Each vertebrae has a nerve that exits either
below or above it
31 pairs of spinal nerves
8 cervical nerves
12 thoracic nerves
Part of the CNS along with brain
Contained within vertebral canal
Extends from cranium to 1st-2nd
Lumbar roots & sacral nerves for a
―horse-like tail‖ called cauda equina
Who’s at risk?
ADULT MEN BETWEEN 15 AND 30 YEARS
Anyone in a risk-taking occupation or lifestyle
SCI in older clients increasing largely due to
Causes (in order of frequency)
Gunshot wounds/acts of violence
Below site of injury:
Total lack of function
Decreased or absent reflexes and flaccid
Lasts from a week to several months after
End of spinal shock signaled by muscular
spasticity, reflex bladder emptying,
Total paralysis and loss of sensory and motor
function although arms or rarely completely
Incomplete (partial transection)
Mixed loss of voluntary motor activity and
Four patterns or syndromes
Central cord syndrome More common
in older clients
Frequently from hyperextension of
Weakness in upper and lower ext, but
greater in upper.
Anterior cord syndrome
Posterior cord syndrome
Compression of the ant. Cord, usually
a flexion injury
Sudden, complete motor paralysis at
lesion and below; decreased sensation
(including pain) and loss of
temperature sensation below site.
Touch, position, vibration and motion
Assoc with cervical
Dorsal area of cord is damaged
resulting in loss of proprioception
Pain, temperature sensation and
motor function remain intact.
Damage to one half of the cord on either side.
Caused by penetrating trauma or ruptured disk.
ischemia (obstruction of a blood vessel), or
infectious or inflammatory diseases such as
tuberculosis, or multiple sclerosis. BSS may be
caused by a spinal cord tumor, trauma (such as a
puncture wound to the neck or back),.
a rare SCI syndrome which results in
weakness or paralysis (hemiparaplegia) on one
side of the body and
a loss of sensation (hemianesthesia) on the
Depend on the LEVEL and DEGREE of the injury!
Quadriplegia occurs with C-1 through
Paraplegia occurs with T-1 thru L-4.
C1 – C3: Absence of ability to breathe independently.
C4 – poor cough, diaphragmatic breathing,
C5 – T6: decreased respiratory reserve
T6 or T7 – L4: functional respiratory system with
C1 – T5 shows decreased or absent SNS influence.
BRADYCARDIA AND HYPOTENSION (due to vasodilation)
The phrenic nerve stimulates the diaphragm to contract.
Two phrenic nerves (right and left) - injury to one or the other
paralyzes contraction of only one half of the diaphragm but
even hemi- (half) paralysis can significantly interfere with
breathing for patients with lung disease.
The nerve arises from branches of the C3,4, and 5 nerve roots.
The phrenic nerve can be damaged by procedures exploring
the neck & upper back
Loss of the phrenic nerve on either side results in paralysis of
the diaphragm on that side.
Paralysis of the diaphragm on one side results in less inflation
of the lung on that side.
Whether this is physiologically significant (producing
respiratory distress, hypoventilation/hypercapnia) depends on
other aspects of a patient's pulmonary physiology (namely
underlying chronic obstructive pulmonary disease
[emphysema, bronchitis], pneumonia, etc.).
The longest of the cranial nerves-
exits out of the medulla and ends in
It supplies sensory and motor function
to the pharynx
Supplies motor function to the
muscles of the abdominal organs
Provides parasympathetic activity to
the heart, lungs, and most of the
Atonic bladder with RETENTION in
Post acute phase – irritability causing
dribbling or frequent urination.
Urinary infection and calculi from
retention and distention.
Gastric distention – intermittent NG
Increased H2 – administer H2 inhibitors such
as Zantac or Pepcid in initial stages
Carafate and antacids later as prophylaxis
Intra-abdominal bleeding! Remember, no
pain or tenderness to warn you.
Watch for impactions.
Muscle atrophy in flaccid paralysis
Contractures in spastic paralysis
Poikilothermism – the adjustment
of body temp to room
Decreased ability to sweat below
DVT common but not detected
Pulmonary embolism a significant
cause of death.
Doppler studies, measurement of
extremity girth, impedance
plethysmography (what the heck
Goals are to
Prevent further cord damage
Assessment of muscle groups; motor status
Both sides of the body
Ask to move legs, hands, fingers, wrists, then shrug
shoulders Thorough motor examination including
position sense and vibration.
Pinprick starting at toes and working upward
ALWAYS HAVE CLIENT CLOSE EYES OR LOOK AWAY! If
he can see what you’re doing, he will answer
Assess for head injury and ICP
X-ray, CT scan, EMG
MRI provides Better Evaluation of Spinal cord.
CT Scan is good for Bony Injury but radiation
exposure is involved.
X-Ray is still good for initial evaluation &
Screening purposes with multiple views.
Myelogram is outdated but still may be used
where MRI is not available.
Tomograms may be of little value.
Continuous Imaging (Fluoroscopy) may be
used during surgery & Manipulation of Spine.
Reduces injury and stabilizes the SC
Done for Compression, Bony fragments in the cord,
Compound fracture, Penetrating trauma
Vasopressors: to keep mean arterial pressure greater
than 80mm to 900mm/Hg so that PERFUSION TO
CORD is improved.
MethylPrednisolone: Increases the recovery of
function. IV bolus then continuous IV over a 23 hour
period. Improves blood flow and reduces edema in
GI problems - zantac, tagamet, pepcid
Bradycardia - atropine
bladder spasticity - anticholinergics
autonomic dysreflexia – blood pressure reduction