Nursing Care for Spinal Cord Injury

A spinal cord injury refers to any damage to the spinal cord, or the bundle of nerves, called cauda equina, that protrude from the bottom of the spinal cord.

Now, spinal cord injuries can have different causes. In younger patients, most spinal cord injuries are caused by motor vehicle crashes; or recreational injuries, like those caused by impact sports. In older patients, though, spinal cord injuries are often caused by falls, as well as medical conditions, like degenerative diseases of the spine.

Risk factors for developing a spinal cord injury include engaging in high-risk behaviors, such as speeding when driving or not wearing safety equipment when playing sports. Lastly, patients with a history of bone or joint disorders are also at a higher risk, since even minor trauma could damage the weakened bones and injure the spinal cord.

Okay, so the pathology of a spinal cord injury involves primary and secondary injury. Primary injury typically involves a sudden, traumatic impact on the spine that fractures or dislocates vertebrae, causing compression on the spinal cord.

Following the primary injury, secondary injury causes additional damage. The acute phase of the secondary injury begins immediately after the spinal injury, and includes bleeding, ischemia, and swelling at the site of the injury. As time passes, additional neuronal cell death can be caused by oxidative stress, neurotransmitter accumulation, and demyelination of surviving axons. Eventually, specialized glial cells begin to form a scar at the site of injury, which creates a barrier across the injured tissue that prevents the spread of neuronal damage. Unfortunately, since neurons have limited regenerative capacity, these injuries tend to yield permanent damage to the spinal cord.

Alright, now clinical manifestations of spinal cord injuries depend on the severity and location of the injury and may include partial or complete loss of sensation and motor function below the level of injury.

Upper cervical lesions lead to quadriplegia, so there’s loss of function of the limbs and trunk, and a ventilator is needed to maintain respiration.

On the other hand, lower cervical lesions can still lead to a complete loss of trunk and lower limb function; however, some movements of the upper limbs may remain intact, allowing for functions such as feeding or using a wheelchair.

Next, thoracic lesions can lead to paraplegia, where there’s paralysis of both lower limbs, but upper limb function remains intact. Thoracic lesions from T1 to T12, and lower cervical lesions at C5 to C7, can impair intercostal muscle function, leading to shallow, ineffective breathing and impaired coughing. Lower thoracic and lumbar lesions can lead to some level of dysfunction of the lower limbs, resulting in difficulty with ambulation.

If the injury affects the nerves of the cauda equina, this can result in cauda equina syndrome, which is a medical emergency since delayed decompression can lead to permanent disability. There can also be decreased bowel and bladder control, as well as sexual dysfunction. It can also cause saddle anesthesia, which is a loss of sensation in the saddle area, which includes the buttocks, inner surface of the thigh, and perineum.