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GERALDINE ROMULO

WHAT IS A SPINAL CORD INJURY (SCI) ?

A spinal cord injury (SCI) is an insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function. Patients with spinal cord injury usually have permanent and often devastating neurologic deficits and disability.

SCI are described at various levels of incomplete, which can vary from having no effect on the patient to a complete injury which means total loss of function.
A devastating and common neurologic disorder that has profound influences on modern society from physical, psychosocial, and socio- economic perspectives. According to the National Institutes of Health (NIH), among neurological disorders, the cost to society of automotive SCI is exceeded only by the cost of mental retardation.

After a suspected SCI, the goals are to establish the diagnosis and initiate treatment to prevent further neurologic injury from either mechanical instability secondary to injury from the deleterious effects of cardiovascular instability or respiratory insufficiency.

Spinal cord injuries occur most frequently in July and least commonly in February. The most common day on which these injuries occur is Saturday. Spinal cord injuries also occur more frequently during daylight hours, which may be due to the increased frequency of motor vehicle accidents and of diving and other recreational sporting accidents during the day.

Spinal cord injury may be divided into both primary and secondary mechanisms of injury:
1) The primary injury, in large part, determines a given patients neurologic grade on admission and thereby is the strongest prognostic indicator. 2) Secondary mechanisms of injury can exacerbate damage and limit restorative processes, and hence, contribute to overall morbidity and mortality.

MECHANISMS:
Direct trauma Compression by bone fragments / hematoma / disc material Ischemia from damage / impingement on the spinal arteries

RISK FACTORS:
Young healthy individuals, ages 16-35 y / o
Risky physical activities

People with medical problems

CAUSES:
Motor vehicle accidents - 56% Accidental falls - 14%

Firearm injuries - 9%

Sports injuries - 7%

Fall- 10%

Diving in shallow water

High Risk activities

Activities without proper protection

Children sitting in front of the car/ not wearing seatbelt-67.7%

Alcohol and drug on SCI pediatric Cases- 30%

ANATOMY OF NERVOUS SYSTEM

ANATOMY & PHYSIOLOGY OF THE SPINAL CORD

The spinal cord is about 18 inches long and extends from the base of the brain, down the middle of the back, to about the waist. 31 pairs of spinal nerves 8 Cervical 12 Thoracic 5 Lumbar 5 Sacral 1 Coccygeal

Upper motor neurons (UMNs) lie within the spinal cord which carries messages back and forth from the brain to the spinal nerves along the spinal tract.
Lower motor neurons (LMNs) branch out from the spinal cord to the other parts of the body. Sensory portions of the LMN carry messages about sensation from the skin and other body parts and organs to the brain. The motor portions of the LMN send messages from the brain to the various body parts to initiate actions such as muscle movement.

GREY MATTER contains cell bodies (dendrites and terminals, Spinal reflex integrating centers) Sensory and Motor Nerve cells

WHITE MATTER consists of : A.) Myelinated axons that occur in bundles called tracts Ascending tracts-sensory Descending tracts-motor B.) Dorsal roots C.) Ventral roots D.) Ventral roots

CENTRAL CANAL contains CSF

Stimuli I Nerve impulse from sensory receptor I Inter neurons in the spinal cord I Nerve impulse from motor neurons I Skeletal muscle contraction I Response to stimuli

PATHOPHYSIOLOGY:

DERMATOMES
Area of skin innervated by sensory axon within a particular segmental nerve root. Essential in determining level of injury and assessing the improvement or deterioration

MYOTOMES
Segmental nerve root innervating a muscle Important in determining level of injury

Normal

Post SCI

Areas affected post in SCI:

QUADRILEGIA/ TETRAPLEGIA
-injury in cervical region -4 extremities involvement

PARAPLEGIA
-Injury in the thoracic, lumbar, and sacral segments -2 extremities involvement

TYPES OF SPINAL CORD INJURY:

COMPLETE:
--Loss of voluntary movement of parts innervated by segments/ innervation --Loss of sensation / Spinal shock Ex. Central Cord Syndrome, Anterior Cord Syndrome, Posterior Cord Syndrome, Cauda Equina Syndrome

INCOMPLETE:
--Some function is present below the site of injury --Favorable prognosis --Pattern of injury varies S/Sx: Loss of power, decrease pain below lesion

CLASSIFICATION OF SCI:
(according to American Spinal Injury Association)

A COMPLETE-no sensory/ motor fxn preserved in sacral segment S4-S5 B INCOMPLETE-sensory but no mo-tor fxn in sacral segment C INCOMPLETE-motor fxn preserved below and power graded <3 D INCOMPLETE-motor fxn preserved below level and power graded 3/ more E NORMAL- sensory /motor fxn normal

SIGNS & SYMPTOMS

Increased muscle tone (spasticity)

Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)

Numbness

Sensory changes

Weakness, paralysis

Pain

Abnormal sweating,altered temperature and BP(chest injury)

Difficulty in breathing( neck injury)