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Lesson 41. Spinal Cord Injuries

2-41. SPINAL CORD INJURIES

a. Facts about Spinal Cord Injuries.

(1) Common causes of spinal cord injuries include:

(a) Automobile accidents.
(b) Athletic injuries (diving, hard-contact sports).
(c) Falls.
(d) Gunshot wounds, stab wounds.
(e) Industrial accidents.

(2) Common locations of spinal cord injuries.

(a) Flexion-extension injuries are commonly located at C4 - C7 ("whiplash").
(b) T11, T12, and L1 are frequent sites of spinal cord injury resulting rom falls.

(3) Mechanisms of spinal cord injury.

(a) Flexion-extension: whiplash, seen with rapid deceleration injuries.
(b) Subluxation: incomplete or partial dislocation.
(c) Torsion: twisting of the spinal cord.
(d) Compression.

(4) Pathophysiological changes associated with spinal cord injuries.

(a) Damage to the cord may be a concussion, contusion, laceration, compression, or complete transection of the cord.
(b) Cord's response to injury includes hemorrhage, ischemia, and edema.

b. Signs and Symptoms.

(1) Patient's symptoms will mirror the level of the cord injury.
(2) There will be total sensory loss and motor paralysis below level of the injury.
(a) Cervical spinal cord injuries will produce quadriplegia--loss of function of all four extremities.
(b) Injuries to the thoracic spinal cord below the level of T1 will produce paraplegia--paralysis of the lower extremities.
(3) Loss of bowel and bladder control; usually urinary retention and bladder distention.
(4) Loss of sweating and vasomotor tone below the level of the cord injury.
(5) Marked reduction of blood pressure due to loss of peripheral vascular resistance.
(6) Neck/back pain.
(7) Priapism--persistent, painful erection of the penis.

c. Medical and Nursing Management.

(1) Objectives of care:

(a) Reduce the fracture/dislocation and obtain immobilization of the spine as soon as possible to prevent further cord damage.
(b Observe for symptoms of progressive neurological damage.
(2) Maintain patient on a turning frame or Circo-lectric bed to maintain spinal alignment.
(3) Patient with cervical spine injury will have some form of skeletal traction. Maintain traction and provide nursing care IAW local policy.
(4) Continuously observe patient's breathing pattern.
(a) Patients with injuries at high levels are at risk for respiratory failure.
(b) Observe strength of cough effort.

(5) Continuously observe patient for motor and sensory changes due to cord edema or hemorrhage, which may further compromise cord function.

(a) Test patient's motor ability by asking him/her to spread fingers, grip your hands, shrug shoulders, etc.
(b) Test sensory level by gently pinching the skin at shoulders and progressing down sides; ascertain level at which patient can no longer feel pinch.
(c) Note presence/absence of sweating.
(d) Carefully record findings in patient's clinical record; report changes in patient's motor/sensory level immediately to professional nurse.

(6) Be alert for signs of spinal shock and report immediately.

(a) Spinal shock represents a sudden loss of continuity between the spinal cord and higher nerve centers.
(b) It is characterized by a complete loss of motor, sensory, reflex, and autonomic activity below the level of the injury.
(c) Though temporary, spinal shock may last for several weeks.
(7) If turning is allowed and patient is not on a turning frame or turning bed, the patient must be carefully log-rolled with the spine maintained in alignment.
(8) Surgery, depending upon the injury and pathological findings, may have to be performed to stabilize the spine before rehabilitation can begin.
(9) Patient will require passive range of motion exercises.
(10) Assist with active rehabilitation procedures when patient is stable.
(a) Program is designed according to neurological deficit.
(b) Usually involves 6 weeks of gradual mobilization with brace or cast, depending upon level of injury.

(11) Provide constant encouragement and psychological support to the patient with a spinal cord injury.

David L. Heiserman, Editor

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Revised: June 06, 2015