SCI

Spinal Cord Injury (SCI)

Overview

  • SCI occurs with or without associated vertebral injury.

  • Results in complex biochemical changes in the spinal cord.

Risk Factors

  • Demographics: Men, young adults, seniors.

  • Activities: Sports, high-risk activities, acts of violence.

  • Health conditions: Predisposing health conditions.

SCI Definition

  • Permanent or temporary loss of motor and sensory function.

  • Can lead to various physical and psychological changes.

Pathophysiology of SCI

  • Damage to the spinal cord leads to multiple physiological changes.

  • Altered autonomic functions: Decreased heart rate (HR), blood pressure (BP), and temperature regulation.

  • Neurogenic shock due to loss of input and cord edema.

  • Vascular changes: Microscopic hemorrhages can cause ischemia and subsequent cell death, resulting in permanent neurological deficits.

Dermatomes and Spinal Sections

  • Cervical (C): Neck region.

  • Thoracic (T): Upper back region.

  • Lumbar (L): Lower back including lower extremities.

  • Sacral (S): Pelvic region.

  • Coccyx (Co): Tailbone region.

  • Brain, spinal cord, and spinal nerves play crucial roles in sensory and motor functions.

Effects of Thoracic Level Injuries

  • Loss of movement in chest, trunk, bowel, bladder, and legs.

  • Potential Conditions:

  • Paraplegia

  • Autonomic dysreflexia

  • Visceral distention.

Lumbar-Sacral Injuries

  • Specific level of injury determines effects on movement and sensation.

  • May lead to loss of movement in lower extremities and neurogenic bladder.

  • Key Nerves: S2-S4 control sexual function.

Sexual Function Post-SCI

  • Male:

  • Above T11: Erection possible; ejaculation <10%.

  • T12 and below: Erection may be possible; ejaculation unlikely.

  • Female:

  • Levels correlate with clitoral stimulation and orgasm.

  • Menstrual cycle and child-bearing potential.

Considerations for Bladder and Bowel Function

  • Autonomic dysreflexia can occur, especially if SCI is above T6.

  • Importance of annual physical exams.

  • Sexual pleasure is primarily psychological.

SCI Classifications

  • Complete SCI: Permanent loss of functions below the level of injury.

  • Incomplete SCI: Some motor/sensory function remains.

Incomplete Lesion Types

  • Anterior Cord Syndrome: Loss of pain and temperature sensation, preservation of position and vibration sense.

  • Central Cord Syndrome: Greater upper extremity weakness than lower, distal muscle weakness prevalent.

  • Brown-Sequard Syndrome: Loss of sensation and motor function on the same side as the injury and different sensations on the opposite side.

Respiratory Assessment

  • Complete Lesions:

  • C1 to C3: Ventilator dependent.

  • C4 to C5: May involve phrenic nerve dysfunction.

  • Below C5 to T6: Diaphragmatic breathing possible; muscle impairment varies.

Priority Interventions in SCI

  • Ensure airway maintenance through endotracheal airway or tracheotomy.

  • Cervical stabilization using rigid collars and backboards.

  • Focus on trauma-oriented interventions and ICU admission.

Neurological Assessment

  • Regular monitoring of motor, reflex, and sensory functions.

  • Perform hourly assessments and GCS monitoring.

Hemodynamic Assessment

  • Conduct initial assessments during ICU stay for the first 7-14 days.

  • Monitor spinal perfusion: Maintain MAP 85-90 mm Hg.

  • Support BP and heart rate through vasoactive agents and fluid volume.

Spinal Shock

  • Characterized by electrical silence below the injury level, resulting in loss of all activities initially.

  • Symptoms can evolve from weakness and numbness to hyperreflexia and autonomic symptoms over weeks to months.

Skin Assessment

  • High risk for skin breakdown necessitates routine inspections.

  • Focus on pressure points, especially in cervical collar areas.

Additional Priority Interventions

  • Monitor for spinal shock and labs related to acid-base balance and electrolytes.

  • Thermoregulation measures.

Autonomic Dysreflexia

  • A medical emergency for SCI at T6 or higher.

  • Triggered by sustained stimuli below the injury level (e.g., bladder distention, tight clothing).

  • Signs include hypertension, severe headache, sweating, and facial flushing.

Neurogenic Shock

  • Also known as distributive or vasogenic shock, often seen in SCIs at T6 and above.

  • Symptoms include low BP, low heart rate, vasodilation, and hypovolemia.

Medical Interventions in SCI

  • Stabilization of the spinal column and respiratory support as needed.

  • Consider glucocorticoid protocols and initiate high-dose methylprednisolone within 8 hours post-injury.

  • Monitor for side effects closely.

Continued Medical Intervention Needs

  • Maintain spinal perfusion, manage autonomic dysreflexia, and ensure thromboembolism prevention.

  • Surgical options involve decompression and removal of bone fragments.

  • Address nutritional needs, skin care, and mental health support through counseling and referrals for therapy.