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Spinal Cord Injury

4 min read

Reference:

  1. Lecturer (Rotairo)

A spinal cord injury damages the indwelling nerves running along the spinal column. This may be caused by motor vehicle accidents, falls, violence, sporting injuries, etc. that produce hyperextension, hyperflexion, vertical compression, and extreme rotation, among other forms of injury. Acceleration, deceleration, deformation, traction, shearing, sliding, fractures, and dislocation all may cause spinal cord injury.

The extent of damage depends on what part of the spinal column is damaged, with the most damage being caused by injury to the cervical spine, then the thoracic spine, then the lumbar spine. By frequency, the proportion of each type of injury is:

  1. Incomplete Quadriplegia (C6): 34.1%
  2. Complete Quadriplegia (C4): 18.3%
  3. Incomplete Paraplegia (L1): 18.1%
  4. Complete Paraplegia (T6): 23.0%

Clinical Manifestations

  1. Spinal Shock: 1 week to 3 months after injury, this affects skeletal muscles, the bladder, the bowel, sexual function, and autonomic control:
    • Skeletal Muscles: Paralysis and flaccidity; loss of sensation
    • Loss of bladder and rectal control
    • Drop in blood pressure
    • Poor venous circulation
    • Poor thermal control with an impaired sympathetic nervous system
    • Sweating and capillary dilation (autonomic control)
  2. Neurogenic Shock: a loss of sympathetic nervous system outflow will result in vasodilation, hypotension, bradycardia, and hypothermia.
  3. Autonomic Hyperreflexia occurs when blood pressure rises after spinal shock resolves or in regions above the level of injury. The cardiovascular system responds to the return of sympathetic nervous system stimulation, overcompensating to produce:
    • Paroxysmal hypertension: pounding headache, blurred vision
    • Sweating, flushing of skin
    • Nasal congestion, nausea
    • Piloerection
    • Bradycardia
    • Bladder or rectal distention

Causes

This is a syndrome that may occur after spinal shock resolves, but it may also be due to the nervous system “overfiring” as it attempts to reach parts of the body that are below the level of injury, i.e., not receiving the appropriate signals by the brain. This results in a clinical image of pale, cool, lower extremities (if the injury is mid-thoracic; T6), while the upper half of the body experiences severe blood pressure, flushing, headaches, distended neck veins, bradycardia, sweating, etc.

The brain attempts to send these autonomic signals to parts of the body when they experience pressure (pressure areas), restrictive clothing, a full bladder (neurogenic bladder) and fecal impaction/rectal distention (neurogenic bowel). Autonomic Dysreflexia (AD) is a medical emergency that can develop suddenly which, if not treated, can lead to seizures, stroke, and even death.

First Aid

  1. Place the patient in a sitting position. Keep the head elevated to reduce pressure.
  2. Drain the bladder; if catheterized, check for kinks. A distended bladder is one of the causes of AD.
  3. Loosen or take anything tight off, such as restrictive garments, belts, etc. as pressure on parts of the body is also a cause of AD.
  4. Empty the bowel or stop digital stimulation until symptoms subside. The same as a distended bladder, this may cause AD.
  5. Monitor blood pressure every five minutes.
  6. Check the skin for sores, toenail problems, and the soles of the feet. Pressure points are a cause of AD.
  7. Seek professional help even if symptoms subside. If symptoms remain or return, head to the emergency room. Inform the staff of the presence of autonomic dysreflexia.
    • Maintain the upright position, blood pressure monitoring, and identify the causes of AD.

Diagnostic Examination

  1. Physical Examination
  2. Radiologic Studies: chest and spine x-ray
  3. Myelographic Examination
  4. Somatosensory Evoked Potential Studies
  5. Pulmonary Function Tests
  6. Arterial Blood Gases
  7. CT Scans
  8. MRIs

Management

  1. Immobilization
  2. Decompression
  3. Corticosteroids
  4. Nutrition
  5. Lung Function
  6. Skin Integrity
  7. Bowel and bladder management

Nursing Diagnoses

  1. Ineffective breathing pattern (if respiratory muscles are affected)
  2. Risk for trauma
  3. Impaired physical mobility
  4. Disturbed sensory perception
  5. Acute pain
  6. Anticipatory grieving (loss of function/disability)
  7. Bowel Incontinence/Constipation
  8. Impaired urinary elimination
  9. Risk for autonomic dysreflexia/hyperreflexia
  10. Risk for impaired skin/tissue integrity
  11. Inadequate knowledge regarding condition, prognosis, complications, treatment, self-care, and discharge needs

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