This document discusses spinal cord injuries, including causes such as trauma from accidents, most common vertebral levels injured, types of injuries, symptoms depending on injury level, complications, assessment, management including initial care, drug therapy, and long term care needs. Key points include trauma as the main cause, cervical vertebrae most commonly affected, complete versus incomplete injuries determined by degree of sensation and motor function loss below injury level, and management focusing on respiratory, cardiovascular, bladder, bowel and skin integrity issues.

1. RATHEESH R L

2.  A spinal cord injury refers to any injury to
the spinal cord that is caused by trauma
instead of disease.

3.  Trauma (automobile or motor cycle
accidents, gunshot or knife wounds, falls
and sports mishaps)
 Vertebrae most commonly involved are the
5th, 6th and 7th cervical vertebrae, 12th
thoracic vertebrae and 1st lumbar vertebrae

4.  Mechanism of injury
 Level of injury
 Degree of injury

5.  Flexion rotation injuries
 Hyper extension injuries
 Compression injuries

6.  Occurs when the head strikes the
steering wheel, the spine is forced
into acute hyper flexion
 Rupture of posterior ligaments results in
forward dislocation of the vertebrae
 Cervical spine usually affected are the C5 to
C6 level

7.  Results after a fall in
which the chin hits an
object and the head
is thrown back
 Anterior ligament is ruptured with fracture
of the posterior elements of the vertebral
body
 Greatest area of stress is at the C4 and C5

8.  Caused by falls or jumps
in which the person lands
directly on the head,
sacrum or feet
 Force of impact fractures
the vertebrae and the
fragments compress the
cord
 Lumbar and lower
thoracic vertebrae are
usually affected

9.  Skeletal level
 Neurologic level

10.  Complete cord injury
- Results in total loss of sensory and motor
function below the level of injury
 Incomplete cord injury
- mixed loss of voluntary motor activity and
sensation and leaves some tracts intact

11.  Central cord syndrome
 Anterior cord syndrome
 Brown sequard syndrome
 Posterior cord syndrome
 Conus medullaris and cauda equina syndrome

12.  Damage to central
spinal cord
 Occurs most commonly
in the cervical region
 Motor weakness and
sensory loss are present
in both upper and lower
extremities

13.  Caused by damage to
anterior spinal artery
 Results from injury causing
compression of anterior
portion of the spinal
cord(flexion injury)
 Paralysis and loss of pain
and temperature sensation
below the level of injury
 Sensation of touch, position
and vibration remains intact

14.  Result of damage to
one half of the spinal
cord(knife or missile
injury)
 Ipsilateral paralysis
with ipsilateral loss of
touch and pressure
and contralateral loss
of pain and
temperature

15.  Results from damage to the posterior spinal
artery
 Dorsal columns are damaged resulting in loss
of proprioception
 Pain, temperature and motor function below
the level of lesion remains intact

16.  Result from damage to the
very lowest portion of the
spinal cord (conus) and the
lumbar and sacral nerve
roots(cauda equina)
 Flaccid paralysis of the
lower limbs and
areflexia(flaccid bladder and
bowel)

17. Respiratory system
 Injury below the level of C4
diaphragmatic breathing hypoventilation
 Cervical and thoracic injuries paralysis of
abdominal and intercostal muscles
patient cannot cough effectively to remove
secretions atelectasis and pneumonia
 Neurogenic pulmonary edema

18. Cardio vascular system
 Injury above the level of T6 decreases the
influence of sympathetic nervous system
bradycardia occurs
peripheral vasodilation
reduces return of blood to the heart
Decreases cardiac output hypotension

19. Urinary system
 Urinary retention (loss of sensation and
decreased reflexes)

20.  Gastrointestinal system
 Injury above the level of T5 decreased
gastro intestinal motility development of
paralytic ileus and gastric distension
 Development of stress ulcers
 Intra abdominal bleeding
 Less voluntary control over the bowel
neurogenic bowel(bowel is arereflexic and
sphincter tone is decreased)

21. Problems with thermoregulation
 Poikilothermism is lost in spinal cord injuries
 Decreased ability to sweat or shiver below
the level of the lesion
 Patients with high cervical injury have a
greater loss of ability to regulate
temperature

22.  Peripheral
vascular problems
 Deep vein
thrombosis(during
the first 3 months)

23. Spinal shock and neurogenic shock
 Spinal shock
- Temporary loss of neurologic function
characterized by decreased reflexes, loss of
sensation and flaccid paralysis below the
level of injury
- syndrome lasts days to months

24.  Neurogenic shock
- Effects are associated with cervical or
high thoracic injury
- Due to loss of vasomotor tone caused by
injury and is characterized by hypotension
and bradycardia
- peripheral vasodilation decreased
cardiac output

25.  History and physical examination
 X ray spine
 CT scan
 MRI scan
 Vertebral angiography

26.  Neurologic deterioration
 Pressure sores
 Pulmonary complications
- Atelectasis
- Increased work of breathing
- Decrease cough retained secretions
Pneumonia
- Muscle fatigue

27.  Neurogenic bladder
- Include urgency, frequency,
incontinence, inability to void and high
bladder pressure resulting in reflux of urine
into the kidneys
 Neurogenic bowel
- Voluntary control of bowel evacuation
is lost

28. -Hypertension
- Throbbing headache
- Marked diaphoresis above the level of
the lesion
- Bradycardia
- flushing of the skin above the level of
the lesion
- pale extremities below the level of the
lesion

29.  Loss of circulatory control
 Muscle tone problems
- Spastic and flaccid muscles

30. Initial care
 Neck should be stabilized in a
neutral position without flexion or
extension
 Place the affected person on a
spine board and secure the spine
with a hard collar around the neck

31.  Log rolling
technique
 Maintain a patent
airway
 Mechanically
assisted ventilation
 patients with
severe cervical
injury, placed in
skeletal traction

32.  Drug therapy
 Methyl prednisolone(effective if given within
8 hours of injury)
 Loading dose of 30mg|kg given within 3
hours of injury followed by 24 hours of
5.4mg|kg IV methyl prednisolone drip
 Vasopressor agents (dopamine)
 Histamine 2 receptor blocking agents

33.  Managing respiratory dysfunction
 If the injury is at or above C3 endotracheal
intubation and mechanical ventilation
 Chest physiotherapy, adequate oxygenation and
pain management
 Use of incentive spirometry

34.  Managing cardiovascular instability
 In case of bradycardia, administer
anticholinergic(atropine)
 Hypotension managed with dopamine infusion
 Compression gradient stockings to prevent DVT
 If severe blood loss has occurred, blood should
be administered according to protocol

35.  Fluid and nutritional balance
 First 48 to 72 hours after SCI GI tract may stop
functioning (paralytic ileus)
 NG tube insertion for gastric decompression
 Introduce oral foods and fluids once the bowel
sounds returns
 In patients with high cervical injuries swallowing
capacity must be evaluated
 Increased dietary fiber

36.  Temperature control
 Monitor body temperature
 Monitor the environment closely to maintain
appropriate temperature
 Patient should not be overloaded with covers
or unduly exposed

37.  Managing stress ulcers
 Stool and gastric contents are tested daily
for blood
 Give corticosteroids along with antacids
 H2 receptor blockers or proton pump
inhibitors

38.  Bladder and bowel management
 Insertion of indwelling catheter
 After patient is stabilized, start intermittent
catheterization
 Suppository should be inserted daily
 Increased fiber intake

39.  Ineffective breathing pattern related to
weakness or paralysis of abdominal and
intercostal muscles
 Impaired physical mobility related to motor
and sensory impairments
 Disturbed sensory perception related to
motor and sensory impairment
 Impaired urinary elimination related to
inability to void spontaneously
 Constipation related to presence of atonic
bowel

40.  Risk for impaired skin integrity related to
immobility
 Risk for autonomic dysreflexia related to
reflex stimulation of sympathetic nervous
system after spinal shock resolves