Spinal Cord Injury
The spine transmits messages
Motor and sensory functions
Etiology
Causes
Motor vehicle crashes (majority)
Males ages 16-30 are at greatest risk
Falls
Violence
Sports injuries
Major Problems
Premature death
Disrupts growth and development
○ Disrupts growth
Economic loss/Health care cost
○ Rehab
Common sites for injury
Cervical
○ C4-C7
○ T1
Thoracolumbar junction
○ T12, L1-L2
Trauma to the spinal cord causes
Concussion
Contusion
Laceration
Hemorrhage
○ Leads to swelling/compression
○ Not much are for expansion in the spinal cord
Transaction
○ Complete or incomplete
○ Loss of motor/sensory
Pathophysiology
The spinal cord can be injured by
Direct forces - traumatic
○ Penetration
○ Gun shot wound
○ Sports injury
○ Other Injuries (fracture, dislocation, and subluxation)
Indirect forces - non-traumatic
○ Compression
○ Tumor
○ Infection
Primary Injury
○ The initial mechanical disruption of axons as a result of stretch or laceration
○ Actual physical disruption of axons
○ Hyperflexion, hyperextension, axial loading, rotation and penetrating.
○ Initial Injury
Spinal cord injury can be due to:
Cord compression by bone displacement
Interruption of blood supply to the cord
Traction
, Pulling on the cord
Penetrating trauma
Gunshot and stab wounds
Can result in tearing and transaction
Secondary injury
○ The ongoing, progressive damage that occurs after the initial injury
Because secondary injury progresses over time
The extent of injury and prognosis for recovery are most accurately
determined at least 72 hours or more after the injury
○ Ischemia
○ Hypoxia
○ Hemorrhage
○ Edema
○ Hypovolemia
○ Neurogenic shock (EMERGENCY)
The spinal cord has minimal ability to adapt to vasospasm
Permanent damage may occur because of the development of edema
○ Lack of space for tissue expansion
○ Compression of the cord
○ Increased ischemic damage
Spinal and Neurogenic Shock
○ Spinal Shock
Temporary Neurological problem
Below the level of the injury
Decreased reflexes
Loss of sensation
Flaccid paralysis
Lasts days to months (Iggy says <48 hours but up to several weeks)
May mask post injury neurologic function
Muscle spasticity begins in patients with cervical or high thoracic injuries when
spinal shock is resolved.
○ Neurogenic Shock
Due to the loss of vasomotor tone caused by injury
Severe Hypotension
Severe Bradycardia
Warm, dry, flushed skin
Loss of sympathetic nervous system innervation
Peripheral vasodilation
Venous pooling
Decreased cardiac output
Generally associated with a cervical or high thoracic injury
T6 or higher
Classification
Mechanism of Injury
○ Hyperflexion
Occurs when head is suddenly and forcefully accelerated forward, causing
extreme flexion of the neck. (head on collision) Flexion injury to thoracic and
lumbar when trunk is flexed suddenly (fall on butt)
Posterior ligaments can be torn or vertebrae may fracture or dislocate.
Respiration
○ Hyperextension
, Head is suddenly accelerated and then decelerated. (rear end collision) Or
during falls when the patient’s chin is struck (upper cut)
Stretches or tears the anterior longitudinal ligament, fractures or subluxates the
patient’s vertebrae and perhaps ruptures an invertebral disc.
○ Compression Axial loading (vertical compression)
Diving accidents, falls on butt or a far jump where a person lands on their feet, a
blow to the top of the head.
Vertebrae can shatter, pieces of the bone enter the spinal cord.
Bladder/bowel
Leg movement
Seen in the elderly
Due to osteoporosis (bones are brittle)
○ Flexion-rotation/ Extension-rotation
Caused by turning the head beyond the normal range.
Flexion-rotation Most unstable because of ligaments that stabilize the
spine are torn! = most neurologic deficits
○ Penetrating
Classified by the speed of the object. Low speed/impact injuries cause damage
directly at the site or local damage. High speed/impact cause both indirect and
direct damage.
○ Dislocation
Level of Injury
○ Skeletal level
Vertebral level
Most damage to vertebral bones and ligaments
○ Neurologic level
Lowest segment of the spinal cord
Normal sensory and motor function on both sides of the body
○ The level of injury may be:
Cervical
Paralysis of all four extremities occurs (tetraplegia or quadriplegia)
Quadriparesis (weakness) in all four extremities.
When the damage is low in the cervical cord
The arms are rarely completely paralyzed
The higher the level, the more serious the injury
Thoracic
Lumbar
If the thoracic or lumbar cord is damaged
Paraplegia (paralysis and loss of sensation in the legs)
Paraparesis (weakness) in lower extremities
Sacrum
Cervical and Lumbar = most common injuries b/c they are associated with the greatest
flexibility
Degree of Injury
○ Complete
Total loss of sensory and motor function below the level of injury
○ Incomplete (partial)
Mixed loss of voluntary motor activity and sensation
Some tracts are intact
Six syndromes are associated with incomplete lesions:
Central Cord Syndrome
Damage to the central spinal cord
Occurs most commonly in the cervical cord region
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