Spinal Cord Injury

Epidemiology

80% occur among males 12,000 new SCI's per year

Spinal Cord Injury (SCI)

Damage to any part of the spinal cord causing temporary or permanent loss of sensory, motor, or autonomic function below the level of injury.

Medical Management

Early Stabilization and lessening of secondary injuries. Methylprednisolone within the first 6-8 hours to reduce inflammation and reduce damage to nerve cells. Surgery - Laminectomy and spinal fusion

Rotational

Extreme lateral rotation of the spine. High energy impacts from sports or collisions cause this type of injury. The spine will need to be surgically stabilized.

Treatment of Spinal Cord Injury - On scene

First responders give a rapid assessment of the victim and follow ABC's, they then stabilize the spine, rapidly transport them to a hospital. -ALL TRAUMA PATIENTS REQUIRE VIGILANT MONITORING OF AIRWAY AND RESPIRATORY FUNCTION -19% of SCI victims have more than one fracture STABILIZE THAT SPINE!

Hyperflexion

Occurs when there is a sudden deceleration in movement. Think about a head-on motor collision. The head and neck are flexed forward in an exaggerated motion. Fracture of anterior portion of the vertebral body. Remember (Flexion Forward)

Compression

Vertical force applied to the spine causes a fracture of the vertebral body. This occurs from a significant fall where the individual lands on their feet or buttocks. Fragments from the fracture can "Retropulse" and move back into the canal causing compression or mass effect on the spinal cord.

Hyperextension

Occurs when the spine is extended backwards. Think about a rear-impact collision or a fall where the chin strikes the ground first. Fractures the posterior segments of the spinal column.

Gardner-Wells Tongs

Surgically inserted, aligns cervical spine to reduce cervical fractures before surgical stabilization.

Mechanisms of Injury

There are five primary mechanisms of injury to the spine: Hyperfelxion, Hyperextension, Rotation, Compression, and penetrating Injury.

Types of Injuries

-Concussion: Blow to the spinal column. Temporary loss of function for hours or days. -Contusion: Bruising of the spinal cord. Necrosis of the spinal cord may occur because of bleeding and edema. -Compression: Pressure on the spinal cord -Laceration: A tear or cut in the spinal cord, permanent injury -Transection: Severing of the spinal cord -Hemorrhage: Bleeding within or around the spinal cord, can cause compression or irritation of neural tissues. -Infarction: Interruption of blood flow can cause death of spinal cord in that area

Clinical Manifestations of SCI

Cardiovascular: -Neurogenic shock results in cardio compromise -Bradycardia if high cervical -Hypotension -Peripheral Vasodilation -Orthostatic Hypotension -DVT Pulmonary: -C4 or higher impairs lungs, Ventilation needed -C1-C2 if fractured there is no breathing -Atelectasis -Pneumonia -Embolism GI: -Loss of peristalsis and ileus -ABD. Distention (risk for vomiting and aspiration) -NG tube feed these patients Genitourinary: -Loss of control (Over-distention is possibly and increases UTI risk) -Decreased Renal function (Acute kidney Injury) -Renal Calculi Integumentary: -Pressure Ulcers

Treatment of Spinal Cord Injury - Emergency Department

Initial assessment and diagnosis of injuries so that surgical measures can be taken is priority. Baseline neuro and physical assessment -motor/sensory -Deep tendon reflexes -Perform PRIOR TO ADMINISTERING PAIN OR PARALYTICS IF POSSIBLE -Glasgow coma scale (higher is better) -palptation of spine after X-ray -Past medical History Monitor Respiratory effort -Ventilation if needed Monitor Cardiovascular function- watch for shock -PAC if needed

Penetrating

Projectile such as a bullet or knife enters the spinal column. Can cause contusion (bruising) or a complete transection of the spinal cord.

Cervical Collar

Provide stability to cervical spine

Classification of Injury

Spinal cord injuries are classified according to the degree of loss of sensory and motor function below the level of injury. Complete Spinal Cord Injury -The complete loss of voluntary movement and sensory function below the level of injury. -Injuries in the cervical spinal cord will result in quadraplegia (complete loss of upper/lower extremeties and bowel/bladder control). -Injuries in the thoracic or lumbar spinal cord will result in Paraplegia (the loss of motor/sensory in the lower extremeties and loss of bowel/bladder control). Incomplete Spinal Cord Injury -Some preservation of sensory/motor function below the level of injury.

Halo Brace

Stabilize cervical fractures, if collar does not provide adequate stability

Sternal Occipital Mandibular Immobilizer (SOMI)

Stabilizes both cervical and upper thoracic regions.

Primary Injury

The initial insult to the spinal cord at the time of trauma. May range from mild cord concussion to complete and permanent loss of function. Spinal shock occurs as a result of the primary injury.

Secondary Injury

The primary injury can set forth a cascade of events that worsen the injury itself and damage surrounding tissues. Disruption of spinal cord blood flow, cellular necrosis, inflammation/edema, and scarring all worsen the SCI. Disruption of autonomic regulation is a secondary injury that leads to neurogenic shock