Spinal Cord Injury Overview and Types

Spinal Cord Injury Overview

• Spinal cord injury (SCI) is a significant health concern.
• Approximately 86,000 Canadians live with disabilities resulting from SCI.

Risk Factors

• Age, gender, alcohol and drug use are associated with increased risk.

Prevention

• See Chart 65-1 for prevention strategies for head and spinal cord injuries.
• Primary prevention is crucial.

Types of Injury

• Concussion: Full recovery is expected.
• Contusion: Injury, but with potential for recovery.
• Laceration: Injury with significant damage to the tissue.
• Compression: Pressure on the spinal cord leading to injury below.
• Complete transection: complete loss of function below the injury site, resulting in paralysis.
• Primary injury: Normally the result of initial trauma; largely permanent.
• Common vertebrae involved: 5th, 6th, and 7th cervical; 12th thoracic; and 1st lumbar (higher mobility levels).
• Secondary injury: Often starts with nerve tissue damage (swelling/disintegration.)
• Time-sensitive: Secondary injuries are often reversible within first 4-6 hours after injury.

Manifestations and Levels of Injury

• Manifestations depend on the injury level.
• Chart 65-7 details the effects of spinal cord injuries.
• American Spinal Injury Association Impairment Scale (ASIA) details different levels/degrees of impairment.

Emergency Management

• Emergency management including immobilization and proper handling is crucial.

Assessment: Assessing Traumatic Brain Injury

• Watch for altered level of consciousness, confusion, pupil changes, impaired reflexes, absence/changes in gag/corneal reflexes, sudden onset neurological deficits, changes in vital signs (respiratory rate, cardiac rhythm/pressure, fever/hypothermia).
• Monitor vision, hearing, sensory function, persistent headaches, seizures.

Mechanisms of Injury

• Hyperflexion: The neck is forced abruptly backward.
• Hyperextension: The neck is forced abruptly forward.
• Axial Loading: The spine endures a force from above, often a compression injury, like a fall.
• Excessive rotation: The spine is forcefully turned.
• Penetrating injuries: An object or projectile penetrates the spine.

Etiology

• Trauma: motor vehicle accidents account for approximately 50% of cases.
• Falls are also a common cause.
• Diseases: Polio, spina bifida, and multiple sclerosis (MS) are potential causes.
• Tumours can also cause spinal cord injury.

Clinical Manifestations

• Clinical manifestations depend on the location (level) of the injury.
• Neurological level: Lowest level where sensory and motor functions are normal.

Sign and Symptoms

• Total sensory and motor paralysis below the neurological level.
• Loss of bladder and bowel control, often with retention.
• Diminished or absent sweating and vasomotor tone below the injury site.
• Blood pressure drop from peripheral vascular resistance loss.
• Pain in the back or neck (if conscious.)

Respiratory Problems

• Respiratory function is compromised based on injury severity.
• Respiratory failure is a significant cause of death in high cervical spinal cord injuries. (e.g. C4 injuries).

Assessment and Diagnostic Procedures

• Detailed neurological examination.
• MRI/CT scan.
• ECG (electrocardiogram) to monitor cardiac issues like bradycardia (slow heart rate) or asystole (no cardiac output.)
• Radiographic examinations of spine (e.g. cervial lateral x-ray)

History and Medical History

• How the injury happened (mechanism.)
• Position immediately after injury.
• Symptoms after the injury.
• Techniques used to initially immobilize the patient.
• Treatment provided at the accident/ER scene.
• Medical history: Existing conditions such as arthritis of the spine, congenital spine problems, osteoporosis, cancer, and past injuries.
• Respiratory history if cervical injury suspected.

Assessment – Head to Toe

• Assess airway and maintain it.
• Monitor for hemorrhage (internal bleeding.)
• Monitor level of consciousness.
• Assess injury level.
• Assess sensory function.
• Assess motor function.
• Assess cardiovascular status.
• Assess respiratory function.
• Assess gastrointestinal function.
• Assess genitourinary function.
• Assess musculoskeletal function.
• Assess psychosocial factors.

Assessment (Diagnosis)

• Laboratory tests, such as baseline routine labs and urinalysis to assess for blood.
• ABGs (arterial blood gas).
• Imaging, such as X-rays of the spine, CT (computed tomography) scans, MRIs (magnetic resonance imaging).

Nursing Diagnoses

• Altered (spinal cord) tissue perfusion
• Ineffective airway clearance
• Impaired physical mobility
• Altered urinary elimination
• Impaired adjustment

Non-Surgical Management

• Monitor vital signs.
• Positioning.
• Spinal immobilization (cervical, thoracic, lumbar.)

Medical Management

• High-dose corticosteroids (like methylprednisolone/prednisone).
• Oxygen to maintain high arterial oxygen concentration.
• Extreme care to avoid neck flexion or extension.
• Mechanical ventilation may be necessary.
• Immobilization, reduction, and stabilization of the vertebral column.
• Fracture reduction and alignment with traction devices (e.g., skeletal tongs, calipers, halo).
• Weights for traction hung correctly.
• Early surgery is sometimes preferred over traction management.
• Laminectomy may sometimes be performed for decompression or correcting fracture/dislocation.

Types of Cervical Spine Traction

• Gardner-Wells tongs.
• Halo fixation device (with jacket.)

Other Related Equipment

• RotoRest bed.
• Cervical collars.

Nursing Interventions – Promoting Effective Airway Clearance & Breathing

• Monitoring and early detection of potential respiratory failure.
• Monitoring pulse oximetry and ABGs.
• Assessment of lung sounds.
• Early and robust pulmonary care to remove secretions.
• Suctioning with caution.
• Breathing exercises.
• Assisted coughing.
• Maintaining hydration/humidification.

Nursing Interventions – Compensating for Sensory/Perceptual Alterations & Maintaining Skin Integrity

• Implement strategies to deal with sensory and perceptual changes.
• Measures to maintain skin integrity.
• Temporary indwelling or intermittent catheterization.
• Use of NG tube to decompress stomach.
• High-calorie, high-protein, high-fibre diet.
• Implement bowel program and use of stool softeners.
• Care of traction pin sites.
• Hygiene and skin care related to traction devices.

Nursing Interventions – Improving Mobility

• Proper body alignment.
• Movement only if spine is stable and based upon physician direction.
• Monitor blood pressure with position changes.
• Passive range of motion (PROM) at least four times per day.
• Usage of neck brace/collar if prescribed, during periods of mobilization.
• Gradual movement to erect position.

Complications

• Deep vein thrombosis (DVT)
• Orthostatic hypotension.
• Spinal shock.
• Neurogenic shock.
• Autonomic dysreflexia.

Nursing Interventions – Addressing DVT

• Low-dose anticoagulation therapy.
• Permanent vena cava filter.
• Daily measurements of thighs and calves.
• Elastic stockings/pneumatic devices for prevention.
• Routine lab monitoring (blood work).

Nursing Interventions – Addressing Spinal Shock

• Recognition of loss of reflex activity (areflexia.)
• Assessment of flaccid extremities.

Nursing Interventions - Addressing Neurogenic Shock

• Monitoring for low blood pressure, slow heart rate and decreased cardiac output.
• Recognition of venous pooling.
• Assessment for lack of sweating in affected areas.
• Monitoring for possible hypothermia.

Nursing Interventions – Managing Autonomic Dysreflexia

• Perform rapid assessment promptly and identify triggers.
• Empty bladder using catheterization as needed.
• Examine for potential causes, such as rectal fullness.
• Observe skin.
• Administer medications such as dopamine/dobutamine to improve blood pressure, or atropine for bradycardia.
• Document risk status for autonomic dysreflexia.

Additional Nursing Interventions

• Repositioning every two hours is important.

Review Questions

• Given in the slides at the end of the presentation. Specific answers are presented on the slides.

This quiz provides an overview of spinal cord injuries (SCI), highlighting key risk factors, prevention strategies, and the types of injuries that can occur. Understand the implications of these injuries and their associated recovery prospects. A must for anyone studying health sciences or rehabilitative therapies.