this slide contain introduction, definition, indication, types, risk factor, causes, pathophysiology, clinical manifestation , types, diagnostic evaluation, management - emergency, medical, nursing, treatment.

1. SPINAL CORD INJURY
Mrs. Mamta Toppo
Associate Professor
College of Nursing
RIMS , Ranchi
Neetu Kumari
Roll no – 11
3rd year basic
B.sc. Nursing
Session – 2017 -21

2. CONTENT
1. Anatomy and Physiology of Spinal Cord
2. Introduction
3. Definition 12. Different surgeries for SCI
4. Incidence 13. Halo and orthotic devices
5. Risk factor 14. Nutritional Diet
6. Causes 15. Complications
7. Pathophysiology 16. Prognosis
8. Clinical Manifestation 17. Rehabilitation of SCI
9. Types 18. Recent Research
10. Diagnostic Evaluation 19. Summary
11. Management 20. Reference
a. Emergency Management 21. Bibliography
b. Medical Management
c. Surgical Management
d. Nursing Management

3. ANATOMY AND PHYSIOLOGY

5. The SPINAL CORD is a part of the Central
Nervous System. It is a long pipe- like
structure arising from the Medulla oblongata
part of the brain consisting of a collection of
nerve fibres , running through the Vertebra
column of the Backbone.
In adults , the spinal cord is usually 40cm
long and 2cm wide. It form a vital link
between the brain and the body.
The Spinal cord is divided into five
different parts :-

6. 1. CERVICAL CORD :-
Cervical means of the Neck. There are 8cevicalnerves that emerge from
the cervical spine (C1 - C8).
2. THORACIC CORD :-
Thoracic means of the Chest. There are 12 thoracic nerves that emerge
from the thoracic spine (T1 – T12).
3. LUMBAR CORD:-
Lumbar means from the lower back region . There are 5 lumbar nerves
that emerge from the lumbar spine (L1 – L5).
4. SACRAL CORD :-
Sacral means of the sacrum. The sacrum is a bony plate at the base of
the vertebral column. There are 5 sacral nerves that emerge from the
sacral bone (S1- S5).
5. COCCYGEAL CORD :-
Coccygeal means of theTailbone. There is 1 nerve that emerges from
the coccygeal bone.

7. FUNCTIONS OF SPINAL CORD
Carrying signals from the brain:- The spinal
cord receives signals from the brain that control movement and
autonomic functions.
Carrying information to the brain :- The
spinal cord nerves also transmit messages to the brain from the body ,
such as sensations of touch , pressure and pain.
Reflex responses :- The spinal cord may also act
independently of the brain in conducting motor reflexes.
 Forms a connecting link between the brain and the PNS.
 Provides structural support and builds a body posture.
 Facilitates flexible movements.

8. INTRODUCTION
The spinal cord is a collection of nerves
that travels from the bottom of the
brain down your back.
There are 31 pairs of nerves that leave
the spinal cord and go to arms, legs,
chest and abdomen.
These nerves allow your brain to give
commands to your muscles and cause
movements of your arms and legs.

9. DEFINITION
Spinal cord injury (SCI) is damage or
trauma to the spinal cord that results in
a loss of impaired function causing
reduced mobility or sensation.
The cervical and lumbar vertebrae are
the most common sites of injury.

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

11. RISK FACTORS
Male sex
Age between 18 to 25 years
Young adults and seniors
People who are active in sports
People with predisposing conditions

12. CAUSES
• Trauma
• Loss of its normal blood supply
• Infectious conditions
• Extreme twisting of the middle of the body
• Gunshot wounds
• Inflammation of the spinal cord
• Acts of violence
• Spinal cord tumor
• Falls from a great height
• Sports and recreation injuries
• Electric shock
• Motor vehicle accidents
• Multiple sclerosis

13. PATHOPHYSIOLOGY
Damage to the Spinal cord ranges from transient concussion to contusion ,
laceration and compression of the cord substance to complete transection
of the cord.
Spinal cord injuries can be separated into two categories -
Primary injuries are the
result of the initial insult
or trauma and are usually
permanent.
Secondary injuries are usually
the result of a contusion or tear
injury in which the nerve fibres
begin to swell and disintegrate.

14. An injury to the upper portion of the spinal cord
in the neck can cause quadriplegia paralysis of
both arms and both legs.
If the injury to the spinal cord occurs lower in the
back , it can cause Paraplegia paralysis of both
legs only.

16. CLINICAL MANIFESTATION
Symptoms vary depending on the location of the
injury.
The most common sites are the cervical areas C5,C6
and C7 and the junction of the thoracic and lumbar
vertebrae T12,L1.
CERVICAL {NECK} INJURIES :-
o Breathing difficulties
o Loss of normal bowel and bladder control
o Numbness
o Sensory changes
o Spasticity ( increased muscle tone)

17. THORACIC { CHEST LEVEL } INJURIES :-
o Loss of normal bowel and bladder control
o Numbness
o Sensory changes
o Spasticity (increased muscle tone)
o Weakness , paralysis
LUMBAR SACRAL {LOWER BACK} INJURIES :-
o Loss of normal bowel and bladder control ( you may
have constipation, leakage and bladder spasms)
o Numbness
o Pain
o Sensory changes
o Weakness and paralysis

18. TYPES
SCI
COMPLETE
SCI
INCOMPLETE
SCI

19. Complete Spinal Cord Injuries
It is described as absence of sensory and motor function in
lowest sacral segment after resolution of spinal shock.
1. TETRAPLEGIA :- Spinal cord injury above the first
thoracic vertebrae, or within the cervical sections of C1 –
C8. Result is some degree of paralysis in all four limbs – the
legs and arms.
2. PARAPLEGIA :- Spinal cord injury below the first thoracic
spinal levels ( T1 – L5). Paraplegia are able to fully use their
arms and hands , but the degree to which their legs are
disabled depends on the injury.

20. Incomplete Spinal Cord Injuries
It is defined as the presence of sensory and motor function
in lowest sacral segment .
1. 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).

21. 2. ANTERIOR CORD SYNDROME
CAUSE :-Acute dark disk herniation
associated with fracture dislocation
of vertebra and also occur injury to
anterior spinal artery and lesion.
CHARACTERISTICS ;- Loss of pain ,
temperature , motor and sensory
function is deficit , poor prognosis.

22. 3. BROWN – SEQUARD SYNDROME
CAUSE :- The lesion is caused by a
transverse hemi-section of the cord ,
as a result of a knife or missile injury
, fracture, dislocation of a unilateral
articular process.
CHARACTERISTICS :- Ipsilateral
paralysis or together with ipsilateral
loss of touch , pressure ,vibration
and contralateral loss of
pain and temperature.

23. DIAGNOSTIC EVALUATIONS
o Spine x-ray
o CT Scan or MRI of the spine
o CBC (e.g. Hb , RBC , WBC)
o Arterial blood gas level

25. EMERGENCY MANAGEMENT
Emergency management of patient with spinal cord
injury includes a rapid assessment , immobilization ,
stabilization or control of life - threatening injuries
and transportation to the most appropriate medical
facility.
Emergency management involves careful
monitoring of vital signs and airway and keeping
the patient immobilized.

26. MEDICAL MANAGEMENT
o Respiratory Management :- The goal of care of
patient with spinal cord injury is maintenance of pulmonary
and cardiovascular stability. Patient may require oxygen
therapy , tracheostomy and continuous mechanical
ventilation.
o Pharmacologic Therapy :- Corticosteroids , such as
dexamethasone or methylprednisolone , are used to reduce
swelling that may damage the spinal cord.
o Immobilization :- Spinal traction may be
recommended. A special bed may help immobilize body such
as Roto Rest bed and Stryker.
o Supportive Therapy :-

27. SURGICAL MANAGEMENT
o Surgery is necessary to remove fragments of
bones , foreign objects , herniated disks or
fractured vertebrae that appear to be
compressing the spine.
o If the spinal cord is being compressed by
tumor , infection or severe arthritis , surgery
can be performed to reduce the amount of
compression.
o Surgery may also be needed to stabilize the
spine to prevent future pain or deformity.

28. NURSING MANAGEMENT
ASSESSMENT :-
o Disturbance in level of consciousness from
slightly drowsy to unconscious.
o Sudden onset of neurologic deficits.
o Cerebrospinal fluid leakage at ears and nose
, which may indicate skull fracture.
o Irregular respirations.
o Puppillary abnormality.

29. DIAGNOSIS :-
o Impaired physical mobility related to loss of
motor function.
o Fluid volume deficit related to decrease loss
of consciousness.
o Risk for injury related to loss of motor
function.
o Urinary retention related to inability to void
spontaneously.
o Pain and discomfort related to treatment and
prolonged immobility.
o Knowledge deficit regarding the treatment
modalities and current situation.

30. PLANNING :-
o Improved breathing pattern and airways
clearance.
o Improved mobility.
o Improved sensory and perceptual
awareness.
o Maintenance of skin integrity.
o Relief of urinary retention.
o Improved bowel function.
o Promotion of comfort.

31. INTERVENTIONS :-
o Monitor respiratory rate , depth and pattern of the
respirations.
o Promote adequate breathing and airway clearance.
o Range of motion exercises help to prevent
contractures.
o Place the patient on special beds that move the
patient frequently without the need for turning.
o Assess all body surfaces and document skin integrity
at least every 8 hours.
o Turn reposition the patient every 2 to 4 hours.
o Assess the bladder distension , urinary and bowel
function and elimination.
o Record fluid intake , voiding pattern , amount of
residual urine after catheterization.
o Provide high fiber and high protein diet.

32. DIFFERENT SURGERIES FOR
SCI
o SPINAL FUSION :- It is a surgical
procedure used to correct problems
with the small bones in the spine
(vertebrae). It is essentially a
“welding” process.
The basic idea is to fuse together
two or more vertebrae so that they
heal into a single , solid bone.
This is done to eliminate painful
motion or to restore stability
to the spine.

33. DECOMPRESSION
LAMINECTOMY
It is a type of
surgery in which a
surgeon removes
part or all of the
vertebral bone
(lamina). This helps
ease pressure on
the spinal cord or
nerve roots that
may be caused by
injury , herniated
disk or narrowing of
the canal.

34. FORAMINO-
TOMY
This surgery is
used to relieve pain
associated with a
compressed nerve
in the spine. The
surgeon cuts away
bone at the sides of
your vertebrae to
widen the space
where nerves exit
your spine.

35. DISC
REPLACEMENT
A surgeon
removes the
damaged
spinal disk
and inserts an
artificial one
between your
vertebrae.

36. INTERLAMINAR
IMPLANT
This is a minimally
invasive alternative to
more invasive
laminectomy or
laminectomy plus
fusion surgery. The
surgeon implants a U-
shaped device
between two
vertebrae in lower
back. It helps keep
the space between
them open and eases
pressure on spinal
nerves. It can be done
at the same time as a
laminectomy.

37. HISTORY
o 5,000 years ago nearly Ancient Egyptians used first
splints.
o Middle ages armorers manufactured splints that
protected as well as stabilized the body.
o Late 16th century french surgeon Ambroise Pare
developed metal corsets.
o Late 17th century Lorenz Heister is created with
developing the first spinal orthosis quite similar to
the modern day halo brace.

38. HALO AND ORTHOTIC DEVICES
FOR SCI
Cervical – Thoracic
Orthosis Lumbosacral Orthosis

39. Cervico – Thoraco -
Lumbosacral Orthosis (CTLSO)
Thoraco – Lumbo - Sacral
Orthosis (TLSO)

40. HALO CERVICAL
ORTHOSES COLLARS

41. NUTRITIONAL DIET
o Eat a variety of foods such as whole grains ,
fruits and vegetables
o Protein foods such as lean meats , eggs or
legumes and low or non fat dairy products.
o Eat foods high in fiber – fiber adds bulk to
stool , making it easier to pass and prevent
bowel problem.
o Avoid the too much salt intake.
o Eat less of foods high in fat and sugar.
o Should drink plenty of water.

42. COMPLICATIONS
IMMEDIATE COMPLICATION :-
o Respiratory arrest
o Spinal shock
LONG – TERM COMPLICATION :-
o Autonomic dysreflexia
o Pressure ulcers
o Urinary tract infection
o Contractures
o Respiratory tract infection
o Calcium loss from the bones

43. PROGNOSIS
o Patients with a complete cord injury have a less
than 5% chance of recovery.
o If complete paralysis persists at 72 hours after
injury , recovery is essentially zero.
o The prognosis is much better for the incomplete
cord syndrome.
o If some sensory function is preserved , the chance
that the patient will eventually be able walk is
greater than 50%.
o Ultimately , 90% of patients will SCI return to their
homes and regain independence.

44. REHABILITATION OF SCI
“It is a measures that help individuals with a
disability or a disabling health condition achieve
and maintain optimum functioning in interaction
with their environments”.
GOAL :- The primary goals of rehabilitation are
prevention of secondary
complications.
 Promote recovery and maximize
independence.

45. TEAM MEMBERS :-
Physical therapists typically focus on lower
extremity function and on difficulties with mobility.
Occupational therapists address upper extremity
dysfunction and difficulties in activities of daily living.
Rehabilitation nurses are concerned with the issues
of bowel and bladder dysfunction and the management of
pressure injuries.
Psychologists deal with the emotional and behavioral
concerns of the newly injured patient and with any potential
cognitive dysfunction.
Speech-language pathologists address with
issues of communication and swallowing.

46. Case managers and social workers are the
primary interface between the rehabilitation team, the
patient and his or her family and the payer source.

47. RECENT RESEARCH
A Follow-Up Program In India For Patients With Spinal Cord
Injury: Paraplegia Safari
M. Prabhaka , MS (Ortho) &Tejas H. Thakker , MS (Ortho)
Pages 260-262 | Received 13 Jun 2003, Accepted 06 Nov 2003,
Published online: 02 Sep 2016
Abstract
Background: Once patients with spinal cord injury
(SCI) were discharged from the hospital, it was very
difficult for them to return for follow-up,
particularly during the first year, due to problems

48. regarding finances and social issues, as well as extreme physical barriers.
Because of these barriers, a large number of patients were presenting for re-
admission for reasons that might have been prevented if they had come for
routine follow-up. Therefore, it was felt that an attempt to visit the patient's
residence to conduct follow-up would be of great help.
Objectives: To evaluate and improve the status of rehabilitation of
community-dwelling SCI patients in their homes and attempt to decrease the
rate of re-admissions.
Material and Methods: ln this program, the home visit team consisted of an
orthopedic surgeon, physiotherapist, occupational therapist, prosthetist and
orthotist engineer, medical social worker, and a nurse. Rehabilitated
discharged patients received needed medical treatment, orthotics, and
vocational guidance at their residences. Patients who required re-admission
were assisted back to the hospital.
Conclusion: The home visit program decreased the number of re-admissions
by improving the status of rehabilitation, which raised the quality of care for
patients with SCI.

49. SUMMARY
Spinal Cord Injury (SCI) is a sudden onset
disruption to the neuronal tissue within
the spinal canal resulting in spinal cord
damage , which occurs as a result of
trauma , disease or degeneration.
Any damage to the spinal cord is a very
complex injury. It can present as either
an upper motor neuron lesion or lower
motor neuron lesion with varying loss of
motor , sensory and autonomic function.

50. EVALUATION
o What do you mean by spinal cord injury?
o What is the types of spinal cord injury?
o Listed the diagnostic evaluation?
o What is the difference between a complete
and incomplete spinal cord injury?
o What are causes of spinal cord injury?
o What is the prognosis of spinal cord injury?

51. REFERENCE
o Books
o Internet
o Teacher

52. BIBLIOGRAPHY
o Ansari Javed , textbook of medical
surgical nursing , volume – 2 , PV
publications , page no – 312 to 316.
o Brunner and Suddarth’s , Textbook of
Medical Surgical Nursing , South Asia
edition , volume – 2 , Wolters kluwer
publications , page no- 1676 to 1682
o www.wikipedia.org
o www.slideshare.com