Spinal Cord Trauma

1
Spinal Cord Trauma

• Deborah Cary, MSN, BC
• Broward Community College

2
Etiology

• Leading cause of injury
• Cause for premature death
• 50 are due to MVA
• Followed by Falls, Violence
• Other causes sports injuries Football, Diving,
  Skiing
• Increase in older adults with SCI

3
Typical SCI Patient

• Unmarried
• Males
• Less than 36 y/o majority 15-30
• 19 most common age

4
What happens?

• Initial Injury due to compression by bone
  displacement, interruption of blood supply to the
  cord, or traction
• Primary injury initial mechanical disruption of
  axons as result of laceration
• Secondary -ongoing, progressive damage
• (ischemia, hypoxia, edema)

5
Spinal/Neurogenic Shock

• Spinal Shock A temporary neurologic syndrome
  known as spinal shock
• Neurogeneic shock due to loss of vomotor tone
  caused by injury

6
Level of Injury

• Skeletal injury injury is at vertebral level
  damage to bones/ligaments
• Neurologic level - lowest segment of the cord
  with normal sensory/motor fx on both sides of
  body

7
Tetraplegia

• Paralysis
• Weakness
• Involves all 4 extremities
• Seen with cervical cord Injuries

8
History

• Gather data
• Position
• Symptoms
• Changes

9

• Medical tx given initial goal is to sustain
  life/prevent further cord damage
• Past medical hx
• Past Ilnessness, Meds, Allergies
• Thorough neurological assessment once stabilized
  (Airway, cervical collar,etc.)

10
Degree of Injury

• Complete Cord
• Involvement results in total loss of
  sensory and motor function below injury
• Incomplete Cord
• Mixed loss

11
Incomplete Lesions

• Central cord syndrome
• Anterior cord syndrome
• Brown-Sequard syndrome
• Posterior cord syndrome
• Cauda equina syndrome
• Clonus medullaris syndrome

12
ASIA (American Spinal Injury
Association Impairment Scale)

• The ASAI Impairment scale is commonly used for
  classifying the severity of impairment resulting
  from spinal cord injury
• Combines assessments of motor/sensory function to
  determine neurologic level and completeness of
  injury ( Figs. 59-8 and 59-9)
• Useful for recording changes and id goals for
  rehab

13
Clinical Manifestations

• Airway
• Respiratory Pattern
• Protect/ensure adequate airway
• Cervical spinal injury is at high risk for
  respiratory compromise!!

14
Manifestations ( cont)

• Cervical spinal nerves C3-C5 innervate the
  phrenic nerve
• Phrenic nerve controls the diaphragm
• Prepare for emergency airway management
• Assess Hemorrhage (at site)
• High incidence of intra-abdominal injury

15
Signs and Symptoms

• 50 of people with SCI temporary neurologic
  syndrome called spinal shock
• DTR, loss sensation, flaccidity injury
• Hypotension
• Tachycardia
• Use GCS for rapid assessment
• 15-20 have associated head injury
• Neurogenic shock may mask post injury neuro fx

16
Neurogenic shock

• Due to loss vasomotor tone
• S/S hypotension, brady, warm dry extremities
  loss of SNS innervation leads to vasodilation,
  venous pooling and CO
• Neurogenic shock assoc with cervical or high
• thoracic injury

17
Classification

• SCI classified by mechanism of injury, skeletal
  and neurological level of injury and completeness
  or degree of injury
• Major mechanisms injury flexion, hyperextension,
  flexion-rotation, extension-rotation and
  compression the flexion-rotation is the most
  unstable

18
Additional Manifestations

• The manifestations of SCI are result of trauma
  that cause compression cord, ischemia, edema and
  possible transection
• R/T level/degree injury
• Mixture s/s with incomplete lesions
• Higher the injury, more serious

19
Central Cord Syndrome

• Damage to the central spinal cord is termed
  central cord syndrome
• It occurs most commonly in the cervical cord
  region more common in older
• Motor weakness/sensory loss are present in BOTH
  the upper/lower extremities
• Upper extremities affected gt lower

20
Anterior Cord Syndrome

• Caused by damage to anterior spinal artery
• Results from injury causing acute compression of
  anterior portion spinal cord, often a flexion
  injury (see Fig 59-7)
• Manifestations motor paralysis, loss pain and
  temp sensation below injury
• Posterior cord tracts are not injured, so
  sensations of touch, position, vibration OK

21
Brown-Sequard

• Result of damage to ½ of the spinal cord
• (See fig 59-7)
• Loss motor fx/position and vibratory sense
• Vasomotor paralysis on same (ipsilateral)
• side of lesion
• Opposite (contralateral) side has loss of pain
  and temperature below lesion

22
Posterior Cord

• Results from compression or damage to posterior
  spinal artery
• VERY RARE
• Dorsal columns are damaged proprioception
  loss
• Pain, temp, motor fx OK below lesion

23
Complications

• Respiratory Above C4 total loss Resp
• Below C4 diaphragmatic breathing if phrenic
  nerve is fx
• Below C4 spinal cord edema/hemorrhage
• can affect phrenic nerve
• Cervical and thoracic injuries paralysis
  abdominal muscles and intercostals

24

• CV - if above T6 influence SNS
• Bradycardia. Vasodilation leads to BP
• Vasopressive drugs
• Urinary Retention common
• atonic bladder leads to overdistention
• GI if above T5 hypomotility
• N/G, Reglan, Histamine H2 receptor
  blockers
• Neurogenic bowel if below T12

25

• Integumentary skin breakdown potential
• Thermoregulation Poikilothermism
• (adjustment body temp to room temp)
• Occurs in SCI SNS affected
• Decreased ability to sweat below lesion
• Depends on level of injury - gthigh cervical
  lesions

26

• PV DVT common during first 3 months
• More difficult to detect
• PE leading cause of death
• Doppler studies

27
Autonomic Dysreflexia

• Major complication and medical emergency
• Severe, rapidly occurring hypertension
• Bradycardia
• Flushing face/neck
• Severe throbbing headache
• Diaphoresis
• Blurred Vision

28
Treatment for Autonomic
Dysreflexia

• High Fowlers position
• Notify MD
• Loosen clothing
• Check foley for kinks/obstruction
• Insert foley if none in place
• Check for Fecal Impaction
• Check VS q 15 mins.
• Nitrates or hydraziline (Apresoline) as ordered