SPINAL CORD INJURY
BY ESIMIKHE GIFT
OUTLINE
INTRODUCTION
Spinal cord injury is any damage to any part of the spinal cord or
nerves at the spinal canal [spinal equina]
This causes permanent changes in strenght,sensation and other
body functions below the site of injury.
Your ability to control your limbs depends on the level of injury
and the severity of injury.
Relevant Anatomy
The vertebral column consist of 33 vertebrae
[7cervical, 12 thoracic, 5 lumber,5 sacral,4
coccygeal] joined together by ligaments and
muscles .each vertebra consist of an anterior
body and a posterior neural arch.each vertebral
body has a central part of cancellous bone and a
peripheral cortex of compact bone.the margins
of the upper and the lower surfaces of the
vertebral body are thickened to form ring.
Between any two vertebrae is a strong
cushion which is the intervertebral disc
Which comprises of two parts ,a central nuclues
pulposus and a peripheral annulus fibrosus.
The entire vertebral column has similar
articalation except the atlanto axial joint .the
vertebral bodies are primarily joined by
intervertebral disc.anteriorly,
ETIOLOGY
• TRAUMA-[automobile or motor cycle accident,gunshot or
knife wounds,falls sports mishaps.
• Vertebrae most commonly involved are the 5th,6th, 7th,cervical
vertebral, 12th thoracic vertebrae and 1st lumbar vertebrae.
Classification
1.Mechanism of injury
2.Level of injury
3.Degree of injury
MECHANISM OF INJURY
• Flexion injuries
• Hyper extension injuries
• Compression injuries
FLEXION ROTATION INJURIES
• It occur when the head strike the steering
wheel,the spine is forced into acute flexion
• Rupture of posterior ligaments results in
forward dislocation of the vertebrae
• Cervical spine usually affected are the C5 to C6
level
HYPER EXTENSION INJURIES
• Result after a fall in which the chin hits an
object and Result e head is thrown back
• Anterior ligament is raptured with fraction of
the posterior elements of the vertebral body
• Greatest area of stress is at the C4 and C5
COMPRESSION INJURIES
• Caused by falls or jumps in which the person
lands directly on the head,sacrum or feet
• Force of impact of fractures the vertebrae and
the fragments compress the cords
• Lumbar and lower thoracic vertebae are
affected
LEVEL OF INJURY
• Skeletal level
• Neurologic level
DEGREE OF INJURY
• COMPLETE CORD INJURY-result in total loss of
sensory and motor function below the level of
injury.
• INCOMPLETE CORD INJURY-mixed loss of
voluntary motor activity and sensation and
leaves some tracts intact
IMCOMPLETE INJURY
• Central cord syndrome
• Anterior cord syndrome
• Brown sequard syndrome
• Posterior cord syndrome
• Conus medullaris and cauda euina syndrome
CENTRAL CORD SYNDROME
• Damage to central spinal cord
• Occur most commonly in the cervical region
• Motor weakness and sensory loss are present
in both upper and lower extremities
ANTERIOR CORD SYNDROME
• Caused by damage to the anterior spinal artery
• Result from injury causing compression of
anterior portion of the spinal cord [flexion
injury]
• Paralysis and loss of pain and temperature
sensation below the level of injury
• Sensation of touch,position and viberation
remains intract.
BROWN SEQUARD SYNDROME
• Result of damage to one half of the spinal
cord[knife or missile injury]
• Ipsilateral paralysis with ipsilateral loss of
touch and pressure and contralateral loss of
pain and temperature
POSTERIOR CORD SYNDROME
• Result from damage to the spinal artery
• Dorsal columns are damaged resulting in loss
of proprioception
• Pain,temperature and motor function below
the level of lesion remains intact
CONUS MEDULLARIS AND CAUDA EQUINA
SYNDROME
• Result from damage to the very lowest portion
of the spinal cord [conus]and the lumbar and
sacral nerve root[cauda equina]
• Flaccid paralysis of the lower limbs and are
flexia [flaccid bladder and bowel]
CLINICAL MANIFESTATION
• RESPIRATORY SYSTEM –Injury below the level
of C4 leads to hypoventilation
• Cervical and thoracic injuries –paralysis of
abdominal and intercostal muscles making the
patient unable to cough effectively to remove
secretions
• Neurogenic pulmonary edema
CADIOVASCULAR SYSTEM
• Injury above the level of T6 deceases the
influence of sympathetic nervous system-
bradycardia occur-peripheral vasodilation-
reduces return of blood to the heart-
decreases cardiac output-hypotension
URINARY SYSTEM
• Urinary retention [loss of sensation and
decreases reflexes
Peripheral vascular problems
Deep vein thrombosis [during the first 3 months]
SPINAL SHOCK AND NEUROGENIC SHOCK
• SPINAL SHOCK-
• Temporary loss of neurologic function
characterized by decreased reflexes,loss of
sensation and flaccid paralysis below the level
of injury
• NEUROGENIC SHOCK-Effects are associated
with cervical or high thoracic injury.
• Due to loss of vasomotor tone caused by injury
and is characterized by hypotension and
bradycardia
DIAGNOSTIC MEASURE
• History and physical examination
• X ray spine
• CT scan
• MRI scan
• Vertebral angiography
COMPLICATIONS
• NEUROGENIC BLADDER-
urgency,frequency,incontinence,inability to
void and
• NEUROGENIC BOWEL-voluntary control of
bowel evacuation is lost.
• Throbbing headache
• Bradycardia
• Loss of circulation control
MUSCLE TONE PROBLEM
• Spastic and flaccid muscles
MANAGEMENT
• Neck should be stabilized in a neutral position
without flexion or extension
• Place the affected person on a spine board
and secure the spine with a hard collar around
the neck.
INITIAL CARE
Log rolling technique
Maintain a patient airway
• Mechanically assisted ventilation
• Patient with severe cervical injury, placed in a
skeletal traction
MANAGEMENT
• History taking
• Physical examination
• investigations
