Spinal cord injury (SCI): Nursing

A spinal cord injury refers to any damage to the spinal cord, or the bundle of nerves protruding from the bottom of the spinal cord, called cauda equina. Now, let’s quickly review some anatomy and physiology. The spinal column consists of 33 vertebrae organized in 5 main regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 5 coccygeal. Together, the vertebrae create a bony canal that houses the spinal cord and surrounding meninges. The spinal cord is a bundle of nerve fibers that serves as a highway for information to travel between the brain and the rest of the body. This information is transmitted by highly specialized spinal tracts that carry motor information down the spinal cord to the body, and sensory information from the body up to the brain. The spinal cord travels through the spinal canal, and stops at the second lumbar vertebra. Here it ends in a cone, called conus medullaris. Since the spinal cord is shorter than the spinal canal, the nerves of the lumbar, sacral and coccygeal regions have to travel down the spinal canal to reach their corresponding openings. In doing so, they form a nerve bundle below the spinal cord called the cauda equina. Now, spinal cord injuries can have a number of different causes. In younger clients, most spinal cord injuries are caused by a motor vehicle crash; penetrating trauma, like a gunshot or a stab wound in the back; or recreational injuries, like those caused by impact sports or diving in shallow waters.

In older clients, though, spinal cord injuries are most often caused by severe falls, such as falling from a ladder; as well as medical conditions, including large tumors, infections, or degenerative diseases of the spine, like a protruding intervertebral disk or osteophytes. Risk factors for developing a spinal cord injury include engaging in high-risk behaviors, such as not wearing safety equipment when playing sports, speeding, and diving in shallow waters. Lastly, clients with a history of bone or joint disorders are also at a higher risk, since even minor trauma could damage the weakened bones, thereby injuring the spinal cord. Okay, so the pathology of a spinal cord injury can be primary and secondary. Primary injury typically involves a sudden, traumatic impact on the spine that fractures or dislocates vertebrae, causing compression on the spinal cord. After the primary injury, there is usually additional damage that occurs over the following days or weeks because of the body’s natural response to trauma, which is known as the secondary injury. The acute phase of the secondary injury begins immediately after the spinal injury, and includes bleeding, ischemia, and swelling on the site of the injury. As time goes by, there can be additional neuronal cell death 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.