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NU 530 Advanced PathophysiologyStudy Guide Quiz 4
Cervical cord injuries- serious complications Chapter 16
12,000-person experience serious spinal cord injuries each year.
Risk factors:
1. Male gender and age 16 to 30 are strong risk factors.
2. Motor vehicle accidents are the leading cause of injury (36.5%)
3. Falls are the next most common cause (28.5%)
4. Violence, other events
5. Sports activities
6. Elderly
Hemiplegia means loss of motor function on one side of the body. Paraplegia refers to
loss of motor function of the lower extremities. Diplegia is the paralysis of both upper
and lower extremities as a result of cerebral hemisphere injuries. Quadriplegia refers to
paralysis of all four extremities.
The five categories that are critical for the evaluation process for neurologic function
include: (1) level of consciousness (LOC), (2) pattern of breathing, (3) size and reactivity
of pupils, (4) eye position and reflexive response, and (5) muscle motor responses.
Serious complications:
Spinal Shock – below the site of the injury loss of reflex function, flaccid paralysis,
absence of sensation, loss of bladder and rectal control, transient drop in blood pressure,
and poor venous circulation.
a. Disturbance in thermal control
b. Individuals assume temperature of air (poikilothermia)
c. Last 7 to 20 days or up to 3 months
d. Reappearance of reflex activity, hyperreflexia, spasticity & reflex emptying
of bladder
Spinal shock does involve function of skeletal muscles resulting in paralysis and
flaccidity. Such an injury is characterized by a complete loss of reflex function below
the level of the lesion, and impairment of control of thermal regulation is observed.
Neurogenic shock, also called vasogenic shock, occurs with cervical or upper thoracic
cord injury above T5 and be seen in addition to spinal shock.
e. Complications hypovolemic or cardiogenic shock with heart failure or blood
loss
,Autonomic hyperreflexia (dysreflexia) Sudden, massive reflex sympathetic discharge
associated with spinal cord injury at T6
f. Paroxysmal hypertension (up to 300mm Hg systolic)
g. Pounding HA
h. Blurred vision
i. Sweating above the level of the lesion with flushing of the skin
j. Nasal congestion
k. Nausea
l. Piloerection caused by pilomotor spasm
m. Bradycardia (30-40 bt per minutes)
n. Serious complications:
i. Stroke
ii. Seizures
iii. Myocardial ischemia
iv. Death
o. Extended bladder – increase in blood pressure carotid sinus receptors – ninth
cranial nerve stimulated by carotid receptors send messages to vasomotor
center of medulla, vague nerve stimulated; impulse sent to SA node; results
in bradycardia
A comminuted fracture is also called a burst fracture, in which the vertebral body is
shattered into several fragments.
A simple fracture is a single break usually affecting the transverse or spinous process.
A compressed fracture is also called a wedge. This occurs when there is a crush type of
injury and the vertebrae lose height.
A dislocation is when two bones at a joint are no longer in alignment.
Decorticate posture (also referred to as antigravity posture or hemiplegic posture) is
characterized by upper extremities flexed at the elbows and held close to the body and
by lower extremities that are externally rotated and extended.
A spastic gait or posture manifests by a shuffling gait with the leg extended and held
stiff, causing a scraping over the floor surface. The leg swings improperly around the
body rather than being appropriately lifted and placed. The foot may drag on the ground,
and the person tends to fall to the affected side.
Decerebrate posture refers to increased tone in extensor muscles and trunk muscles,
with active tonic neck reflexes. When the head is in a neutral position, all four limbs are
rigidly extended.
,Basal ganglion posture refers to a stooped, hyperflexed posture with a narrow-based,
short-stepped gait
Spinal cord injury involves damage to neural tissues by compressing tissue, pulling or
exerting tension on tissue, or shearing tissues so that they slide into one another.
Vertebral fracture occurs with direct or indirect trauma.
Spinal cord injury may cause spinal shock with cessation of all motor, sensory, reflex,
and autonomic functions below the transected area. Loss of motor and sensory function
depends on the level of injury.
Neurogenic shock occurs with cervical or upper thoracic cord injury (above T5) and can
occur concurrently with spinal shock.
Autonomic hyperreflexia (dysreflexia) is a syndrome of sudden, massive reflex
sympathetic discharge associated with spinal cord injury at level T6 or above. Flexor
spasms are accompanied by profuse sweating, piloerection, and automatic bladder
emptying.
Complete cord transection results in paralysis. Paralysis of the lower half of the body with
both legs involved is called paraplegia. Paralysis involving all four extremities is called
quadriplegia.
Return of spinal neuron excitability occurs slowly. Reflex activity can return in 1 to 2
weeks in most persons with acute spinal cord injury. A pattern of flexion reflexes
emerges, involving first the toes, then the feet and the legs. Eventually, reflex voiding
and bowel elimination appear.
Primary spinal cord injury: Occurs with initial mechanical trauma and immediate
tissue destruction
Inadequate mobilization following injury
May occur in absence of vertebral fracture or dislocation
Pathophysiologic cascade of events that begins immediately after injury and continues
for weeks
Life threatening if swelling occurs in cervical region
Most commonly occurs due to vertebral injuries: Simple fracture, Compressed (wedged)
fracture
Comminuted (burst) fracture. Dislocation,
Traumatic injury of vertebral and neural tissues as a result of compressing, pulling, or
shearing forces
Spinal shock
➢ Normal activity of the spinal cord ceases at and below the level of injury;
sites lack continuous nervous discharges from the brain
➢ Complete loss of reflex function (skeletal, bladder, bowel, thermal
control, and autonomic control) below level of lesion
Neurogenic shock
➢ Occurs with injury above T5
➢ Caused by absence of sympathetic activity and unopposed
parasympathetic tone
, Autonomic hyperreflexia (dysreflexia)
➢ Massive, uncompensated cardiovascular response to stimulation of the
sympathetic nervous system
➢ Stimulation of the sensory receptors below the level of the cord lesion
Low back pain is pain between the lower rib cage and gluteal muscles and often radiates
into the thigh.
Most causes of low back pain are unknown; however, some secondary causes are disk
prolapse, tumors, bursitis, synovitis, degenerative joint disease, osteoporosis, fracture,
inflammation, and sprain.
Degenerative disk disease is an alteration in intervertebral disk tissue and can be related
to normal aging.
Degenerative disk disease (DDD) - how does disease manifest?
➢ Spondylolysis
➢ Spondylolisthesis
➢ Spinal stenosis
Disc herniation’s- Herniation of an intervertebral disk is a protrusion of part of the
nucleus pulposus. Herniation most commonly affects the lumbosacral disks (L5-S1 and
L4-5). The extruded pulposus compresses the nerve root, causing pain that radiates
along the sciatic nerve course.
1. Rupture of an intervertebral disk usually is caused by trauma, degenerative disk
disease, or both
2. Risk Factors:
a. Weight bearing sports
b. Light weight lifting
c. Work activities – repeated lifting
3. Mena are affected more than women
a. 30 – 50 – year range
Patho – ligament & posterior capsule of the disk are usually torn, nucleus pulposus is
showing and compress the nerve root.
Injury can tear entire disk loose; causing disk capsule and nucleus pulposus to protrude.
Herniation of an intervertebral disk is a protrusion of part of the nucleus pulposus.
Herniation most commonly affects the lumbosacral disks (L5-S1 and L4-5). The extruded
pulposus compresses the nerve root, causing pain that radiates along the sciatic nerve
course.
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