Spinal Cord Injury: Assessment, Management, and Complications

Spinal Cord Injury (SCI)

A highly debilitating condition requiring treatment focused on rehabilitation and preventive measures.

Incidence of SCI in Canada

Approximately 1,050 new cases annually, or 35 new cases per million people.

Mortality rate for isolated SCI

7% for patients with isolated spinal cord injuries.

Primary SCI

Injury occurring at the moment of impact, typically leading to complete or partial loss of function.

Spinal cord compression

Ranges from "cord concussion with brief transient neurologic deficits" to "complete and permanent paralysis."

Spinal cord concussion

Temporary dysfunction (24–48 hours) in 3%–4% of SCIs.

Spinal cord contusion   

Associated with edema, tissue damage, vascular leakage.

Cord laceration

Results in hemorrhage, swelling, and disruption of communication pathways.

Secondary SCI

"Occurs when multiple factors permit a progression of primary SCI," involving an inflammatory response, leading to "further hypoxia, hypoglycemia, and hypothermia." Minimizing this through "Spinal motion restriction, neutral alignment," "Minimize heat loss," and "Maintain oxygenation/perfusion" is crucial.

Anterior Cord Syndrome

Disruption of blood flow leading to paralysis below the level of insult, often due to flexion injuries.

Incomplete SCI

"Some degree of cord function remains."

Neurogenic Shock Syndrome

Temporary loss of autonomic function characterized by hypotension, bradycardia, and warm skin.

Central Cord Syndrome

Hyperextension injury to the cervical area with hemorrhage and edema, often in older patients with spinal stenosis. Patients have "greater loss of function in upper than lower extremities." Prognosis is generally good.

Posterior Cord Syndrome

Associated with extension injuries, rare. Dysfunction of dorsal columns leading to loss of sensation of light touch, proprioception, and vibration. Good prognosis.

Brown-Séquard Syndrome

Associated with penetrating trauma causing hemisection of the cord. Results in "Motor loss on same side of injury below lesion level," loss of light touch, proprioception, and vibration sensation if dorsal column damaged, and "loss of sensation of temperature and pain on opposite side of body."

Spinal Shock

Temporary condition due to edema in the spinal cord. Symptoms "improve and resolve in hours or weeks."

Complete SCI

Permanent loss of all spinal cord-mediated functions below the injury level.

Cervical Plexus

Network of nerves (C1–C5) supplying structures in the neck and associated regions.

Autonomic dysreflexia

Late complication of SCI, most common in injuries above T4–T6, presenting with cardiovascular compromise.

Spinal motion restriction

A critical principle in managing SCI aimed at preventing further injury during transport.

Flexion injuries

Injuries resulting from forward head movement, potentially causing unstable dislocations or fractures.

Rotation With Flexion

Often from high acceleration forces. C1-C2 is the only area allowing significant rotation, making injuries unstable. Can cause stable dislocations in the cervical spine or fractures in the thoracolumbar spine.

Vertical Compression

Forces transmitted through the vertebral body (e.g., direct blow to parietal region, rapid deceleration from a fall on feet/legs/pelvis). Often produces "burst" or compression fractures, potentially with SCI if bone embeds in the cord. "Serious airway compromise is possible if there is retropharyngeal edema."

Hyperextension

Can result in fractures and ligament injury of variable stability, including "hangman’s (C2) fracture." A teardrop fracture of the vertebral body can also occur.

CSF (Cerebrospinal Fluid)

Fluid that bathes the brain and spinal cord, providing protection and cushioning.

Vagus nerve

Part of the parasympathetic nervous system that remains intact following a spine injury.

Vertebral Structure

Consists of individual vertebrae with a body, lamina, pedicles, and processes that protect the spinal cord.

Types of spinal cord injuries due to trauma

Include Flexion, Rotation with Flexion, Vertical Compression, and Hyperextension.

Rapid Extrication

Procedure to quickly move a patient from sitting to a supine position on a backboard when the scene is unsafe.

Spinal column

Divided into three columns: posterior, middle, and anterior, with injury affecting stability.

Coccygeal nerve

The single nerve that arises from the coccyx region of the spine.

Motor vehicle collisions

One of the leading causes of spinal cord injuries, accounting for 35%–40% of cases.

Backboard usage in SCI management

Essential for spinal motion restriction and safe movement of the patient.

Horner syndrome

A set of symptoms indicating sympathetic pathway injury, characterized by drooping eyelid and constricted pupil.

Spinal shock

A temporary condition due to spinal cord edema, where symptoms may resolve in hours or weeks.

SAMPLE history taking

An acronym used to gather patient history: Signs, Allergies, Medications, Past medical history, Last oral intake, Events leading up to injury.

Dermatomes

Areas of skin supplied by specific spinal nerves, important in assessing sensory function during examination.

Positive Babinski reflex

Condition where toes move upward when the sole of the foot is stroked, indicating neurological function.

Prognosis for Central Cord Syndrome

Generally good, but patients often have greater loss of function in upper extremities.