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    Traumatic Spinal Cord Injuries

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    bibi benny

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    Traumatic Spinal Cord Injuries

    Uploaded by

    bibi benny
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    Traumatic spinal cord injuries.pptx

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    4 views28 pages

    Traumatic Spinal Cord Injuries

    Uploaded by

    bibi benny

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 28

    Traumatic spinal cord

    Injuries
    Definition of spinal cord injuries (SCI)
    • abuse to spinal cord resulting in a change,
    in the normal motor, sensory or autonomic
    function. This change is either temporary or
    permanent.
    Spinal Cord
    • White tracts send
    messages to and
    from the brain
    • Ascending Tracts-
    - carry into higher
    levels of CNS
    - touch, deep
    pressure,vibration,
    position,
    temperature
    • Descending Tracts
    - impulses for
    voluntary muscle
    movement
    Segmental Spinal Cord Level and Motor Function

    Level Motor Function

    C1-C6 Neck flexors

    C1-T1 Neck extensors

    C3, C4, C5 Supply diaphragm (mostly C4)

    Shoulder movement, raise arm (deltoid);


    C5, C6 flexion of elbow (biceps); C6 externally
    rotates the arm (supinates)

    Extends elbow and wrist (triceps and wrist


    C6, C7
    extensors); pronates wrist

    C7, T1 Flexes wrist


    C7, T1 Supply small muscles of the hand

    T1 -T6 Intercostals and trunk above the waist

    T7-L1 Abdominal muscles

    L1, L2, L3, L4 Thigh flexion

    L2, L3, L4 Thigh adduction

    L4, L5, S1 Thigh abduction

    L5, S1, S2 Extension of leg at the hip (gluteus maximus)

    Extension of leg at the knee (quadriceps


    L2, L3, L4
    femoris)
    L4, L5, S1, S2 Flexion of leg at the knee (hamstrings)

    L4, L5, S1 Dorsiflexion of foot (tibialis anterior)

    L4, L5, S1 Extension of toes

    L5, S1, S2 Plantar flexion of foot

    L5, S1, S2 Flexion of toes


    Etiology of Traumatic SCI
    • MVA . motor vehicle accidents- most common cause
    • Other: falls, violence, sport injuries
    • SCI typically occurs from indirect injury from vertebral

    bones compressing cord

    • SCI frequently occur with head injuries


    • Cord injury may be caused by direct trauma from knives,
    bullets, etc
    Etiology of Traumatic SCI
    • 78% people with SCI are male

    • Typically young men - 16-30

    • Number of older adults rising (>61 yr)

    • Greater complications

    • Life Expectancy 5 years less than same age without injury


    • 90% go home
    Mechanism of injury

    Types of movements that can cause spinal injury are:

    •Hyperextension: the head is forced back.

    •Hyperflexion: the head is forced forward.

    •Axial loading: a severe blow to the top of the head.


    Mechanism of injury cont…
    •Compression: forces from above and
    below compress the vertebrae.
    •Lateral bend: the head and neck are
    bent to one side beyond the range of
    motion.
    •Overrotation and distraction: the head
    turns to one side, and the cervical vertebrae
    are forced beyond normal limits.
    Classifications:

    •Complete spinal injury:


    When complete injury occurs,
    motor and sensory function cease
    below the level of injury, pain,
    touch, temperature and
    inhalation are evaluated as part
    of sensory evaluation.
    Incomplete spinal injury
    1-Central Cord Syndrome

    • Characteristics: Motor deficits (in the upper

    extremities compared to the lower extremities;

    sensory loss varies but is more pronounced in the

    upper extremities); bowel/bladder dysfunction is

    variable, or function may be completely preserved.

    • Cause: Injury or edema of the central cord, usually

    of the cervical area.


    Incomplete spinal injury cont͙
    2-Anterior Cord Syndrome

    • Characteristics: Loss of pain, temperature, and motor


    function is noted below the level of the lesion; light touch,

    position, and vibration sensation remain intact.


    • Cause: The syndrome may be caused by acute disk
    herniation or hyperflexion injuries associated with fracture-

    dislocation of vertebra. It also may occur as a result of injury

    to the anterior spinal


    artery, which supplies the anterior two thirds of the spinal
    cord.
    Incomplete spinal injury cont͙
    3-Brown-Sequard Syndrome (Lateral Cord Syndrome)

    • Characteristics: Ipsilateral paralysis or paresis is noted,

    together with ipsilateral loss of touch, pressure, and


    vibration and contralateral loss of pain and temperature.
    • Cause: The lesion is caused by a transverse hemisection

    of the cord (half of the cord is transected from north to


    south), usually as a result of a knife or missile injury,

    fracture dislocation of a unilateral articular process, or

    possibly an acute ruptured disk.


    Clinical Manifestations
    “Neurologic level” refers to the lowest level at
    which sensory and motor functions are normal.

    Below the neurologic level


     loss of bladder and bowel control
    (usually with urinary retention and bladder
    distention)
     loss of sweating and vasomotor tone
     marked reduction of blood
    pressure from loss of peripheral vascular
    resistance.
     A complete spinal cord lesion can result in
    paraplegia (paralysis of the lower body) or
    quadriplegia (paralysis of all four extremities).
    Assessment and diagnostic finding

    • A detailed neurologic examination is performed.


    • Diagnostic x-rays (lateral cervical spine x-rays)
    • CT scanning are usually performed initially.
    • An MRI scan may be ordered as a further workup

    if a ligamentous injury is suspected


    Management
    Emergency Management
    - a rapid assessment, immobilization,
    extrication, stabilization or control of
    life-threatening injuries, and
    transportation to the most
    appropriate medical facility
    Management cont͙
    Acute Phase

    -PHARMACOLOGIC THERAPY
    -high-dose corticosteroids,

    RESPIRATORY THERAPY
    Oxygen is administered to maintain a high arterial PO2
    If Endotracheal intubation is necessary, extreme care is

    taken to avoid flexing or extending the patient’s


    Management cont͙
    Surgery
    • Depending on the circumstances, when
    surgery is required, it may be performed
    within 8 hours following injury. Surgery may
    be considered if the spinal cord is compressed
    and when the spine requires stabilization. The
    surgeon decides the procedure that will
    provide the greatest benefit for the patient.
    Management cont͙
    Surgery Management
    • Early surgery, within 12 - 24 hours of the
    injury, is done when all body systems are stable,
    for:

    • Evidence of cord compression


    • Progressive neurological deficit
    • Compound fracture of the vertebrae
    • Penetrating wounds of the spinal cord
    • Bony fragment in the spinal canal
    Types of surgery include:
    • Decompression laminectomies using anterior cervical and
    thoracic approaches with fusion, in which one or more
    laminae are removed to allow for cord expansion due to
    edema
    • Posterior laminentomy using interspinous wiring and
    fusion with an autologous iliac bone graft, to immobilize
    the neck and prevent further damage to the spinal column
    from hypermobility of the vertebrae

    • Posterior approach using an autologous fusion graft or the


    insertion of rods or other instruments, to correct and
    stabilize thoracic deformities
    Halo & Orthotic devices:
    •Some patients may have Halo devices applied by
    surgeons, or a brace made by orthotics to maintain
    correct alignment of the spine. These devices are fixed
    to the child’s chest.

    •Ensure you know how to open devices to perform


    chest compressions in the event of a cardiac arrest, and
    that spinal immobilization is maintained manually
    throughout any resuscitation
    Skeletal Fracture Reduction and Traction

    Cones Caliper Cervical or neck Traction

    Tractions

    Gardner-Wells Tong
    Complication of SCI
    These complications include:
    • urinary tract infections or urinary
    incontinence (inability to control the flow of urine),
    • bowel incontinence (inability to control bowel
    movements),
    • pressure sores,
    • infections in the lungs (pneumonia),
    • blood clots,
    • muscle spasms,
    • chronic pain, and depression.
    Pain Management
    • Assess for pain
    • Use a self-reported numeric rating if possible
    • Ask about characteristics, location, onset
    • Minimize evoked pain through careful
    handling
    Pain Management
    Planning and Goals
    improved breathing pattern and airway clearance

    improved mobility

    improved sensory and perceptual awareness

    maintenance of skin integrity

    relief of urinary retention

    improved bowel function

    promotion of comfort

    absence of complications

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