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.

Finally, severe spinal cord injuries may result in spinal shock, which is a transient condition that develops shortly after an acute injury.

It’s characterized by flaccid paralysis, loss of sensation, and loss of deep tendon and sphincter reflexes below the level of injury.

Neurogenic shock can also occur where the sympathetic neurons are damaged, leading to unopposed parasympathetic activity.

This can cause peripheral vasodilation, hypotension, and bradycardia. Another complication is autonomic dysreflexia, which involves an extreme autonomic response to a sensory stimulation such as a distended bowel or bladder, resulting in massive vasoconstriction and an extremely elevated blood pressure.

Diagnosis of a spinal cord injury starts with the patient’s history and physical examination. The severity of the injury is determined by testing muscle function, sensation, and proprioception at each dermatome level, which is then scored using the American Spinal Injury Association, or ASIA, scale.

The scale ranges from class A for a complete cord injury to E for normal nervous function. In addition, imaging tests like X-rays, CT scans, or MRI can be used to look for the cause of injury.

Treatment for spinal cord injuries begins with immobilizing the spinal column until an imaging test can be performed, and using ventilatory and cardiovascular support, as needed.

Other treatments may involve surgery to relieve pressure, provide stabilization, and prevent additional injury. Some patients may also receive corticosteroids to help reduce the inflammation.

After the acute phase, much of the treatment is geared towards rehabilitation with physical and occupational therapy. When caring for your patient with a spinal cord injury collaborate with the registered nurse, or RN, to avoid further injury to your patient’s spine and prevent complications.

First, apply a cervical collar to immobilize the neck and keep their head in a neutral position. During repositioning, ask additional staff members to help you move your patient’s body using the log-roll technique.

Then, implement measures to prevent complications. Use pressure distribution surfaces and help them change position at least every 2 hours to prevent pressure injuries; provide parenteral or enteral nutrition to prevent negative nitrogen balance and support healing; administer the prescribed medications to prevent pain as well as prevent venous thromboembolism; and collaborate with physical therapy for early mobilization, as appropriate, to prevent contractures.

You’ll also watch closely for signs of respiratory dysfunction, like ineffective cough, oxygen saturation less than 93 percent, diminished lung sounds, or crackles; and monitor for signs of neurogenic shock, like bradycardia, hypotension, and warm, flushed skin in the lower extremities.

Also, watch for signs of autonomic dysreflexia, including anxiety, headache, nasal stuffiness, bradycardia, and paradoxical hypertension, as well as coolness below the level of injury, and diaphoresis and flushing above the level of injury.

Finally, support your patient emotionally. Recognize that they’ll experience disturbances in body image and self-concept and provide opportunities for them to talk about their feelings.

Refer them to counseling services, as indicated. Alright, as a quick recap… A spinal cord injury refers to any damage to the spinal cord, and can be caused by direct trauma, or degenerative diseases of the spine.

Clinical manifestations depend on the level of injury. Diagnosis includes a history, physical examination, as well as imaging tests.

Treatment depends on the level of injury and includes rehabilitation care. Nursing care involves avoiding further injury and preventing complications.