Spinal cord injuries: Nursing

A spinal cord injury refers to any damage to the spinal cord, which is a bundle of nerve fibers that serves as a highway that carries information between the brain and the body.

Now, a spinal cord injury can involve primary and secondary injury. Primary injury typically involves a sudden, traumatic impact on the spine that fractures or dislocates the protective vertebrae, damages the spinal cord, or interrupts its blood supply.

Then, after the primary injury, there’s usually additional damage, or secondary injury, that occurs due to the body’s natural response to trauma. Secondary injury begins immediately after the spinal injury, and includes bleeding, inflammation, and edema. This is followed by compression of the spinal cord, ischemia, and neuronal damage. As time goes by, additional neuronal cell death occurs.

Eventually, specialized glial cells begin to form scar tissue at the site of injury, which creates a barrier across the injured tissue, impairing cellular regeneration, which can result in permanent nerve damage and subsequent neurologic deficit.

Now, spinal cord injuries can have several different causes, including trauma, like with a motor vehicle crash or falls, such as falling from a ladder; penetrating trauma, like a stab wound in the back or a gunshot; or recreational injuries, like those caused by impact sports. They can also be caused by medical conditions, including spinal tumors, infections, or degenerative diseases of the spine, like a protruding intervertebral disk.

Risk factors for developing a spinal cord injury include engaging in high-risk behaviors, such as not wearing safety equipment when playing sports or speeding while driving. Lastly, a history of bone or joint disorders increases the risk, since even minor trauma could damage already weakened bones and injure 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. For instance, injury between C1 and T1 leads to tetraplegia, sometimes called quadriplegia, which can involve loss of function of the limbs, trunk, and loss of innervation to the diaphragm, requiring mechanical ventilation.

Next, injury between T2 and L1 leads to paraplegia, where upper limb function remains intact, but there’s paralysis of both lower limbs. There can also be a loss of accessory respiratory muscle function like the intercostal muscles, as well as bowel and bladder dysfunction.

Moreover, 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, leading to loss of sympathetic outflow and unopposed parasympathetic activity to the heart and peripheral vessels. This can cause peripheral vasodilation, hypotension, and bradycardia.

Diagnosis of a spinal cord injury starts with a history and physical assessment. Motor and sensory function is tested at each dermatome level on both sides of the body, and the severity of impairment is scored using the American Spinal Injury Association or ASIA scale. In addition, imaging tests like X-rays, CT scan, or MRI can be used to look for the exact cause of spinal cord injury.