Spinal Injury Overview

1. Chanda Rana, MPT
Rehabilitation In charge
Spinal Injury Rehabilitation Centre
Sanga, Nepal

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3. Overview
 Definition - SI vs. SCI
 Developing country- ~fatal.
 Resource limitations.
 Mass casualty vs. normal situation
 SCI management
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4. Aim of Treatment
 To prevent further injury
 To prevent complications
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5. The spinal column
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 Small bones called vertebrae
 Begins in the neck and ends at tailbone.
 Backbone surrounds and protect the
spinal cord.

6. The cervical area
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 Seven cervical
Vertebrae
 Called as C1- C7

7. The thoracic area
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 Twelve thoracic
Vertebrae
 Called as T1-T12

8. The lumbar
vertebrae
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 Five lumbar
Vertebrae
 Called as L1-L5

9. The sacral area
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 One sacral bone
Located at lowest
Part of the back

10. Functions of spinal cord
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 To relay message
Or signals from body
To brain and vice versa
Sensory ( feeling)
Motor (movement)
Reflexes

11. SCI
 An insult to spinal cord resulting in a
change, either temporary or permanent in
its normal motor, sensory or autonomic
function.
International Standard for Neurological Classification
of Spinal Cord Injury (ISNCSCI)
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12. How is it different from other
injuries??
 Lack of inherent ability of neurons to
regenerate effectively for functional
improvement.
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13. Determinants of degree of
disability
 Site of injury
 Completeness of injury
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14. Epidemiology
 Month
Most - July and least -February
 Day
 Saturday
 During daylight hours.
 Marital status
Single
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15. Epidem…
 Gender
Males >4 times females
 Age 16-30 years
 Older Higher mortality
 Divorce
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16. Causes
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20. Principles of
Care
Aggressive and rapid
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21. Principle
 Establish SI
 Immediate care
 Identify other injuries
 Care with transport
 Prevention of complications
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Care with Transport

23. Clinical Evaluation-
Symptoms
Weakness of limbs
Retention/ incontinence
↓Sensation
Radicular pain/ tingling
Neck/Back pain
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24. Clinical Evaluations-
Signs
 ‘Step- off’ deformity
 Sphincters
 Reflexes
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25. Level
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26. Grading –ASIA Impairment
Scale
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27. Definitive Care
 Acute care
 Specific
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28. SCI Management
 Most expensive as compared to any other
alignment.
 Requires prolong hospitalization and life
long follow up
 Requires a multidisciplinary team
approach.
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29. SCI Management…..
 Comprehensive rehabilitation
 Pre discharge planning
 Community inclusion
 Life long follow up
 Prevention of complications
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31. Conclusions
 Protocol with defined role of different
providers.
 Minimize neuro deterioration.
 Decrease complications.
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