SCI + Degenerative Spinal Conditions

Primary Spinal Cord Injury

Direct mechanical trauma occurring at impact via compression, intermittent compression, distraction, or transection/laceration of the cord

Secondary Spinal Cord Injury

Ongoing progressive tissue destruction following impact driven by ischemia, inflammation, hematoma formation, hypovolemia, and edema

ASIA Impairment Scale Grade A

Complete spinal cord injury with total loss of sensory and motor function preserved in sacral segments S4-S5

ASIA Impairment Scale Grade B

Incomplete sensory injury where sensory function is preserved below the neurological level but motor function is completely lost

ASIA Impairment Scale Grade C

Incomplete motor injury where more than half of key muscles below the neurological level have a muscle grade less than 3

ASIA Impairment Scale Grade D

Incomplete motor injury where at least half of key muscles below the neurological level have a muscle grade of 3 or greater

ASIA Impairment Scale Grade E

Normal motor and sensory function throughout all spinal segments

Tetraplegia (Quadriplegia)

Paralysis caused by cervical spinal cord injury (C1 to T1) resulting in impairment or loss of function in all four extremities, trunk, and pelvic organs

Paraplegia

Impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments (T2 to S5), sparing upper extremity function

Spinal Injury Level C1 to C4

Results in complete loss of diaphragm function and loss of independent breathing, requiring lifelong mechanical ventilation support via tracheostomy

Spinal Injury Level C5

Retains shoulder movement and elbow flexion, allowing the client to feed self and perform basic ADLs using adaptive devices

Spinal Injury Level C6

Retains wrist extension, enabling the client to propel a manual wheelchair and drive an adapted motor vehicle

Spinal Injury Level T1 to T8

Results in paraplegia with full upper extremity control, but loss of trunk control and abdominal muscle innervation

Spinal Injury Level T9 to T12

Intact trunk control and partial abdominal muscle control, improving sitting balance and cough capability

Cauda Equina Bundle

A nerve root collection at the lower end of the spinal cord that innervates the legs, bladder, bowel, and sexual organs

Spinal Shock

Immediate, temporary loss of all reflex activity, spinal cord function, muscle tone, and autonomic reflexes below the injury level following acute trauma

Neurogenic Shock

Hemodynamic collapse caused by loss of sympathetic vascular tone in injuries at T6 or above, presenting with severe hypotension, bradycardia, and hypothermia

Autonomic Dysreflexia (AD)

Life-threatening hypertensive emergency in clients with SCI at or above T6, triggered by an uninhibited sympathetic response to a noxious stimulus below the injury

Autonomic Dysreflexia Common Triggers

Bladder distension or catheter obstruction (most common), fecal impaction, pressure injuries, restrictive clothing, or severe temperature changes

Autonomic Dysreflexia Manifestations Above Injury Level

Severe pounding headache, paroxysmal hypertension (SBP > 150 mm Hg), bradycardia, facial flushing, diaphoresis, and goosebumps

Autonomic Dysreflexia Manifestations Below Injury Level

Pale, cool, clammy skin with cold extremities caused by intense sympathetic vasoconstriction

Autonomic Dysreflexia First Priority Nursing Action

Immediately elevate head of bed to 90 degrees with legs dangling over the edge of the bed to promote orthostatic venous pooling and lower BP

Autonomic Dysreflexia Secondary Nursing Actions

Loosen tight clothing, check for bladder distension, use anesthetic gel prior to urinary catheterization or digital rectal exam, and monitor BP every 2 to 5 minutes

Autonomic Dysreflexia Pharmacological Treatment

Nitroglycerin 2% paste applied 1 to 2 inches above the level of injury or sublingual/immediate-release Nifedipine 10 mg

Assisted Cough Technique (Quad Cough)

Nursing intervention for clients with abdominal weakness where hands are placed below the ribcage pushing in and upward during exhalation to clear secretions

Halo Fixation Device Purpose

External immobilization device providing rigid upper cervical spine stabilization via a ring secured to the skull with four pins and attached to a torso vest

Halo Fixation Device Critical Safety Rule

Wrenches/tools must be taped directly to the vest at all times for rapid vest removal during CPR

Halo Fixation Pin Care

Cleanse pin sites daily or every other day with chlorhexidine/antiseptic using separate cotton swabs for each site to prevent pin-site osteomyelitis

Venous Thromboembolism (VTE) Risk in SCI

Highest during the first 8 weeks post-injury due to venous stasis and paralysis

Heterotopic Ossification (HO)

Abnormal bone growth into soft tissues, muscles, or joints below the SCI level (most common in hips, knees, elbows), presenting 3 to 12 weeks post-injury with decreased ROM

Upper Motor Neuron Lesion Bowel/Bladder

Causes spastic bowel and bladder dysfunction characterized by involuntary reflex emptying and leaking of urine or stool

Lower Motor Neuron Lesion Bowel/Bladder

Causes flaccid bowel and bladder dysfunction characterized by urinary retention, overdistension, and loss of voluntary or reflex evacuation

Clean Intermittent Self-Catheterization

Preferred bladder management technique for SCI clients to prevent CAUTIs, performed 5 to 6 times daily based on residual urine volumes

Mean Arterial Pressure (MAP) Goal in Neurogenic Shock

Maintain MAP between 85 and 90 mm Hg for the first 7 days post-injury using IV fluids and vasopressors (Norepinephrine or Dopamine) to maintain cord perfusion

Baclofen (Lioresal) Indication

Centrally acting skeletal muscle relaxant used to reduce muscle spasticity and improve bowel and bladder function in SCI

Baclofen Boxed Warning

Never discontinue Baclofen abruptly

Dopamine (Intropin) Vasopressor Action

Increases BP and cardiac output

Atropine Sulfate Indication in SCI

Anticholinergic antiarrhythmic administered IV to treat symptomatic bradycardia associated with neurogenic shock

Enoxaparin (Lovenox) Safety

Low-molecular-weight heparin used for VTE prophylaxis

Sildenafil (Viagra) Critical Contraindication

Co-administration with nitrates (e

g

, Nitroglycerin) causes severe, life-threatening hypotension and cardiovascular collapse

Degenerative Disc Disease (DDD) Pathophysiology

Age-related loss of fluid absorption in intervertebral discs causing brittleness, cracking, disc flattening, loss of disc height, and osteophyte development

Spinal Stenosis Pathophysiology

Narrowing of the central vertebral canal, neural foramina, or lateral recesses, compressing the spinal cord, CSF, and exiting nerve roots

Spondylolisthesis

Forward displacement or slipping of one vertebra over another, causing narrowing of the spinal canal and nerve compression

Osteophytes (Bone Spurs)

Bony projections originating from vertebral margins due to altered pressure dynamics, projecting into spinal spaces and irritating nerve roots

Cauda Equina Syndrome Definition

Emergency medical condition where a herniated disc or mass severely compresses the cauda equina nerve roots at the base of the spinal cord

Cauda Equina Syndrome Manifestations

Saddle anesthesia (perineal numbness), new onset bowel or bladder incontinence, inability to initiate a urine stream, and lower extremity paralysis

Cauda Equina Syndrome Priority Treatment

Immediate emergency surgical decompression within 48 hours to prevent permanent paralysis and irreversible bowel/bladder dysfunction

Shopping Cart Posture

Forward-leaning posture adopted by clients with lumbar spinal stenosis that opens up the vertebral canal and temporarily relieves lower back/leg pain

Foot Drop Manifestation

Dragging of the foot during ambulation due to weakness or paralysis of dorsiflexion muscles, causing a high fall risk

C6 to C7 Disc Herniation Manifestation

Upper extremity paresthesia, weakness, and wrist drop affecting the second and third fingers

Lumbar Spinal Stenosis Manifestation

Lower back pain, burning leg pain, calf/buttock cramping (neurogenic claudication), and lower extremity numbness

MRI Gold Standard in Spinal Degeneration

Diagnostic imaging modality of choice to visualize soft tissues, nerve root compression, disc herniations, and ligamentous hypertrophy

Epidural Steroid Injections (ESI)

Injection of corticosteroids into the epidural space to reduce inflammation surrounding compressed nerve roots

Epidural Steroid Injection Complications

Infection, bleeding, epidural hematoma, epidural abscess, allergic reaction, or medication side effects

Spinal Cord Stimulation (SCS)

Implantation of electrical leads in the epidural space that deliver pulsed electrical energy based on Gate Control Theory to disrupt spinal pain signals

Acetaminophen (Tylenol) Maximum Adult Duration

Should not exceed 10 days of continuous use in adults without provider order to avoid hepatotoxicity and renal failure

Acetaminophen Safety Teaching

Avoid alcohol (3+ drinks/day increases liver damage risk), verify OTC labels to prevent double-dosing, and monitor Warfarin interaction at high doses

Laminectomy

Surgical removal of the vertebral lamina to relieve pressure on the spinal cord or exiting nerve roots

Foraminotomy

Surgical enlargement of the neural foramina to decompress exiting spinal nerve roots

Discectomy with Fusion

Surgical removal of a damaged or herniated intervertebral disc followed by bone grafting and hardware placement to stabilize adjoining vertebrae

Log-Roll Turning Technique

Method of repositioning a spinal client as a single unit with at least 3 to 4 staff members while maintaining strict inline cervical alignment