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.