Spinal Cord Injuries Overview

Spinal Cord Injuries Overview

• Definition: Spinal cord injury (SCI) involves damage to the spinal cord, vertebral column, supporting soft tissue, or intervertebral discs from trauma.

• Prevalence: Approx. 294,000 individuals in the U.S. live with SCI; around 17,810 new cases are reported annually.

• Common Causes: Motor vehicle accidents, falls, violence (especially gunshot wounds), and sports injuries.

• Demographics: 78% of patients are male, with an average age of 43 at the time of injury.

• Economic Impact: Average indirect cost per patient is approximately $77,701 per year (2019 dollars).

• Risk Factors: Include younger age, male gender, alcohol, and illicit drug abuse.

Life Expectancy and Causes of Death

• Life expectancy is improving for those with SCI but remains lower than those without.

• Major causes of death: pneumonia, pulmonary embolism (PE), and sepsis.

Types of Paralysis

• Paraplegia: Paralysis of the lower body.

• Tetraplegia: Paralysis affecting all four extremities. Most common injury is incomplete tetraplegia.

Injury Classification and Mechanisms

• Primary Injuries: Result from the initial trauma; typically permanent.

• Secondary Injuries: Include additional damage like edema or hemorrhage, critical for treatment.

• Damage Range: From transient concussion to complete transection of the spinal cord.

Common Injury Sites

• Frequent sites of injury include:

  • Cervical: C5–C7

  • Thoracic: T12

  • Lumbar: L1

Categories of SCI

Types of Injuries

• Complete Spinal Cord Lesion: Total loss of sensory and motor communication.

• Incomplete Spinal Cord Lesion: Some sensory/motor function remains below the injury level.

Specific Syndromes

1. Central Cord Syndrome

   • Caused by injury or edema, typically cervical.

   • Manifestations: Greater motor deficits in upper limbs, varying sensory loss, bowel/bladder dysfunction may vary.

2. Anterior Cord Syndrome

   • Linked to acute disc herniation; impacts front part of the spinal cord.

   • Manifestations: Loss of pain, temperature, and motor function below injury; sense of touch remains intact.

3. Brown-Séquard Syndrome (Lateral Cord Syndrome)

   • Caused by transverse hemisection of the cord.

   • Manifestations: Ipsilateral paralysis and sensory loss on the side of the injury; contralateral loss of pain and temperature sensation.

Assessment and Diagnosis

• Neurologic examination crucial; x-rays, CT scans, or MRIs used for in-depth assessment.

• Respiratory function is affected based on injury level (C4 for diaphragm).

• Continuous electrocardiographic monitoring recommended due to bradycardia risk.

Management and Treatment

• Goals of Management: Prevent secondary injury, symptoms observation, complication prevention.

• Treatment includes:

  • Oxygen therapy to maintain oxygenation levels.

  • Ventilator support for high cervical injuries.

  • Surgical or non-surgical interventions for vertebral stabilization.

Surgical Interventions

• Indicated when:

  • Cord compression is present.

  • Unstable vertebral body injury.

  • Neurologic status is deteriorating.

• Early stabilization improves patient outcomes.

Complications

Acute Complications

1. Spinal Shock: Reflex activity below injury ceases; muscles become flaccid with absent reflexes.

2. Neurogenic Shock: Autonomic nervous system disruption affects vital organs.

3. Venous Thrombosis: High risk due to immobility; manage with anticoagulants and compression devices.

4. Respiratory Complications: Related to diaphragm and chest muscle paralysis.

Long-Term Complications

• Include infection risk (UTIs, sepsis), skin integrity issues, spasticity, and emotional responses (depression, anxiety).

• Autonomic dysreflexia can occur post-spinal shock; characterized by severe hypertension, headache, and sweating.

Rehabilitation and Long-Term Care

• Importance of Early Rehabilitation: To avoid disuse atrophy and contractures, implement continuous movement.

• Nutritional counseling to manage body weight and ensure muscle maintenance.

• Psychological support through counseling; address emotional issues post-injury.

• Encourage independence and self-management in care strategies.

Support Systems

• Family education and involvement in care are critical for long-term success and adjustment.

• Community resources should be utilized to assist adaptation to living with SCI.