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i) Direct trauma
ii) Compression by bone fragments / haematoma
/ disc material
iii) Ischemia from damage / impingement on the
spinal arteries
Statistics:
Occurs primarily in young males (> 75% of
cases)
Half of these injuries result from MVAs
2/3 of patients are < 30 years old
Other sources of SCI: Falls, sporting and
industrial accidents, gunshot wounds.
Most common vertebrae involved are C5, C6,
C7, T12, and L1 because they have the greatest
ROM
National Spinal Cord Injury Database
{ USA Stats }
• MVA 44.5%
• Falls 18.1%
• Violence 16.6%
• Sports 12.7%
Upper limbs:
C5 - Deltoid
C 6 - Wrist extensors
C 7 - Elbow extensors
C 8 - Long finger flexors
T 1 - Small hand muscles
• Lower Limbs :
L2 - Hip flexors
L3,4 - Knee extensors
L4,5 – S1 - Knee flexion
L5 - Ankle dorsiflexion
S1 - Ankle plantar flexion
Spinal Cord Injury
Classification
National Spinal Cord Injury Association dan The
Christopher & Dana Reeve Foundation
Incomplete:
Clinically
Non specific symptoms – back
pain
- bowel and bladder
dysfunction
- leg numbness and weakness
- saddle parasthesia
Management of Spinal Cord
Injuries
Immediate management at the scene is critical.
Improper handling can cause further damage and loss of functioning
Always assume there is a spinal cord injury until it is ruled out
Immobilize
Prevent flexion, rotation or extension of neck
Avoid twisting patient
If conscious, patients will usually mention acute pain in back or neck
which may radiate along the involved nerve.
Management is aimed at preventing further injury and observing for
progression of neuro deficits
Consists of emergency treatment following an A-B-C-D-E sequence.
Breathing circularion
Airway
• Lesions above C5 level • Cardiac output is
will cause partial to affected by external or
complete internal hemorrhage
• First priority.
diaphragmatic and neurogenic shock.
• Open airway with
paralysis (the • Two signs of internal
jaw-thrust maneuver.
diaphragm is bleeding from
• Use bag-valve-mask
innervated at C3-5 abdominal trauma are
devise initially for
levels). abdominal pain and
airway compromise
• Any lesion above T12 muscular rigidity.
and if necessary to
may cause some However, these signs
prepare for
airway compromise. may be masked in a
intubation.
• Lesions at C5 and patient with sensory
• High concentration of
below will allow full and motor deficits.
02 will prevent
diaphragmatic • Other usual signs of
bradycardia or
movement, but shock from internal
asystole for patients
intercostal muscles bleeding are absence
exhibiting signs of
(innervated at T1) and of urine and/or classic
neurogenic shock.
abdominal muscles signs of shock
(innervated at T12) are (decreased BP and
affected. increased HR)
Exposure management
Dissability
• Lesions above C5 level
will cause partial to
• Neurological complete High dose corticosteroids
Examination diaphragmatic (Methylprednisolone) -
• Lateral C-Spine X-ray paralysis (the improves the prognosis
• CT scan diaphragm is and decreases disability
• MRI innervated at C3-5 if initiated within 8 hours
• ECG - bradycardia levels). of injury. Patient receives
and asystole are • Any lesion above T12 a loading dose and then a
common with acute may cause some continuous drip.
cervical injury airway compromise. High dose steroids,
• Search for other • Lesions at C5 and Mannitol, Dextran
injuries - spinal below will allow full Naloxone - has shown
trauma is often diaphragmatic promise in use on
accompanied by movement, but humans, minimal side
other injuries, intercostal muscles effects, may promote
particularly of the (innervated at T1) and neurological
head and chest. abdominal muscles improvement
(innervated at T12) are
affected.
Spinal Shock vs Neurogenic
Shock
Spinal Shock :
Reduction
Fixation
Fusion
Reduction
Fusion involves
Fixation
involves attaching injured
stabilizing vertebrae to uninjured
vertebral vertebrae with bone
fractures with grafts, and steel rods
wires, to help maintain
plates,screws structural integrity.
and other types
of hardware.
Complications of SCI -
Pulmonary
Pulmonary complications - Function
compromise, Airway compromise,
infection, decreased vital capacity,
atelectasis, retention of secretions,
respiratory failure, pulmonary edema
Acute respiratory failure is the leading
cause of death in high cervical injuries.
Deep Vein Thrombosis
(DVT)
The incidence of DVT is extremely high in SCI patients due to pressure
on their calf muscles, loss of the skeletal muscle pump, and the
hypercoagulability of their blood.
Treatment :DVT prophylaxis - pneumatic compression hose, low dose
Heparin, and vena cava filters.
Orthostatic Hypotension