According to the National Spinal Cord Injury Association, as many as 450,000 people in the United States are living with a spinal cord injury (SCI). Other organizations conservatively estimate this figure to be about 250,000. Show
Every year, an estimated 17,000 new SCIs occur in the U.S. Most of these are caused by trauma to the vertebral column, thereby affecting the spinal cord's ability to send and receive messages from the brain to the body's systems that control sensory, motor and autonomic function below the level of injury. According to the Centers for Diseases Control and Prevention (CDC), SCI costs the nation an estimated $9.7 billion each year. Motor vehicle accidents are the leading cause of SCI in the U. S. in younger individuals, while falls are the leading cause for SCI for people over 65. Acts of violence and sports/recreation activities are other common causes for these injuries. Just over half of all SCI occurs in persons age 16-30, most of whom are male (80%). Males also represent nearly all (90%) of sports-related SCIs. A complete SCI produces total loss of all motor and sensory function below the level of injury. Nearly 50% of all SCIs are complete. Both sides of the body are equally affected. Even with a complete SCI, the spinal cord is rarely cut or transected. More commonly, loss of function is caused by a contusion or bruise to the spinal cord or by compromise of blood flow to the injured part of the spinal cord. In an incomplete SCI, some function remains below the primary level of the injury. A person with an incomplete injury may be able to move one arm or leg more than the other or may have more functioning on one side of the body than the other. SCIs are graded according to the American Spinal Injury Association (ASIA) grading scale, which describes the severity of the injury. The scale is graded with letters:
The more severe the injury, the less likely a recovery will occur. Spinal concussions can also occur. These can be complete or incomplete, but spinal cord dysfunction is transient, generally resolving within one or two days. Football players are especially susceptible to spinal concussions and spinal cord contusions. The latter may produce neurological symptoms, including numbness, tingling, electric shock-like sensations and burning in the extremities. Open or penetrating injuries to the spine and spinal cord, especially those caused by firearms, may present somewhat different challenges. Most gunshot wounds to the spine are stable; i.e., they do not carry as much risk of excessive and potentially dangerous motion of the injured parts of the spine. Depending upon the anatomy of the injury, the patient may need to be immobilized with a collar or brace for several weeks or months so that the parts of the spine fractured by the bullet heals. In most cases, surgery to remove the bullet does not yield much benefit and may create additional risks, including infection, cerebrospinal fluid leak and bleeding. However, occasional cases of gunshot wounds to the spine may require surgical decompression and/or fusion in an attempt to optimize outcome. Following trauma, seek immediate medical attention if you experience any of the following:
In the trauma situation, the doctor will check first to make sure the patient has a working airway, is breathing and has a pulse. The next step in the evaluation is to assess an individual’s neurologic function. The doctor will do this by testing the patient’s strength and sensation in his/her arms and legs. If there is obvious weakness or the patient is not fully awake, the patient is kept in a rigid cervical collar and on a spine board until a full imaging assessment can be complete. Radiological Evaluation Historically, the radiological diagnosis of SCI started with x-rays. However, with the technological advancements and availability at most hospitals, the entire spine may be imaged with computerized tomography (CT or CAT scan) as an initial screen to identify fractures and other bony abnormalities. For patients with known or suspected injuries, MRI is helpful for looking at the actual spinal cord itself as well as for detecting any blood clots, herniated discs or other masses that may be compressing the spinal cord. How Can You Make a Difference in the Future of Spine CareFor more than 30 years, the NREF has funded research and training to improve treatments and care for conditions like spinal cord injury. Your contribution can make a difference. Learn more about the NREF and make a donation today. donate now Treatment of SCI begins before the patient is admitted to the hospital. Paramedics or other emergency medical services personnel carefully immobilize the entire spine at the scene of the accident. In the emergency department, this immobilization is continued while more immediate life-threatening problems are identified and addressed. If the patient must undergo emergency surgery because of trauma to the abdomen, chest or another area, immobilization and alignment of the spine are maintained during the operation. Non-Surgical Treatments If a patient has a SCI, he or she will usually be admitted to an intensive care unit (ICU). For many injuries of the cervical spine, traction may be indicated to help bring the spine into proper alignment. Standard ICU care, including maintaining a stable blood pressure, monitoring cardiovascular function, ensuring adequate ventilation and lung function and preventing and promptly treating infection and other complications, is essential so that SCI patients can achieve the best possible outcome. Surgery Occasionally, a surgeon may wish to take a patient to the operating room immediately if the spinal cord appears to be compressed by a herniated disc, blood clot or other lesion. This is most commonly done for patients with an incomplete SCI or with progressive neurological deterioration. Even if surgery cannot reverse damage to the spinal cord, surgery may be needed to stabilize the spine to prevent future pain or deformity. The surgeon will decide which procedure will provide the greatest benefit to the patient. Follow-up Persons with neurologically complete tetraplegia are at high risk for secondary medical complications, including pneumonia, pressure ulcers and deep vein thrombosis. Pressure ulcers are the most frequently observed complications, beginning at 15% during the first year post-injury and steadily increasing thereafter. Recovery of function depends upon the severity of the initial injury. Unfortunately, those who sustain a complete SCI are unlikely to regain function below the level of injury. However, if there is some degree of improvement, it usually evidences itself within the first few days after the accident. Incomplete injuries usually show some degree of improvement over time, but this varies with the type of injury. Although full recovery may be unlikely in most cases, some patients may be able to improve at least enough to ambulate and to control bowel and bladder function. Once a patient is stabilized, care and treatment focuses on supportive care and rehabilitation. Family members, nurses or specially trained aides all may provide supportive care. This care might include helping the patient bathe, dress, change positions to prevent bedsores and other assistance. Rehabilitation often includes physical therapy, occupational therapy and counseling for emotional support. The services may initially be provided while the patient is hospitalized. Following hospitalization, some patients are admitted to a rehabilitation facility. Other patients can continue rehab on an outpatient basis and/or at home.
Spinal Cord Injury Facts and Figures:
Other resources: How do you care for a spinal cord injury patient?If you suspect someone has a spinal injury:. Get help. Call 911 or emergency medical help.. Keep the person still. Place heavy towels or rolled sheets on both sides of the neck or hold the head and neck to prevent movement.. Avoid moving the head or neck. ... . Keep helmet on. ... . Don't roll alone.. What does a spinal cord injury nurse do?Nurses are an integral part of the spinal cord injury (SCI) rehabilitation team and provide significant education to the patient and family about the intricacies of living with SCI, as well as help manage the care process.
What aspects of spinal cord are taken care of while attending injured person?Circulatory control.
A spinal cord injury can cause circulatory problems ranging from low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities. These circulation changes can also increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.
Which intervention would the nurse complete immediately for a client experiencing autonomic dysreflexia?Apply compression stockings. Rationale: The client is demonstrating signs of autonomic dysreflexia which is an emergency requiring immediate intervention. Application of compression stockings will increase stimulus below the cord lesion and make the situation worse.
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A nurse is teaching the family of a client who is receiving treatment for a spinal cord injury
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