANAGEMENT
• Monitor airway frequently, clear airway secretions
• Maintain oxygenation/ventilator settings
• ABG parameters
• Respiratory assessment and interventions
• Skin care-pressure ulcer prevention and management
• Maintain fluid balance
• Pain management

42. NURSING MANAGEMENT
• Log roll position
• Cervical collar
• Spine Board-Immobilization
• Passive exercises
• Assisting coughing measures
• Temperature control/Hypothermia management
• Prevention of secondary injury and complications
• Administration of Drugs

43. NURSING DIAGNOSIS
• Decreased cardiac output
• Ineffective spinal tissue perfusion
• Ineffective thermoregulation
• Impaired Physical Mobility.
• Disturbed Sensory Perception.
• Acute Pain
• Constipation/Bowel incontinence
• Urinary Incontinence
• Anticipatory Grieving.
• Situational Low Self-Esteem.
• Risk for Ineffective Breathing Pattern.
• Risk for Trauma.

44. REFERENCES
.Books:
1.Hasper, Fauci, Hauzer et.al,(2015) “HARRISON’S
Principles of Internal Medicine” Published by Mc
Grew hills companies, 19th Edition.
2.Smeltzer.Suzanne co et al,(2010) “Text book of
Medical Surgical Nursing” Published by Elsevier,12th
Edition: Page no-1953-1955.
Web sources:
http://en.wikipedia.org/wiki/spinalcord
http://www.nlm.nih.gov/medlineplus/spinalcordinjuries

45. THANK
YOU